Sutter Community Hospitals of Sacramento, Inc.

SUTTER COMMUNITY HOSPITALS OF SACRAMENTO 181 Sutter Community Hospitals of Sacramento, Inc.' and International Union of Operating Engineers, Sta- tionary - Local 39, AFL-CIO, - Petitioner2 and California Association of Medical Laboratory Technology, Engineers and Scientists of California (MEBA, AFL-CIO), Petitioner2 Sutter Community Hospitals of Sacramento , Inc. and Hospital and Institutional Workers Union Local 22, Service Employees International Union, AFL- CIO, Petitioner3 Sutter Community Hospitals of Sacramento, Inc. and California Nurses' Association, Petitioner.4 Cases 20-RC-12306, 20-RC-12331, 20-RC-12445, and 20-RC-12523 December 10, 1976 DECISION, ORDER, AND DIRECTION OF ELECTIONS Upon petitions duly filed under Section 9(c) of the National Labor Relations Act, as amended, hearings were held in the above-captioned proceedings before Hearing Officers Earl D. Brand, Enid W. Weber, and Paula Paley, respectively, of the National Labor Relations Board. Following the close of the hearings and pursuant to Section 102.67 of the Board's Rules and Regulations, Series' 8, as amended, these cases were transferred to the Board for decision.5 Thereaf- ter, Local 39, 'SEIU, and the Employer filed briefs which have been duly considered.6 The Board has reviewed the Hearing Officers' rulings made at the hearings and finds that they are free from prejudicial error. They are hereby affirmed. Upon the entire record in these proceedings, the Board finds: 1. The Employer is a California nonprofit corpo- ration located in Sacramento, California, where it is engaged 'in the operation of two nonprofit acute medical care facilities. The parties stipulated and we find that the Employer's gross annual revenue exceeds $3 million; that; during the -year preceding the commencement of the hearings held herein, it purchased directly from sources outside the State of I The names of the Employer and the several Petitioners appear as amended at the hearings held herein 2 At the consolidated hearing held in Cases 20-RC-12306 and 20-RC- 12331, International Union of Operating Engineers, Stationary Local 39, AFL-CIO (hereinafter Local 39), and California Association of Medical Laboratory Technology, Engineers and Scientists of California (MEBA, AFL-CIO) (hereinafter CAMLT), each indicated its interest in participating in an election in any unit found appropriate, in the event the Board , rejected its unit contention. '3 Hospital and Institutional Workers Union Local 22, Service Employees International Union, AFL-CIO (hereinafter SEIU), was permitted to intervene in Cases 20-RC-12331 and 20-RC-12523 based on a proffered showing of interest in the units therein sought. 4 After the hearing held in Case 20-RC-12331, California Nurses' 227 NLRB No. 18 California goods or services valued in excess of $100,000; that it is a health care institution within the definition of the Act, as amended; and that it is engaged in commerce within the meaning of the Act. We further find that it will effectuate the purpose of the Act to assert jurisdiction herein. 2. The parties stipulated that Local 39, CAMLT, SEIU, and, for the purpose of representing registered nurses, CNA are labor organizations within the meaning ,of the Act. We find that they are within the statutory definition of a labor organization. 3. A question affecting commerce exists concern- ing the representation of certain employees of the Employer within the -meaning of Sections 9(c)(1) and 2(6) and (7) of the Act. 4. In Case 20-RC-12306, Local 39 seeks to represent a unit consisting of all employees in the Employer's engineering and maintenance department and in the biomedical repair unit. In Case 20-RC- 12331, CAMLT seeks to represent a unit of medical laboratory technologists, including electron micro- scope technologists and technicians but expressed a willingness to represent a unit consisting of all professional employees, excluding registered nurses? In Case 20-RC-12445, SEIU seeks to represent separate units consisting of (1) all service employees including technical's, and (2) all office clerical em- ployees. In Case 20-RC-12523, CNA seeks to represent all of the Employees registered nurses. The Employer contends that none of the" petitioned-for units are appropriate and that The only appropriate units are: one comprised of all service, maintenance,` and clerical employees, including technical- employees, and the other consisting of all professional, employ- ees. Background The Employer operates two acute medical care facilities; separated by some 30 blocks, in the city of Sacramento, California. The first, known as Sutter General Hospital, is housed in a 7-story building. The second, known as Sutter Memorial Hospital, is housed in two buildings, a main hospital building Association (hereinafter CNA) moved to intervene, to the extent that it desired to participate in any election involving registered nurses. 5 Each petition seeks an election in a separate unit of the Employer's employees. Inasmuch as they present interrelated issues which are best resolved simultaneously, the cases are hereby consolidated for the purpose of this decision only. 6 Local 39, SEIU, and the Employer filed requests for oral argument Their requests are hereby denied as, in our opinion, the records in these cases, including the parties' briefs, adequately present the issues and the positions taken with respect thereto. 7 We view the first amended petition filed by CAMLT, following the close of the hearing held in that case and the submission of briefs, as an, expression of its willingness to representemployees in the broader unit. 182 DECISIONS OF NATIONAL LABOR RELATIONS BOARD consisting of seven floors and an adjacent single-story diagnostic and treatment center. The record reveals that there is substantial interchange of employees between the two facilities and the parties themselves have stipulated that any units herein found appropri- ate should embrace employees at both facilities. Although ultimate responsibility for the operation of the hospitals rests with the board of directors, the Employer's executive director is the person with immediate responsibility for day-to-day operations. Directly subordinate to him in the administrative hierarchy are two assistant administrators, the direc- tor of nursing, and the personnel director. In addi- tion, certain department heads also report directly to the executive director, among them the head of the biomedical repair unit, whose employees are encom- passed within the maintenance unit sought by Local 39. However, the head of the engineering and maintenance department, who is responsible for coordinating and supervising the work of all engi- neering and maintenance employees at both facilities, reports to one of the two assistant administrators. Others reporting directly to the executive director include the heads of the X-ray, laboratory, pharmacy, mental health (psychiatric), purchasing, printing, nuclear medicine, cardiopulmonary, EKG, public relations, medical