Victoria nurses' labor action

By Suzanne Gordon, John Buchanan and Tanya Bretherton

February 12, 2008 -- As the month of October 2007 came to a close, nurses in the state of Victoria in Australia scored a major victory not only for nurses and patients in Victoria, but all across the globe. On October 24, after a bruising months' long battle with the state Labour Party government, the Victorian nurses managed not only to maintain the most impressive experiment in safe nurse-to-patient ratios in the world but also to win pay raises and improvements in nurse staffing in their public health care system.

The stage for this battle was set in the 1990s. At that time, the Australian government, headed by conservative Premier Jeff Kennett, began a series of cut-backs that drove thousands of nurses away from public sector hospitals. Because of excessive patient loads, many nurses left the hospital altogether, others would only work part-time and others became temporary or what is known as agency nurses. Hiring these temporary, "per diem" nurses not only created havoc in the system but cost the government millions of extra dollars. As a result, patient care was eroding, and few young people wanted to become nurses.

As the state faced a major nursing shortage, Victorian nurses pleaded with government to relax the draconian cost-cutting. But Kennett wouldn't budge. Finally, Victorian voters kicked the party out and elected a Labour government, which was led by Premier Steve Bracks. In the 1999 Enterprise Bargaining Agreement that the Australian Nursing Federation's (ANF) Victorian Branch negotiated with the new Bracks government, the nurses sought assurances--in the form of safe nurse-to-patient minimum staffing ratios--that they would never again come to work knowing they would have to care for too many very sick patients.

Even this new Labour government fought the ratios. At one regional hospital in Victoria, the state had invested significant funds in expanding the number of accident and emergency cubicles, but gave no commitment to provide any additional staff to service these cubicles.

In response, the nurses waged a major public relations campaign and also mounted cohesive union action to convey their commitment to ratios. Rather than going on strike, and shutting the system down, the union's members voted instead to refuse to accept a certain number of patients on varying units in what is known as bed closures. Nursing staff continued to provide the same level of service for the existing patient load but refused to open the new beds until adequate staffing could be provided. Nurses employed in all hospitals closed one in every five beds. This tactic, which excludes life-threatening emergencies, cancer and children's hospitals, allows nurses to continue to care for patients while protecting those patients in the long-run by assuring that nursing care is not compromised through under-staffing.

Nurses won public support and through a process of industrial arbitration succeeded in mandating ratios in all of Victoria's public hospitals. On medical-surgical units, there would have to be at least five nurses for every 20 patients, which means at least a 1:4 ratio. Other equally impressive ratios were established for other units. In Victoria, these arbitrated minimum ratios have the force of law and are a funded mandate. Even the Victorian government has credited the implementation of ratios with bringing 7600 inactive nurses back into the workforce.

In 2004, the Victoria government once again tried to attack the ratios and replace them with patient acuity systems. Lisa Fitzpatrick (right), the new Secretary of the union's Victorian Branch, and the over 44,000 nurses the branch represents (that's over 60% of public sector nurses) fought to maintain and even to improve those ratios. The nurses were unable to win significant improvements in the ratios, but their Enterprise Bargaining Agreement maintained them.

In 2007, the government went on an even more aggressive campaign to eliminate ratios and to limit nurses' pay raises to 3.25% per year. Nurses campaigned to maintain the ratios and also demanded pay raises of 6% per year. On Tuesday, October 16th, 4,000 nurses gathered in one of the biggest union meetings that has ever taken place in Victoria and voted to maintain their campaign and to use rolling bed closures to convey their commitment to ratios.

Over a period of nine days, nurses closed 800 beds around the state. The government lobbied hard against the nurses. It docked the pay of nurses and threatened to fine nurses $6,000 each if they attended the public meeting. This strategy backfired with the public, who overwhelmingly supported the nurses.

These nine days of intense industrial action took place after months of negotiations failed to result in any agreement. In the lead up to the dispute, employers would offer wage increases of only 3.25 percent per year, with anything extra requiring 'productivity off-sets'. Employers also sought more 'flexibility' in staffing arrangements. When the old agreement expired in late September 2007, nurses decided to hold unauthorized stop work meetings where thousands of nurses met to endorse work bans, the temporary closure of 900 beds and the cancellation of 1,000 elective surgeries (ABC 26 October 2007).

Some actions taken were illegal and exposed the union and its members to significant fines and legal sanctions. This was because in 2006 new labour laws--known as Work Choices--were passed by John Howard's Federal neo-liberal, neo-conservative government that had recently been re-elected in the lower house and unexpectedly gained control of the upper house. (This is a government that Australians overwhelmingly rejected, voting it out of office in late November 2007 and electing instead a Labour Party government by a landslide.) These laws radically reduced unions' bargaining rights and the capacity of industrial tribunals to settle industrial disputes.

In essence Work Choices consolidated employer power by buttressing managerial prerogatives. This was achieved by a variety of means, the most important of which was requiring all agreements to be enterprise-based, banning pattern bargaining, and confining industrial tribunals' arbitration power to very limited circumstances on a very narrow range of issues.

Work Choices made industry-wide agreements almost impossible and prevented industrial tribunals dealing with staffing matters. Innovations like minimum nurse-patient ratios which operate on a multi-employer basis and limit managerial discretion are essentially illegal and can only prevail if management agrees to their operation site by site. The only way the ratios could have been saved in this context was by illegal direct action.

