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Nursing pay above median at Indian River Medical Center
BY MILTON R. BENJAMIN - STAFF WRITER (Week of January 29, 2009)

Nurses at Indian River Medical Center not only are paid more than the median wage for hospital nurses in Central Florida, but their total compensation would be at the 75th percentile for nurses in the Orlando region under the contract the Teamsters bargaining unit for IRMC nurses has rejected, according to hospital officials.

“That means 25 percent of the nurses in the Orlando region would make more, and 75 percent would make less, than what we are offering our nurses,” said hospital president and CEO Jeff Susi.

In an interview before hospital officials and Teamsters Local 769, which represents 467 registered nurses, met on Tuesday with a mediator from the Federal Mediation and Conciliation Services, Susi said IRMC is committed to paying nurses competitive salaries, but cannot afford to be “paying way above market because reimbursement doesn’t support it.

“Nurses work hard. It is a hard job, and we appreciate what they do. But I’m glad to say the reward has grown over the past decade,” Susi said. “We have 43 nurses last year that made over $75,000 working at Indian River Medical Center, and with the proposed contract, that number would have grown to 71. The highest would have earned $122,000.”

A major sticking point in negotiations between the hospital – which has offered an average 5.5 percent wage increase during a one-year contract – and the nurses appears to be IRMC’s insistence on raising the starting wage for new nurses by 17 percent, while the highest paid nurses would receive only a 1.6 percent wage increase along with a 1.4 percent one-time bonus.

“We have heard back, ‘That’s not fair. Everybody should get 5 percent,’” said Susi. “Well, that doesn’t work for us. We’re above market at the top of the range. We can’t give 5 percent and be way above market.

We’re below market at entry level, and 5 percent would not make us competitive.”

Susi, joined by hospital chief human resources officer Barbara Horne, noted that the current entry-level wage for nurses at IRMC is $18.50 an hour. The Florida Hospital Association says the median entry-level wage for nurses in Central Florida is $19.43 per hour. Under the proposal advanced by the hospital, the IRMC starting wage for new nurses would be jumped to $21.50 per hour.

“If we were to only raise our starting wage 5 percent, we still would not be able to attract younger nurses with limited experience who want to come here and learn and grow with us,” said Susi.

Horne said the problem is compounded by the Teamsters’ view that annual step wage increases for nurses – from one year through 30 years of experience – should be the same each year. “They wanted it to be an equal step from step one to 2 to 3 to 4 up to 30, and there would be 42 cents between each of the steps.”

This would continue to leave IRMC with a wage scale that was not attractive to younger, experienced nurses.

“If you have a nurse with 5 to 10 years experience, it is very hard to attract those nurses into the organization,” Horne said.

Under the contract proposed by IRMC, the median nursing salary would be $28.62 per hour, compared to the median nursing salary in Central Florida of $24.45 per hour.

Interestingly, while only 167 nurses at Indian River Medical Center belong to the Teamsters Local 769, the unit represents all 467 nurses at the hospital. The one-year contract proposal currently on the table would run only until this Sept. 30th, even if it were to go into effect in the next few days, and officials say there would be no retroactive pay increase for the four months that have already lapsed. “We’ve always implemented raises upon approval of the contract,” Susi said. “It will run through the end of the (contract) year, so (even if it was approved quickly) we are talking about Feb. 1 through the end of September. I feel bad that a number of these nurses are not getting the increases that we think they deserve.”

While the previous contract which expired this past Sept. 30th ran for three years, Susi said the hospital preferred a one-year contract this time because “the economic uncertainty in this world – and in the whole world as well as in the health care world – is such that we didn’t know that we could project where we would be at the end of the year. We asked Susi and Horne whether they felt the workload of nurses was a major issue in the current negotiations. “I think if you compared us to comparable hospitals up and down the Treasure Coast, we are probably staffed at a higher level of nurse to patient ratio,” Susi said. “We constantly hear that from nurses who are new to the organization or travel through. I think we stand very generously focused on patient care, and support our nurses with high staffing levels.”

Susi said he felt traveling nurses – who choose to travel about the country, working on short-term contracts at hospitals – are a good barometer.

“Many of those travelers want to come back to this hospital year after year. They have all the choices because they don’t have a residence here. If we weren’t a good place to work, they would pick a different hospital. So a lot of those signs suggest to me it is a good place to work and well staffed,” he said.

Horne noted that Indian River Medical Center also provides nurses “with the ancillary support staff. A lot of hospitals have taken that away. We still have certified nursing assistants on the floor to provide assistance to the nurses, and an IV (intravenous) team.”

“Yes, most hospitals have taken away IV teams, a group of nurses just dedicated to starting IVs,” said Susi. “As a patient, it’s nice to have an IV team.”

Susi and Horne both emphasized that the total compensation for nurses was far more complex than simply looking at an hourly wage rate – that one had to take into account differentials for evening, night and weekend work, certification bonuses and overtime.

“Most of our nurses work three days a week, 12 hour shifts. So a fulltime nurse is working 36 hours a week,” said Susi. “But you pick up additional pay if you work evenings or nights. And if you work weekends, there is a differential. And if you work a weekend night, you get the combination. And some of our nurses have maximized that.”

“Some of the nurses also like to work a fourth shift per week during the busy season, because they get time and a half for that time,” added Horne.

So where do things move from here? “We provided the nurses with our last and best offer the week before Christmas,” said Susi. “When the negotiators got back to us, they told us they were going to recommend against it.”

The Teamsters bargaining unit voted 117 to 3 against the contract on Jan. 14th. So the next step was Tuesday’s meeting with the federal mediator.

“I really hope that the nurses that didn’t vote, or weren’t eligible to vote, spend some time educating themselves more about what was on the table, and understand the offer that was made,”

Susi said. “We think it was very generous, and we know there is no more to give. So hopefully, they will step back and think, do we really want to continue to be at odds or do we want to accept a very generous offer?

“If not, we can go a couple of different paths,” Susi said. “Negotiations could be renewed, we could remain at impasse with neither party budging, we could do nothing nearing the end of the year and look at next year’s contract. We could also, if you are at impasse over a period of time, go ahead and implement the increases unilaterally. And that may be one of the options we would lean towards if this goes an extended period of time.”

And if the Teamsters decide to strike? Horne noted that the contract which expired Sept. 30th had a no-strike clause – put in the contract, she said, by the nurses – because “a majority of the nurses feel very strongly that this is not the appropriate thing to do.”

“While the contract is expired, I think the intent and the feelings are there,” Susi said. “We have a great number of committed nurses, and they are committed to patient care. I am optimistic we will still be able to provide highquality patient care because of the dedication of the entire team.”