education, medical records, and emergency room departments, and the chief of the diagnostic-and treatment center. One assistant administrator is responsible for the operation of the business office and the accounting, budget, and data processing departments. The other assumes responsibility for the housekeeping, laundry, dietary, respiratory therapy, occupational therapy, physical therapy, recreational therapy, social services, and engineering and maintenance departments. The director of nursing is in charge of the medical, surgery, mental health (nursing), central service, IV therapy, obstetrics, anesthesia, EEG, and renal dialy- sis departments. There are over 2,000 hourly paid employees work- ing in the hospitals' 38 departments, of whom over 1,600 are employed on a regular -full-time basis.8 Many departments employ individuals holding the same job classification. However, all employees employed in a given classification are paid according to the same wage scale, irrespective of the department or the location in which they work. On the other hand, the same-wage scales may be applied to different classifications, where the levels of skills and the training required in the performance of different work are deemed commensurate. For example, engi- neer helpers, employed in the engineering and maintenance department, work at the same wage scale as the hospitals' two evening housekeepers. Likewise, registered nurses working either as head nurses, environmental control nurses, or patient care coordinators are paid at the same scale as are employees working either as medical laboratory technologists or assistant electron microscope tech- nologists. Employee fringe benefits are centrally administered and, with one minor exception, are uniform through- out the entire work force. Thus, eligibility require- ments and the rules for determining the amounts of such benefits are the same for all employees. Similar- ly, a uniform premium pay policy is applicable to all employees under which all receive the same percent- age of their base pay as an on-call premium. On the other hand, shift differentials vary according to the department and job classification with a range between $20 and $50 per month. Also, the hospitals employ three different methods for computing over- time and the method used varies from department to department. In this respect, however, the Employer allowed each department to choose the overtime system under which it would operate. Case 20-RC-12306 . Local 39 seeks to represent all employees in the engineering and maintenance department and the biomedical repair unit. As previously mentioned, the director of the engineering and maintenance depart- ment reports directly to one of the Employer's two assistant administrators. Subordinate to the director are two superintendents of plant and operations, each assigned to one of the Employer's two facilities .9 The department is responsible for the maintenance of the hospitals' physical plant: for the integrity of the buildings and for the operation, maintenance, and repair of utilities, such as the water, steam, and electrical systems and the attendant power equip- ment, including steam boilers, refrigeration pumps, air-conditioning equipment, and standby generators. Employees assigned to this department also perform interior remodeling and painting. Within the department, individuals are employed in the following classifications: senior watch engineer, watch engineer, maintenance engineer, engineer helper, leaderman, electronic technician, carpenter, painter, office manager, office clerk, and secretary. The range of skills demonstrated by individuals employed in these classifications varies from highly skilled to unskilled. For example, the senior watch engineer and electronic technicians are, on the one 8 The remainder are employed irregularly or for workweeks of shorter 9 The parties stipulated that these individuals are supervisors within the duration and include two who are classified as temporary part-tune employees The parties have, however , agreed among themselves concerning the voter eligibility of these employees meaning of the Act. SUTTER COMMUNITY HOSPITALS OF SACRAMENTO 183 hand, employed as troubleshooters responsible, re- spectively, for the maintenance of sophisticated machinery and electromechanical equipment. On the other hand, the maintenance engineer, who performs minor maintenance and custodial work, and the engineer helpers, who are primarily employed in cleaning air-conditioner, filters, require little or no skill in the performance of their work. The following is a summary of the qualifications and duties of the 33 individuals employed in the classifications here involved: Watch Engineer: Candidates for this position must have graduated from the eighth grade and have had 4 to 10 years' experience. Their assigned duties include the maintenance and repair of stationary steam boilers and related equipment, using handtools and portable power tools. They perform daily inspections of boilers, pipelines, and operating equipment, watch- ing for steam, water, air, and fuel leaks and defective parts. Using special chemicals, they periodically test and treat boiler water. They repair and maintain machinery and mechanical -equipment in accordance with diagrams, sketches, operation- manuals, and manufacturers' specifications, using hand and power tools and precision measuring and testing instru- ments. Such tools include lathes; drill presses, and grinders. Similarly, watch engineers are responsible for the maintenance and repair of piping systems, plumbing fixtures, refrigeration machinery, cooler and freezer units, and other mechanical equipment, including compressors to provide for utilities such as light, heat, and power. Senior Watch Engineer: These individuals are more highly skilled than watch engineers, and are responsi- ble for =the ° maintenance and repair of the more complicated machinery. They function essentially in the role of "troubleshooters." Maintenance Engineer.