The collective bargaining agreement now being negotiated between the California Nurses Association and Kaiser Permanente will determine, first of all, the nature of the environment in which Registered Nurses will work for the foreseeable future at the HMO's 17 hospitals, 34 medical offices, and 3 regional telephone advice call centers in Northern and Central California. The critical question is whether a new understanding can be reached which will facilitate the recruitment and retention of a sufficient number of qualified RNs in the face of the current "nursing shortage."

What is being called a shortage is not really that; rather, it reflects the fact that many RNs are shunning work in hospitals and direct care situations because of the distorted care delivery standards in the increasingly corporatized healthcare industry. Whether new and veteran RNs are attracted to working for the HMO is directly related to the resolution of issues now on the negotiating table. These include:

• Establishing nurse-to-patient staffing ratios that enable RNs to provide the quality of care the public expects and to which patients are entitled.
• Ending the onerous practice of forced overtime that disrupts the RN's personal or family life and all too often leaves nurses too exhausted to perform at the optimal level.
• Instituting a guaranteed pension sufficient to assure RNs can, when the time comes, retire with dignity and security.

Looming over the current efforts to reach a new agreement is the question of whether Kaiser Permanent views RNs as one of the most important assets to any healthcare delivery system, and whether the nurses are to be treated in a collegial and supportive, rather than punitive and controlling manner. Also on the table is the question of management's commitment to work with RNs to deal effectively with a number of systemic problems that have arisen in the healthcare delivery process.

For CNA, the issue of retirement provision has been a priority matter in all our collective bargaining activities this year. One reason is the current volatile economic situation in the country that has thrown into sharp relief the inadequacies of the pension plans that so many people had come to depend on for retirement. The problem of retirement insecurity, however, takes on an added urgency when it comes to a profession that is predominately female. Largely because of the factor of gender, nurses historically have not fared well as far as pensions are concerned.

Today the average age of Kaiser RNs is 48, therefore most have a very short earning time left to prepare for the future, and most don't have a decent retirement plan. With so many other hospitals now offering dramatically improved pension arrangements, Kaiser risks losing large numbers of its RNs to other hospitals unless there is a significant change in its bargaining stance. We have proposed that Kaiser RNs become participants in the Steelworkers Pension Trust. Adopting this plan would be cost neutral for Kaiser, but nurses would receive a greater pension benefit. The retirement security provided would make a tremendous contribution to ensuring that Kaiser Permanente is an attractive and rewarding place to be employed.

The CNA-Kaiser collective bargaining agreement, covering 10,000 RNs and Nurse Practitioners, is the largest contract entered into by nurses and a hospital system anywhere in the nation. Nurses, the healthcare industry, and health policy analysts everywhere closely watch these talks. The contours of a new agreement will weigh heavily in setting the standard for RN contracts far beyond Kaiser or Northern California. The successful conclusion of a new forward-looking agreement would go a long way toward overcoming the shortfall of available RNs.

California Nurse is the official bulletin of the
California Nurses Association