Two-and-a-half years after nurses voted against unionization, Hospital administrators said the environment for nurses has improved, but that they are still looking for ways to satisfy nurses' needs.
"There is still room for improvement, but the working conditions are good and there is a mutual respect for everyone on the health care team. That has certainly improved over the years," said Dr. William Fulkerson, chief executive officer of Duke Hospital.
Chief Nursing Officer Mary Fuchs said the Hospital has implemented a new recruitment and retention plan for nurses, which has included realigning the clinical hierarchy "ladder," expanding compensation, increasing mobility and offering competitive benefits and wages.
Nurses' wages are based on experience, and can fall anywhere between $18 and $36 per hour. Fuchs said the Hospital implements raises and alters benefits annually. For the 2003 fiscal year, nurses received a 3 percent increase.
One recent plan would also fund nursing tuition for both the Watts School of Nursing at Durham Regional Hospital and the year-old accelerated bachelor's degree program at Duke's own School of Nursing, Fuchs said.
She pointed to the current rate of turnover, which she said has declined over the past three years from 18 percent to 13 percent. Administrators also pointed to Duke's relatively low vacancy rate of about 14 percent, compared to a national average of between 14 percent and 21 percent.
Henry Loftis, a representative from the International Union of Operating Engineers, Local 465, said he believed the atmosphere for nurses improved only when the unionization effort began. "They began to give local floor managers a say on how many patients they would admit based on their capacity to take care of them," he said.
Some employees said that the nationwide nursing shortage is still affecting Duke.
"The main problem here is the shortage of nurses. You need plenty of help to take care of patients the way they should be," said Annie Jones, an assistant nurse in a surgical ward.
But Fulkerson said the national nursing shortage has had a negligible impact at the institution. "We have the appropriate staffing to meet national and Duke standards," he said. "We listen to nurses to make sure there are no problems with staffing."
Both Fuchs and Fulkerson pointed to the results of anonymous work culture surveys completed in 1998, 1999 and 2002 that showed that a mix of employees throughout the Hospital feel professional development has improved and feel a greater sense of pride in the Hospital.
Yet Fulkerson also admitted that nurses do not receive the proper respect they deserve from physicians and other employees within the Hospital.
Fulkerson argued that nurses face increasing demands because of a changing environment and new procedures in the profession. "Hospital populations change," he said. "People stay for shorter times, and therefore nurses have to do more in less time. That can create this so-called stress."
Dr. Ralph Snyderman, chancellor of health affairs and CEO and president of the Health System, said the Hospital has been more successful negotiating with individual nurses than with a potential nurses' union.
"My own personal view is that we do better in patient care building a team... with the ease of working together, with the facility of working as partners, with nurses as nurses, as professionals, rather than nurses as members of a union," Snyderman said. "[Unionization] just creates a lot of difficulty in being able to enhance progress and to be flexible."
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