- This employee performs the least complicated maintenance. and repair tasks falling within the area of a watch engineer's responsi- bilities. Engineer Helper: These individuals, who must have an eighth grade education, are employed in cleaning air-conditioning units, replacing filters as necessary, cleaning the boilerroom and other mechanical spaces, stocking workbenches with appropriate expendable items used in the maintenance and repair of the Employer's facilities and equipment, applying oil to fractional horsepower motors, and otherwise per- forming a variety of jobs in and around the buildings and grounds of the hospital complex to assist mechanics and other workmen in completing their tasks by transporting materials and tools. Electronic Technician: Employees in this position are required to have- an eighth grade education and from 4 to 10 years' experience. They test and repair electronic equipment, following schematic diagrams and using handtools and test meters. They test electrical circuits and components to locate shorts and faulty connections, and they replace defective parts such as tubes, transformers, resistors, conden- ,sors, and switches, using. handtools and soldering irons. They may also be required to perform the duties of anelectrician. - Leaderman: These individuals are required to have the same experience as electronic technicians. They are responsible for properly maintaining all electro- mechanical, electrical, and electronic equipment and systems in the hospitals ^' close cooperation with the chief engineer, and, therefore, must have a thorough knowledge of the work responsibilities of electricians and electronic technicians in order to perform their work. Carpenter: Individuals so employed must have an eighth grade education and from 4 to 10 years' experience in framing and finish carpentry and -millwork. They construct, repair, and maintain wood- en structures such as furniture, equipment, partitions, and other parts- of hospital buildings, using hand and power tools according to written or oral instructions. They must be able to read blueprints and specifica- tions to accomplish these tasks. Painter: In addition to an eighth grade education, painters are required, to have from 4 to 10 years' experience and be able to work from swing staging. They are required to rig stages and erect scaffolding. In addition to the skills required in the mixing of paints, painters are required to prepare and apply plaster to ceilings, walls, and partitions.,, Office Manager, Office Clerk, Secretary: The office manager is primarily responsible for procuring repair parts and acts as the purchasing agent for the Employer's engineering and maintenance depart- ment. In addition, he shares with the office clerk, who is located at Sutter General Hospital, the responsibili- ty for relaying requests for repair assistance. The office clerk's primary responsibility is to pick up the repair parts ordered by the office manager. The secretary is located at Sutter Memorial Hospital. She performs basically the same duties as those per- formed by the office manager and the office clerk except that she does not order or pick up supplies. However, she may occasionally type maintenance directives that are sent to all the departments of the hospitals. There is a limited bargaining history involving a portion of the employees herein sought. The record reveals that the- hospitals entered into a series of collective-bargaining agreements with Local 39, the last of which expired in 1970. Those contracts cover watch engineers, maintenance engineers, and appren- tices, although, during that time, the Employer's 184 DECISIONS OF NATIONAL LABOR RELATIONS BOARD engineering and maintenance department also em- ployed individuals as painters, carpenters, electronic technicians, and clerks. The hospitals' biomedical engineering department (biomedical repair unit), which Local 39 would include within the proposed maintenance unit, is newly formed, having been created approximately 3 years before the hearings held herein to do some of the work which theretofore had been performedby electronic technicians in the engineering and mainte- nance department or farmed out to independent contractors. Presently, insofar as the distribution of work is concerned, electronic engineers within the engineering and maintenance department are respon- sible for plant and related machinery and equipment, whereas the II biomedical repair unit employees, including clerks, are responsible for the maintenance and repair of patient care electronic equipment. In support of its position that a separate mainte- nance unit is appropriate, Local 39 asserts that employees whom it seeks to represent are responsible for the operation and maintenance of complex machinery and equipment requiring highly developed skills and much experience and, further, that in some cases, those employees are paid at a higher wage rate than that received even by registered nurses . Local 39 also avers that the bargaining history between it and the Employer and in the health care industry as a whole justifies finding appropriate the unit herein sought. It bases its argument for inclusion of biomed- ical repair unit personnel on the historical fact that the work they perform was formerly done by employ- ees in the engineering and maintenance department, that such work is similar to engineering and mainte- nance department work, and that employees present- ly working in the biomedical repair unit have been recruited from the aforesaid department. The Employer disagrees, contending that the only appropriate unit herein would be one comprised of all service, maintenance , and clerical employees. In support of its contention, the Employer asserts that only senior watch engineers and electronic techni- cians perform work on sophisticated equipment requiring a high degree of skill; and that, with respect to other employees within the unit sought, many perform unskilled work which is in fact similar to that done by housekeeping department personnel. Ac- cordingly, the Employer argues that there is no basis for a unit predicated upon craft considerations. Further, the Employer argues that bargaining history does not justify the holding of an election in the unit sought. In particular, the Employer calls 10 The Jewish Hospital Association of Cincinnati d/b/a Jewish Hospital of Cincinnati, 223 NLRB 614 (1976). For the reasons stated above and for those stated in his separate concumng opinion to St Vincent's Hospital, 223 NLRB 638 (1976), Member attention to the fact that only a few classifications of the many here involved were covered by the agree- ments between it and Local 39; that agreements between the Local and other employers in northern California involved only 20 percent of the proprie- tary, public, and nonprofit hospitals in that region; and that, in any event, those contracts were the result of voluntary recognition and bargaining, all predat- ing the recent health care amendments to the Act. We have considered the entire record in this case and, in agreement with the Employer, find that the employees sought by Local 39 do not have a sufficiently separate and distinct community of interest to warrant their inclusion in a separate unit appropriate for the purposes of collective bargaining. At the outset, we note that engineering and maintenance department employees and individuals employed in the biomedical repair unit, who are themselves subject to different general supervision, share common working conditions and fringe bene- fits with all hospital employees and work throughout the hospitals, performing tasks which bring them into frequent contact with other employees. Moreover, the employees in question demonstrate wide variations in skill levels and functions, ranging from journeyman level craftsmanship to unskilled labor. Indeed, a number of these employees do work which is similar to that performed by service employees and are paid at the same wage scales. Likewise, bargaining history does not support a contrary finding, as only a small