On October 25, 2007, a new four-year agreement was reached between the Victorian Branch of the ANF and the Victorian Hospitals Industrial Association. It provided for wage rises of between 3.6 and 6 percent per year and improvements in a range of employment conditions. (ANF website, ABC news 25 October). The most important contract feature was preserving and in some cases upgrading the nurse-patient ratios. Under the agreement, 500 new nurses will be added to the system. According to Lisa Fitzpatrick, the majority of these new nurses will go to effectively eliminating the 50 percent rule on the morning and afternoon shifts of the 184 units to which it has applied.

The 50% rule is intended to deal with units that are not neatly divisible by four. If a unit has twenty-two beds, rather than twenty, and the ratio is five to twenty, which works out to one to four, then what happens? Do managers add another nurse and "round up," or do the five nurses deal with the twenty-two patients? According to the 50 percent rule, the union members and managers bargain about whether another nurse is added. The 50 percent rule usually results in a "rounding down" in the number of nurses. Only rarely are staffing levels set in excess of those specified in the ratios.

Eliminating the 50% rule on some of the units some of the time will improve care on units that abused the 50% rule, particularly in targeted areas like geriatric care, palliative care, rehabilitation and some medical and surgical units. Two hundred of the new positions will be allocated to increasing the number of nurses per patient in Emergency Departments and pre- and post-natal areas. In Emergency Departments, nurses will be added to triage and resuscitation. In pre- and post-natal areas the ratios will be improved to 1:4 on morning and afternoon shifts and 1:6 on night shifts. Two country hospitals will also have improved staffing. This means that the ratios have been significantly improved.

The union's success can be attributed to three factors. First, members of the ANF were absolutely resolute in their support and extremely well organized. The venue hired to hold the mass stop work meeting to endorse industrial action could not accommodate the more than the 4,000 members who attended. The motion proposing action was endorsed unanimously. The bed closures and cancellations of elective surgery began the next day. This support reflected growing frustration with wages and workloads that had been documented in the latest study of the ratios in action (Wise 2007). The union had been informing members for months about the slow progress in negotiations. When the call for action came, the entire membership knew what was at stake.

The second factor underpinning the union's success was the widespread support enjoyed by the nurses both within the health system and the community at large. On the day the bans were announced the Australian Medical Association publicly backed the nurses on both the wage and ratio issues. All segments of the media reported the dispute in a way sympathetic to the nurses. Melbourne's most popular daily tabloid--Rupert Murdoch's Herald Sun--even wrote an editorial in support. While not supporting industrial action, it noted nurses were underpaid and overworked and called for rapid settlement of their reasonable claims.

The third, and probably most decisive, factor behind the nurses' victory was the political context of the dispute. The mass meeting endorsing industrial action occurred two days after the 2007 Federal election date was announced. Arguably the key issue of this election was the conservative Federal Government's highly controversial Work Choices industrial laws. These laws had generated significant concern in the community. The Federal Government and State opposition opportunistically exploited the dispute. They called on the State Labor Government to give the nurses what they claimed and urged hospital employers to turn a blind eye to the Work Choices anti-union, anti-industrial labour law regime (Age 22 October 2007).

At the same time Federal government agencies reportedly, behind the scenes, sent inspectors out to ensure the law was being followed ( Age 22 October 2007). As the dispute reached its ninth day, pressure on the State Labor Government grew to settle. A prolonged dispute in the middle of an election campaign was not good for Labor Federally. The dispute was finally ended with direct intervention by the Premier, John Brumby, and the Minister for Health Andrews.

The legacy of the dispute was the creation of a new generation of nurses committed to the minimum ratios, a strengthening of the union and the unsettling of workplace industrial relations. Over 1,900 new members joined the Victorian Branch of the ANF in September and October 2007. Over 2,000 members lodged complaints with the union about management intimidation and harassment that occurred during the dispute. The docking of pay, active threats to impose fines for industrial action and threats to dismiss nurses who spoke to the press poisoned relations at a number of hospitals. (ABC news 26 October 2007) These actions ensured this was a dispute with a lasting impact. Throughout it all nurses had continued to provide core services to the public. Management tactics were all legal. Relations at work, however, require more than adherence to the strict letter of law. Ironically, the nurses won a major victory by actively breaking central elements of Federal labour law. Management found itself isolated, both within the health system and the broader community, by playing within the rules. In this way the dispute highlighted fundamental problems within the Work Choices Federal labour law regime as well as fundamental problems concerning wages and work overload in the public health system.

This struggle and its outcome should be a lesson to nurses all over the world. For the past ten years or more, nurses in Victoria have fought to protect their patients and their profession. They have developed a strong public relations campaign to explain their critical role to the public. Most importantly, faced with a cohesive government offensive, the nurses stuck together. They were supported by nurse managers, who also belong to the union, and in many instances by directors of nursing who understand that minimum ratios bring stability to the nursing budget and allow them to manage care, not costs. In Victoria, people have finally learned that the ANF slogan--"Nurses. You can't live without them."--is more than clever public relations.

By Suzanne Gordon, John Buchanan and Tanya Bretherton from their new book Safety in Numbers: Nurse Staffing Ratios and the Future of Health Care to be published in April 2008 by Cornell University Press' Culture and Politics of Healthcare Work Series.

The views expressed herein do not necessarily reflect those of the staff, Board Members or Advisory Panel of The Center for Nursing Advocacy.

See the article "Nurses' pay tonic with pay rise: UP to 500 extra nurses will be hired by Victorian hospitals under a $600 million pay deal that has ended the crippling health dispute." by John Masanauskas, Grant McArthur and Ellen Whinnett in the October 26, 2007 edition of the Herald Sun.

Also see "Union shuts down Victorian nurses campaign" by Peter Byrne, Socialist Equality Party candidate for the Senate in Victoria from Nov. 6, 2007.

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