Staff nurses at Washington Hospital Center walked out on strike yesterday morning, setting up picket lines and forcing the area's largest private hospital to reduce services sharply.
Sixty-nine percent of the registered nurses assigned to the day shift failed to report for work at 7:30 a.m., according to hospital spokeswoman Jane Snyder, after the hospital and its nurses' union failed to reach an agreement during an all-night negotiating session.
By 8:07 yesterday morning, after a week of working to reduce its patient census, the hospital center had a 44.6 percent occupancy rate, with 10 of its 34 units shut down and 475 of its 911 beds unoccupied.
According to officials transferring information from a computer screen to a giant "strike control board," the hospital had 372 patients and 168 available beds and cribs in open units.
"We're covered," said hospital chief executive officer Richard M. Loughery, as he watched the numbers going up on the blackboard. "We developed our whole plan without (including) a single staff nurse."
Loughery acknowledged that the basic issue separating the hospital and the nurses' union is who will control nursing at the hospital, the union or the administration.
While the two sides are reportedly close on the question of pay scales, there is great disagreement over the union's demand for a union shop, straight day shifts based on seniority - the hospital refuses to assign nurses to permanent day work - the number of sick leave and vacation days a nurse may earn and the union's demand that nurses be allowed to take disputes over work evaluations to an outside arbitrator.
Loughery charged that during the negotiating session, which began at about 10 a.m. Friday morning and - with breaks - finally ended at 8 a.m. yesterday, the nurses presented a "whole new list of things and attempted to open up" issues that had been settled.
Anne Hartzell, the nurses' spokeswoman, accused Loughery of "distortion" and said that the nurses had presented what was an "edited" version of "the hospital's own proposal to us. It was submitted in that form at the suggestion of the federal mediator," who is guiding the negotiations under auspices of the Federal Negotiation and Conciliation Service.
According to Hartzell, "nothing contained in the proposal was new. All of it had been previously placed on the table. In fact, it represented at least the third reduction in the union's demand since 10 a.m. Thursday morning."
Loughery said one of the underlying factors causing the strike is that the nurses "don't see their roles changing as fast as they want the roles to change."
The hospital center nursing strike, first in this area, comes when nurses are experiencing a newfound sense of professionalism. The old image held by some of the nurses as serfs in white is fast giving way, at least among nurses and nursing educators, to an image of nurses as physicians' fellow professionals, members of a team who deliver a form of care as unique and important as that delivered by the more highly trained physicians.
Loughery said he believes both the other area hospitals and their nurses are watching the situation at the hospital center because the outcome of the strike could affect, their nursing programs.
The District of Columbia Nurses Association "obviously wants us because we're the biggest. They want a foot in the door," he said. Of the area's major private hospitals, only the nurses at the hospital center and Howard are unionized.
Area hospitals are also monitoring the strike because of its effect on their business. George Washington University Medical Center, for example, has in the past few weeks gone from an 83 percent occupancy rate to a 90 percent rate yesterday. A hospital official said many of the new patients have been admitted by physicians with provileges at both GW and the hospital center.
Existence of the strike was obvious inside the hospital yesterday morning by what was not going on, rather than what was.
Several units had been padlocked after being cleaned and having beds made up. The doors were chained, said Snyder, to keep staffers on duty from using the rooms to nap.
In units still open but unoccupied, one noticed the empty nursing stations and the absence of the 18-tray carts that were being used to deliver breakfast to the units housing patients.
While hospitals are usually quiet above emergency room levels on holiday weekends, the hospital center was noticeably so yesterday, with corridors empty and the normally busy lobby at times occupied only by a guard with a metal detector, one of 93 special guards hired by the hospital for the strike.
Like the staff physicians who struck Washington's Group Health Association 11 days last month, the strike at the hospital center is forcing nurses to make agaonizing choices between what some see as duty to patients and their profession, and others see as their duty to themselves as well as their profession.
Linda Carl, a staff nurse in the hospital's Surgical Intensive Care Unit and a member of the shock-trauma nursing team, was at work yesterday morning, despite the fact that many of her friends and coworkers were on the picket line.
"There are several reasons why I'm at work," she said, "but the first is that the shock-trauma program is pretty important and we've got some pretty sick patients here.
"I feel that morally I just couldn't leave the patients," said Carl, who was careful to stress that she supports the strikers and their goals and has not been pressured or threatened by either side to go out or stay. "We do primary nursing here, and you get pretty involved with one specific patient. And when the family gets concerned about the strike and wants to know who's going to take care of my patient, and after you've known them for several weeks, it just gets very difficult to go out.
"What they're asking for is very important, but I just couldn't go out on strike. I wish there was some other way to hassle with the administration," said Carl. "I just can't walk out. It's completely against what I feel is the most important part of my job."
But Elizabeth Savage, a nurse at the hospital center for 14 years, "since Sept. 8, 1964," was picketing the hospital yesterday because of what she sees as a professional duty. "I care, for better patient care," she said.
"If a nurse is happy in her job," said Savage, "she can give better care." She was joined on the picket line by her 4-year-old daughter, Janine. "She woke up at 5:30 this morning and "Can I go on strike with you?'"
At times there were as many as 60 pickets at the center's three entrances, two on Michigan Avenue NE and one on Irving Street NE.
The lines of women and a few men, most in white uniforms, were orderly, if loud at times, with pickets chanting things like "No contract, no work!" and carrying obviously hand-lettered signs with message like "Help us to help you", "The Washington Hospital Center is very unfair" and "Nurses on Strike."