portion of those employees whom Local 39 would now include have heretofore been represented by the Local for the purposes of collective bargaining. In sum, we find on the record before us that engineering and maintenance department employees and individuals employed in the biomedical repair unit do not comprise a homogeneous grouping of employees with interests sufficiently distinct from the other employees to constitute a separate unit.10 Local 39 has not indicated whether it wishes to proceed to an election in a broader unit than that sought, but seeks only to preserve its right to do so. In these circumstances, we shall dismiss the petition filed in Case 20-RC-12306, but shall allow the Local an opportunity to participate in the election in Case 20- RC-12445, discussed infra. Case 20-RC-12331 CAMLT seeks to represent all professional medical laboratory technologists, including electron micro- scope technologists and technicians. However, as Penello agrees with the conclusion reached herein to dismiss the petition for a unit of all employees in the engineering and maintenance department and in the biomedical repair unit SUTTER COMMUNITY HOSPITALS`-OF SACRAMENTO previously mentioned, CAMLT expressed a willing- ness to represent a unit .consisting of all professional employees, excluding registered nurses, which SEIU contends is the only appropriate unit. - The Employer contends that the only appropriate unit herein is one embracing all professional employ- ees, including registered nurses.'1 In support of its contention, the Employer -asserts that all profession- als perform functionally integrated work, constantly interact with one another in the performance of their duties, and otherwise demonstrate a broad-communi- ty of interest which should not be fragmented by according separate recognition to any single category of professional employee. To do so, according to the Employer, would lead to an undue proliferation of bargaining units contrary to the intent manifest in the recent health care amendments to the Act. We have considered and, in agreement with the Employer and SEIU, have found that a separate unit of medical laboratory technologists is not appropriate for the purposes of collective bargaining. In Mercy Hospitals 12 we found no compelling tradition of separate representation or separate collective-bar- gaining history which counterbalanced the clearly identifiable community of interest those employees shared with other professionals. On the other hand, we have held that registered nurses may be excluded from units of professional employees,13 and, if they desire, are entitled to separate representation by virtue of their training, skills, and duties, and espe- cially their, singular history of separate representation and collective bargaining.14 There are no intervening factors in this case which would cause us to depart from those conclusions. Accordingly, we, find in this case that a unit comprised of all professional employ- ees, excluding registered nurses, is appropriate for the purposes of collective bargaining. Disputed Professionals There remains for consideration a question con- cerning the professional status of certain employees all of whom the Employer contends should be included in any unit herein found appropriate. The Employer recognizes 22 separate categories of profes- sional employees. However, in addition to registered nurses, the parties were able to agree on the profes- sional status of only the following: pharmacists, electron microscope technologists and their assist- ants, medical laboratory technologists, psychiatric social workers, and medical social workers. There is a question concerning the professional status of indivi- duals employed in the remaining 15 classifications: 11 No party contends that physicians should be included with other professionals. 12 Mercy Hospitals of Sacramento, inc., 217 NLRB 765 (1975). 13 Dominican Santa Cruz Hospital, 218 NLRB 1211 (1975). 185 Audiologists I and II: There are two audiologists who work in the diagnostic and treatment center at Sutter Memorial Hospital. Their primary function is to attempt to identify the causes of hearing impair- ment in- children and adults, prepare evaluation reports for-referral sources, and conduct the remedial training of certain patients. Audiologists mare super- vised by the speech pathologist who, in turn, is subordinate to - the chief of the diagnostic and treatment center. They are required by the Employer to have a' master of arts degree with academic major in - audiology, to possess - a certificate of clinical competence in audiology granted by the American Speech and Hearing Association, and to be licensed by the State of California. An audiologist I must have a minimum of 3 years' experience in clinical audiolo- gy, whereas there is no experience requirement for an audiologist II. Based on the foregoing, we conclude that audiolo- gists I and II are professional employees. As noted above, audiologists fulfill the requirements of Section 2(12)(a) of the Act which defines a professional employee as one whose work is predominantly intellectual and varied, involves the - exercise of discretion and judgment, cannot be standardized in the output produced or the result accomplished, and requires knowledge of an advanced type in a field of science or learning customarily acquired by a pro- longed course of specialized intellectual instruction and study in an institution of higher learning or a hospital.15 Nuclear Physicist: There is one nuclear physicist who is employed in the nuclear medicine department, immediately subordinate to the department director, a physician. His primary functions involve responsi- bility for the performance and calculation of all radioisotope laboratory procedures including the analysis of X-ray -photographic patterns caused by the injection of nuclear isotopes into a patient's bloodstream. In addition, the nuclear physicist acts as the Employer's radiation safety officer, and, as the coordinator of the Employer's nuclear medicine technology school, is responsible for all course curricula and training schedules. He is required to have a bachelor of science degree in physics, chemis- try, or biology and at least 4 years' experience in practical nuclear science,' practical laboratory proce- dures, or the teaching of physics or chemistry. We conclude, on the above facts, that the nuclear physicist is a professional employee as defined in the Act, as he performs work which is predominantly intellectual and varied in character, involves discre- 14 Mercy Hospitals, supra. See, however, fn. 32 infra. 