After Paula Yarbrough, a registered nurse, went through five babysitters in six months, she had had enough. No babysitter could reliably watch her daughter during late-night shifts at St. Joseph's Hospital in Tampa, Yarbrough said, so she appealed to superiors. The hospital was sympathetic. It eventually switched her to a day shift and _ after years of similar requests _ began a day-care service for all shifts, even weekends.
One frustration down _ many more to go.
Yarbrough said she thinks hospital officials are trying to meet nurses' needs, "but they're not hearing all of them. There's a communication gap."
Thanks to a recent U.S. Supreme Court decision, a half-dozen labor unions hope to bridge that gap by organizing thousands of nurses who work in private hospitals. That task may be difficult in Florida, a state where nurses are skeptical of traditional labor unions and where hospitals are trying everything to attract and keep nurses.
In its April decision, the Supreme Court made it possible for nurses and other health professionals to form individual bargaining units in privately owned hospitals. (Public hospitals already allow most health professionals to unionize in individual units.)
The decision was hailed as a victory for labor unions and nurses, who have been trying to organize since the early 1970s, and it could be a significant defeat for hospitals hoping to keep labor costs down.
"We think it may cause some upheaval . . . possibly disrupting the regular flow of patient care," said Jon Ross, a spokesman for the American Hospital Association.
Until last month, nurses in private hospitals had to join other groups of employees _ including maintenance workers, dietitians and pharmacists _ if they wanted to form a union.
Even then, hospitals challenged them in court, sometimes stalling them for years. In 1989 the National Labor Relations Board (NLRB), which certifies unions, sought to speed up the process by adopting organizing rules for hospital workers, allowing each group to unionize separately according to eight categories.
Registered nurses are in a category alone. (Licensed practical nurses are in the technical employees category).
The hospital industry, fearing union proliferation, challenged the NLRB's authority to allow separate bargaining units and filed the suit that eventually landed in the Supreme Court. The high court unanimously backed the NLRB.
As a result, 67 petitions to unionize, most of them pending for years, are being rushed through the NLRB because more are expected to follow, NLRB officials said.
Labor unions want to organize health-care workers to bolster their flat or declining membership. Nurses are the largest segment of health-care workers, but unions also are targeting doctors, particularly those on staff at health-maintenance organizations.
"They (unions) see health care as wide open, a way to raise their image," said Paula Massey, executive director of the Florida Nursing Association, which operates a bargaining unit for 7,000 nurses, mostly in public hospitals in South Florida.
"When you say union, a lot of people think of the Teamsters, Jimmy Hoffa and a blue-collar work force," said Massey. "Nursing is more of a white-collar professional group, what a union would want to have to regain a fairly positive image."
The Teamsters union is attempting to organize nurses, as are the Service Employees International Union (SEIU), the American Federation of State and Municipal Employees (AFSME) and even the American Federation of Teachers. The American Nursing Association, through state bargaining units such as the one in Florida, already represents 130,000 nurses and health-care employees nationwide.
Nurses likely will be a tough nut to crack, particularly in a right-to-work state such as Florida, where union members cannot be forced to pay dues and where employers can hire union and non-union workers alike, Massey said.
Nevertheless, officials from AFSME and SEIU say they have received requests for information from nurses throughout Florida, but they would not elaborate. SEIU is attempting to organize Jackson Memorial Hospital nurses in Miami by raiding the Florida Nursing Association bargaining unit there.
Unions have track records for conventional labor issues, such as pay, overtime and benefits, Massey said. But nurses have other, non-traditional labor dilemmas, such as how to advance in their careers without abandoning bedside care for office work or how to exercise more control over patient care while not being swamped with paperwork, she said.
Yarbrough acknowledged that she would be apprehensive about being represented by a labor union, particularly because the nursing shortage already has prompted hospitals to improve nurses' working conditions. Because they don't want to lose nurses to other hospitals, some hospitals offer annual bonuses and raises, pay for continuing education and a reduction in paperwork.
But if unions could impose staffing requirements on hospitals to force them to increase the number of nurses on duty, that might improve patient care, Yarbrough said. Nurses might embrace unions if they could help the quality of patient care, but not if they foster a punch-clock mentality, she added.
"When a patient . . . may be having an emergency, you don't look down at your watch and say, "I have to leave,' " Yarbrough said. "You do have a conscience; you do feel dedicated."