Nephrology News & Issues Unions beef with Fresenius (article)

Unions beef with Fresenius over staffing levels, input on safety

Two unions that backed a one-day strike at Fresenius clinics in New York say the provider is denying their members input on patient care issues and staffing levels, and reneged on an agreement to hire union-backed nurses for a new clinic

Two unions that backed a one-day strike at Fresenius dialysis clinics in New York say the provider is denying their members input on patient care issues and staffing levels, and reneged on an agreement to hire union-backed nurses for a new clinic.

Hundreds of workers held a strike on Monday, June 12 at seven Fresenius Medical Care dialysis clinics in New York. The strike, organized by the New York State Nurses Association (NYSNA) and 1199 Service Employees International Union (SEIU) United Healthcare Workers East, was held after years of collective bargaining between the two unions and Fresenius had failed to lead to a contract.

NYSNA, which represents ­­­­­nurses in seven Fresenius dialysis clinics in New York, has been bargaining with the dialysis provider over contracts for three years.

“It’s been a very contentious process,” Eric Smith, area director for NYSNA, told NN&I. “We’ve filed many charges at the National Labor Relations Board, because we feel the employer acted in bad faith at the bargaining table. We’re still far apart on staffing and professional practice, and the issue of union recognition, where they’re trying to pull union recognition from certain clinics in our area.”

A spokesperson for Fresenius said they have “negotiated in good faith over the past three-plus years with representatives from NYSNA and two-plus years with representatives from 1199 SEIU. We have extended equitable contract offers that increase wages and protect certain union health and pension funds. Our goal, just as it has been since the start of negotiations, is to reach a fair agreement that reflects the tremendous value our employees bring to our company and the patients they care for. Above all, our focus is on the continued care of our patients and providing access to critical dialysis services in neighborhoods throughout New York City.”

A sticking point for NYSNA, Smith said, is the union’s desire to create a safe staffing/professional practice committee, which would allow nurses to help make decisions concerning patient safety measures and appropriate staffing levels at dialysis clinics.

These types of committees, Smith said, exist in almost all of NYSNA’s other contracts with hospitals and outpatient clinics, including dialysis clinics run by other companies. “We don’t understand why Fresenius wants to be such an outlier on patient care.”

Fresenius said that they have “offered to set up a more formalized structure through a professional practice committee comprised of nurses who would continue to provide input to the clinical decision-making process and collaborate with us in maintaining high quality patient-centered care.”

But Smith said the Fresenius proposal leaves all decision making regarding patient care up to management, not nurses.
“That strikes us as odd because a lot of Fresenius’ administrators are not RNs. They have no clinical background at all.”

Typically, in other NYSNA contracts, there is a vote, where 50% of the voters are NYSNA nurses, and 50% are representatives of management. If there is a stalemate, it’s sent to an administrator who can render a decision. That decision can also be appealed to a third party.

Fresenius defended its clinical practices, saying the company has “more than 2,200 dialysis clinics in the United States and has been awarded more four- and five-star rated clinics from the Centers for Medicare & Medicaid Services than any other dialysis provider in the country. High quality, patient-centered care is at the core of our mission and has been achieved through continually addressing quality of patient care in partnership with the many clinicians and direct care workers who support our patients every day.”

1119 SEIU represents approximately 180 workers, including housekeepers, clerical staff, dietitians, social workers, and licensed practical nurses, at five locations throughout Brooklyn and the Bronx. Their complaints center on wages and benefits, as well as issues with short staffing, Executive Vice President Laurie Vallone told NN&I.

“There’s a history with Fresenius where they close union facilities and they open up non-union clinics,” Vallone said.

Representatives from both unions discussed a new, large clinic in Brooklyn, called Degraw. The unions spent years establishing a presence at the clinic when it was being developed, but said the negotiations were suddenly reversed when Fresenius asked that they drop all recognition rights at the clinic. The clinic has since opened without any union workers.

“It’s a sensitive issue,” Valone said, “an element of distrust is there.”

Representatives from both unions said they considered the strike a success. Many patients showed up in support, they said, and so did Brooklyn Borough President Eric Adams and the Public Advocate for the City of New York Letitia James.

“In health care, no one wants to go out on a strike,” Vallone said, “but sometimes they push your back against the wall.”
Smith said they gave Fresenius 10 days notice before the strike occurred, so they could accommodate patients, and all patients were moved to different shifts. Smith said they have a strike protocol, that includes putting some of the nurses on call and willing to cross the picket line if there is a patient emergency.

Since the strike, both unions and Fresenius have reached out and are trying to schedule ongoing negotiation dates.

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It has been Nichole Jefferson‘s personal mission to tell her story and promote awareness. She was diagnosed with end-stage renal disease (ESRD) in October 2003. At that time, not only was she unaware of what that meant; she also did not know she was a high-risk factor for developing the disease.
After the initial shock of the diagnosis, she decided peritoneal dialysis (PD) was the best option and utilized PD for a few years until she needed to switch to hemodialysis.
She received a kidney transplant from a deceased donor on June 12, 2008, but at the time, she didn’t realize it was simply another form of treatment and not a cure. Today, Nichole is waiting for a new transplant.
Nichole has worked with many advocacy groups on Capitol Hill and has provided her personal experience with ESRD to leaders in the field of nephrology. She tries to express the feelings of those who are unable or unwilling to speak for themselves.