15 Member Jenkins would not find the audiologist II to be a professional employee and, accordingly, would exclude that individual from the unit. 186 DECISIONS OF NATIONAL LABOR RELATIONS BOARD tion and judgment, cannot be standardized, and requires knowledge of an advanced type in a special- ized area acquired in an institution of higher learning. Staff Radiologic Technologists : There are 13 regis- tered staff radiologic technologists who work under the direct supervision of a chief radiologic technolo- gist in the Employer's X-ray department. Their duties, which are performed in the X-ray, surgical, and patient care areas of the hospitals , involve a variety of technical procedures used in taking X-ray pictures as prescribed by an attending physician and require the exercise of some independent judgment. These employees must be high school graduates and are licensed by the State of California after a 2-year training program at an accredited hospital and after passing qualifying examinations administered by the American Registry of Radiologic Technologists. Based on the foregoing, we conclude that staff radiologic technologists do not meet the statutory criteria for professional employees . It is clear that the position requires the use of independent judgment in technical matters and that the ability to perform the job is obtained only after a period of specialized training, certification, and the acquisition of a state license . However, it is equally clear that their func- tions do not involve the intellectual aspects and discretion orjudgment which characterize profession- al duties . Accordingly, we find that staff radiologic technologists may not properly be included in the professional unit herein found appropriate.16 Special Procedures Technologists: The hospitals employ 10 special procedures technologists who are differentiated from the staff radiologic technologists only in that they perform special X-ray procedures, such as arteriograms and venograms, requiring such additional experience and capabilities as are deter- mined to be adequate by the department chief. Because of the nature of their duties, they work more closely with the physicians, registered nurses, and cardiopulmonary technologists than do the staff radiologic technologists. Based on the above facts , we likewise find that special procedures technologists are not professional employees and we shall exclude them from the professional unit herein found appropriate.17 Nuclear Medicine Technologists: There are six nuclear medicine technologists who work in the X- ray areas of both hospitals under the supervision of the nuclear medicine department 's chief radioisotope technologist. They operate special cameras to trace radioactive isotopes through the various organs of a la In Case 20-RC-12445, discussed infra, the parties stipulated that those employees excluded from the professional unit here in question should be included in the overall service unit, including technicals, which SEIU seeks in that case We agree that the aforesaid employees are techmcals who should be included in the unit found appropriate therein and shall so direct 17 See fn 16, above patient searching for physical abnormalities. They also monitor the radiation levels within each patient after the tests are performed. Nuclear medicine technologists are all trained as staff radiologic tech- nologists and licensed by the State of California as such. Some may possess college degrees but, as in the case of staff radiologic technologists, a degree is not required. The record reveals that the Employer operates a school of nuclear medical technology. However, evidence is lacking that the employees here involved are required to attend the school or, if so, that they are required to pursue a course of instruc- tion and study of a specialized intellectual nature. Also lacking is any evidence that the nuclear medi- cine technologists consistently exercise independent judgment in the performance of analytical work for which they are alone responsible. In these circumstances, we find the record insuffi- cient upon which to make a determination as to the professional status of these employees. We shall, therefore, allow nuclear medicine technologists to vote in any election held in this case and in the overall unit in Case 20-RC-12445, subject to challenge.18 Cardiopulmonary Technologists: There are four cardiopulmonary technologists assigned to the Em- ployer's cardiopulmonary department at Sutter Me- morial Hospital. They work exclusively in a small laboratory in that building where they perform laboratory and clinical procedures relevant to cardio- pulmonary diagnosis under the supervision of a physician. This work entails the performance, record- ing, and calculation of pulmonary and cardiac function tests including associated blood gas analysis studies and oxygen consumption measurements. Similar tests are performed on patients during sur- gery. Three of the Employer's four cardiopulmonary technologists have baccalaureate degrees. The fourth was previously employed as a medical laboratory technologist, a professional, as the parties themselves agree. Indeed, the functions of the cardiopulmonary technologists are performed by medical laboratory technologists when the former, who work only on the day shift, are absent. Both categories of employees are paid at the same wage scale. We find on the above facts that cardiopulmonary technologists are professional employees performing work which requires specialized knowledge of an advanced type and which is primarily intellectual and varied in nature, involving the use of analytical skills 19 As previously stated, employees excluded from the unit herein found appropriate shall be included in the overall unit found appropriate in Case 20-RC-12445 As the professional status of nuclear medicine technologists will not be ascertained unless their votes are determinative , of necessity, they shall be allowed to cast challenged ballots in both cases SUTTER COMMUNITY HOSPITALS OF SACRAMENTO 187 to obtain results. for which they are personally responsible.19 - - Electron Microscope Technician: There is currently one electron microscope technician in the medical laboratory department at Sutter Memorial who, with the electron microscope technologist and the assistant electron microscope technologist, operates the Em- ployer's electron microscope. This employee must have a baccalaureate degree, preferably in_the biolog- ical sciences, or an associate degree in electron microscopy -and 1-year experience in an electron microscope laboratory. He is not required, however, to be licensed by the State or certified by an allied professional organization. There is some general testimony that the duties of the electron microscope technician are "substantially the same" as those of the technologist and the assistant, who must have baccalaureate degrees and whom the parties agree are professionals. On the other hand, a comparison of the written job descriptions admitted into evidence in this proceeding reveals that electron microscope techni- cians, unlike the others, have no responsibilities of a substantially analytical nature, such as researching, developing, and evaluating new microscopy tech- niques for use in specialized studies. In these circumstances, we find that electron microscope technicians are not professionals and we shall exclude them from the unit herein found appropriate.20 Certified Respiratory Therapy Technicians: The hospitals' eight certified respiratory therapy techni- cians administer respiratory therapy treatments to patients as prescribed by physicians, using ventila- tors, nebulizers, humidifiers, and other allied equip- ment. They are supervised by a shift leader. Candi- dates for this position must be high school graduates and obtain certification by the Technician Certifica- tion Board of the American Association of Respira- tory Therapy. We find that certified respiratory therapy techni- cians are not professional employees as defined in the Act21 and we shall exclude them from the unit herein found appropriate.22 Physical Therapists: The hospitals employ three physical therapists who are members of the medical care team primarily concerned with the disabled and potentially handicapped patient. Using various treat- ment techniques and agents as prescribed by an attending physician, the principal activities of physi- cal therapists are directed toward relieving pain, preventing disability, developing or improving skills, 19 Member Jenkins would not find the cardiopulmonary technologists to be professional employees and, accordingly, would exclude them from the unit. 20 See fii . 16, supra 21 The Jewish Hospital Association of Cincinnati d1b/a Jewish Hospital of Cincinnati, 223 NLRB 614 (1976). restoring function, and maintaining maximum per- formance within the patient's capabilities. Their duties also include the maintenance of progress reports on patient treatment records for the benefit of the attending physician. Physical therapists must have-a baccalaureate degree in physical therapy and be licensed by the State of California. Among other things, licensing is conditioned upon passing a written examination covering the following subjects: anatomy, pathology, kinesiology, physiology, psy- chology, physics, electrotherapy, radiation therapy, hydrotheraphy, massage, therapeutic exercise, physi- cal therapy as applied to medicine, neurology, orthopedics, surgery, psychiatry, procedures of evalu- ation, testing, and measuring, and technical proce- dures in the practice of physical therapy. Based on the foregoing, we find that physical therapists perform work requiring specialized knowl- edge of an advanced type which is primarily intellec- tual and varied in nature and involves the use of analytical skills to obtain results for which they are personally responsible. Accordingly, we find that they are professional employees and shall include them in the unit herein found appropriate 23 Occupational Therapists: There are three occupa- tional therapists who, following referral by an attend- ing physician, are responsible for planning treatment goals with the therapeutic team, administering and evaluating individual or group treatments of assigned patients, and determining appropriate activities as indicated by the patients' needs. Employees engaged in this work must possess a thorough knowledge of the theory and practice of mental and physical rehabilitation of mentally and physically handi- capped persons; normal development and learning theory; and therapeutic techniques, including prevo- cational exploration, perceptual-motor evaluation and treatment, arts and crafts, and self-care activities, in addition to possessing the skills required in the application of such techniques. They must have a baccalaureate degree in occupational therapy and be registered with the National Registry of the American Occupational Therapy Association or eligible for such registration. We find on the basis of the record before us that occupational therapists are professional employees as defined in the Act and we shall include them in, the unit found appropriate in this case. Recreation Therapists: There are two recreation therapists who work primarily in the mental health field performing a variety of duties, including plan- 22 See fn. 16, supra 23 Member Jenkins would not find the physical therapists to be profes- sional employees and, accordingly, would exclude them from the unit. 188 DECISIONS OF NATIONAL LABOR RELATIONS BOARD ning and carrying out recreation programs, coordi- nating group activities for groups of up to 14 patients, maintaining records of the activities and the partici- pants, and, when appropriate, participating in thera- peutic team conferences. Some programs are highly specialized and recreation therapists may be called upon to assist in adapting activities and/or equip- ment to facilitate the participation of disabled per- sons. Candidates for this position must possess `a baccalaureate degree in recreation therapy. Based on the above, we fmd that recreation therapists are likewise professional employees and we shall include them in the unit herein found appropri- ate.24 Therapeutic Dieticians: There are six therapeutic dieticians who plan and write modified diets, within the limits prescribed by the medical staff, for patients with therapeutic needs. These duties entail reviewing relevant medical orders, coordinating with patients to determine food habits and preferences, inspecting and testing prepared foods, and, when appropriate, instructing patients on proper diet following dis- charge. When requested, these individuals teach employee orientation classes and participate in the in- service training of hospital personnel in the areas of nutrition and diet therapy. Therapeutic dieticians also work on special projects, as planned by the head dietician, and present reports related to the improve- ment of departmental procedures and diet revisions. In addition, these employees may be assigned to relieve the acute kidney dietician in the latter's absence. Candidates for this position must have a baccalaureate or advanced degree from an accredited institution with a major in foods and nutrition or in dietetics, serve a period of internship, and be regis- tered as a member of the American Dietetic Associa- tion. On these facts we fmd that the work performed by therapeutic dieticians is predominantly intellectual and varied in character, involves discretion and judgment, cannot be standardized, and requires knowledge of an advanced type in a specialized area acquired in an institution of higher learning, and, accordingly, that employees engaged in this work are professional employees.25 Teacher-Mental Health: There were no teachers- mental health employed by the hospitals at the time of the hearing held in this case. According to the testimony of the Employer's director of personnel, one teacher-mental health is employed full time during the summer months when the individual involved is on leave from his position as a secondary school teacher and an employee of the Sacramento City School District. According to this same witness, the teacher-mental health,- when employed by the hospitals, is responsible for the continuing secondary school education of up to 14, children who are hospitalized in the mental health department. Exami- nation of the brief job description admitted into evidence reveals only that the person employed in this classification is responsible for providing adoles- cent outpatient mental health counseling and tutoring to participants of the student evening program under the supervision of the director of the mental health center, and that candidates for -this position must have a baccalaureate degree in one of the social sciences. Certification is not required, although the summer employee does possess a teaching certificate. We find the record in this case inadequate for the purposes'of determining the professional status of the teacher-mental health and, accordingly, shall- permit that individual to vote in any election held herein and in the overall unit in Case 20-RC-12445, subject to challenge.26 Data Analyst: There is one individual employed in the data processing department at Sutter General who is known as a "data analyst." The written job description for this position, which was admitted into evidence, would tend to support a claim that a data analyst is a professional employee. However, at the hearing, the Employer's director of personnel testified that the incumbent employee is actually a data processing programmer: "We have this analyst title here, but it is worked into the programming as of this date." Although there is some indication that the employ- ee involved prepares various types of programs for the Employer's computer equipment, we cannot determine on such limited evidence whether or not he is a, professional employee and shall likewise permit him to vote subject to challenge.27 Educational Programmer: There is one educational programmer who is employed in the renal dialysis department. Working with videotaping equipment, this individual is responsible for the development of training programs on the use of home dialysis equipment for presentation to both patients and medical personnel in the aforesaid department. In performing this work, the educational programmer must, among other things, refine basic instruction objectives, coordinate with medical personnel on substantive content, and develop behavioral response patterns used in programmed instruction. He works under the direct supervision of a licensed physician 24 Members Fanning and Jenkins would not find the recreation therapists 26 See fn. 18, supra to be professional employees and, accordingly, would exclude-them from the 27 ]bed unit. 25 Member Jenkins would not find the therapeutic dieticians to be professional employees and, accordingly, would exclude them from the unit SUTTER COMMUNITY HOSPITALS OF SACRAMENTO 189 and with nursing personnel, although he has sole responsibility for development of the videotape programs. The educational programmer is required to have a bachelor's degree in English, speech communi- cation, behavioral science, or in a related field and 2 years of instructional design and communication experience. In the alternative, a candidate for this position must have a master's degree and 1 year of such experience or an equivalent combination of education and experience. On the above facts, we find that the educational programmer performs work which is predominantly intellectual and varied in nature, involves -discretion and judgment, cannot be qualitatively or quantita- tively standardized, and requires knowledge of an advanced type in a specialized area which is acquired in an- institution of higher learning. Accordingly, we find that the educational programmer is a profession- al employee and we shall include him in the unit herein found appropriate. Based -on the foregoing, we find that the following employees constitute a unit appropriate for the purposes of collective bargaining within the meaning of Section 9(b) of the Act: All professional employees of the Employer, except registered nurses, including pharmacists, electron microscope technologists, assistant elec- tron microscope technologists, medical laboratory technologists, psychiatric social workers, medical social workers, audiologists I and II, nuclear physicists, cardiopulmonary technologists, physi- cal therapists, occupational therapists, recreation therapists, therapeutic dieticians, and educational programmers; but excluding staff radiologic'tech- nologists, special procedures technologists, elec- tron microscope technicians, certified respiratory therapy technicians, guards, and supervisors as defined in the Act. Case 20-RC-12445- SEW seeks to represent two separate units, one embracing all service employees in the Employer's nursing, housekeeping, laundry, and dietary depart- ments, including technical employees, and other composed of all office clerical employees. However, SEIU expressed a willingness to participate in any election involving the aforesaid employees in the event the Board finds appropriate a unit or units which might be broader in scope than those originally sought. In Case 20-RC-12306, we found that employees in the Employer's engineering and maintenance depart- ment and in the biomedical repair unit do not comprise a homogeneous grouping of employees with interests sufficiently distinct from others so as to warrant their placement in a separate unit. Indeed, -on the facts heretofore considered, we find,-in agreement with the Employer, that those employees should be grouped with the service employees herein sought in an overall unit comprising all of the Employer's service and maintenance employees, including tech- nicals. We find further, in accordance with the stipulation of the parties, that, the 134 nonconfidential 28 clericals employed at the time of the hearing in the Employer's nursing (ward clerks), surgery, IV therapy, X-ray, emergency room, laboratory, cardiopulmonary, pur- chasing, dietary, respiratory therapy, mental health, social services, central service, obstetrics, renal dialy- sis, nuclear medicine, and medical education depart- ments perform duties which are closely related to the functions performed by personnel in the service and maintenance unit and should therefore be included in the overall unit herein found appropriate. The parties also stipulated that the remaining 182 clericals in the Employer's business office, medical records, accounting, payroll, data processing, nursing (office secretaries), and laboratory (administrative pathology secretary}departments, and in the business office at the diagnostic and treatment center, are business office clericals, but disagree as to their unit placement. As previously stated, SEIU seeks to represent a separate unit of these clericals, asserting that these employees, whom the Board has traditionally recog- nized as having separate interests, perform no work which is functionally integrated with that performed by employees in the larger unit. The Employer, on the other hand, contends- that these clericals 'should likewise be included in the service and maintenance unit herein found appropri- ate. In support of its contention, the Employer avers that all 316 clerical employees, who work in 26 of the hospitals' 38 departments, are supervised by their respective department heads rather than by a single clerical supervisor; that there is a wide functional variation in the different tasks performed by office clericals, depending on the departments to which they are assigned; and that, in contrast to that wide variation, office clericals, whom SEIU seeks to represent separately, do perform work which is substantially similar to that performed by others who, by agreement of the parties, would be included in the service and maintenance unit. Thus, the Employer argues that the distinction between office and plant clericals in the typical manufacturing plant situation 28 The parties stipulated that individuals employed in the following clerk, personnel secretary, executive secretary, administrative secretary, classifications are confidential employees- personnel assistant, personnel business office secretary, and management analyst 190 DECISIONS OF NATIONAL LABOR RELATIONS BOARD does not carry over to the health care industry and, accordingly, that the Board should not find a separate unit of office clerical employees appropriate for the purposes of collective bargaining in this case. We have considered the arguments raised herein and, for the reasons set forth in Mercy Hospitals,29 find that separate units of business office clerical employees in the health care industry are appropriate and that such a unit is appropriate in this case. Based on the foregoing, we find that the following employees constitute units appropriate for the pur- poses of collective bargaining within the meaning of Section 9(b) of the Act: Unit A All service and maintenance employees in the Employer's nursing, housekeeping, laundry, di- etary, engineering and maintenance, and biomedi- cal engineering departments, including technical employees, staff radiologic technologists, special procedures technologists, electron microscope technicians, and certified respiratory therapy technicians; and including all clerical employees in the Employer's nursing (ward clerks), surgery, IV therapy, X-ray, emergency room, laboratory, cardiopulmonary, purchasing, dietary, respiratory therapy, mental health, social services, central service, obstetrics, renal dialysis, nuclear medi- cine, and medical education departments; but excluding all professional employees, business office clerical employees, confidential employees, guards, and supervisors as defined in the Act. Unit B All business office clerical employees in the Employer's business office, medical records, ac- counting, payroll, data processing, nursing (office secretaries), and laboratory (administrative pa- thology secretary) departments, and in the busi- ness office at the diagnostic and treatment center; but excluding all professional employees, all service and maintenance and technical employees, plant clerical employees, confidential employees, guards, and supervisors as defined in the Act. Case 20-RC-12523 CNA seeks to represent a unit consisting of all registered nurses at the Employer's two facilities. The Employer renews its contention, originally made in Case 20-RC-12331, that the only appropriate unit is 29 Mercy Hospitals of Sacramento, Inc, 217 NLRB 765 (1975) 30 Mercy Hospitals of Sacramento, Inc, supra 31 Case 20-RC-12331, discussed supra 32 In view of CNA's request to separately represent the registered nurses, one composed of all professionals, including regis- tered nurses, at both facilities. Registered nurses are employed in 12 of the hospitals' 38 departments. Seven of these 12 depart- ments, i.e., medical, surgery, mental health (nursing), IV therapy, obstetrics, renal dialysis, and emergency room, are generally considered part of the hospitals' nursing services. With the exception of the emergency room, responsibility for these departments rests with the director of nursing, and the several hundred registered nurses employed in these departments report to nursing supervisors. The emergency room is under the direct control of the Employer's executive director. Also under the latter's control are the other five departments in which registered nurses are employed; namely, X-ray, laboratory, mental health (psychiatric), nuclear medicine, and cardiopulmo- nary. The approximately 14 registered nurses em- ployed in these departments are supervised by their respective department heads, rather than by nursing supervisors. However, registered nurses in all depart- ments are deemed qualified for employment by virtue of their specific background and training, and per- form duties with a patient care orientation which fall within the area of their specific professional capabili- ties and skills. We have previously found that registered nurses are entitled to separate representation, if they desire, by virtue of their training, skills, and duties, and espe- cially their singular history of separate representation and collective bargaining.30 Further, we have found no intervening factors in these proceedings which would cause us to reach a different conclusion.31 Accordingly, as the Petitioner and the Intervenor, SEIU, seek to represent registered nurses separately, we find in this case that a unit comprising all registered nurses employed at both facilities is appropriate for the purposes of collective bargain- ing.32 Disputed Supervisory and Managerial Employees The parties stipulated that registered nurses em- ployed in the following classifications are supervisors within the meaning of the Act and, therefore, should be excluded from any unit herein found appropriate: director of nursing, associate director of nursing, supervising nurse anesthetist, and nursing area super- visor. However, they were unable to agree on the status of assistant area supervisors, head nurses, assistant head nurses, charge nurses, and clinical specialists in mental health and renal dialysis, whom Member Walther agrees that they may be excluded from an otherwise all- professional unit Accordingly , it is unnecessary for him to decide at this time whether registered nurses may appropriately be excluded from all-profes- sional units in the absence of a request for their separate representation SUTTER COMMUNITY HOSPITALS OF SACRAMENTO 191 the Employer asserts are also supervisors, or on the status of clinical specialists in neonatology and coronary care, patient care coordinators, in-service coordinators, environmental control coordinators, and clinical practice coordinators, whom the Em- ployer . contends- should be excluded as -managerial employees. Assistant Area Supervisors: The hospitals employ eight assistant nursing area supervisors whose duties are substantially the same as those of the nursing area supervisors, who the parties have stipulated are supervisory employees. Like the area supervisors, the assistants are responsible for the administrative and technical supervision over the nursing programs ,of their respective units; interpreting operating policies and procedures and reviewing work performance; directing development and adaptation of work tech- niques and methods for resolution of unusual or complex nursing problems; and planning with other designated supervisory personnel to provide maxi- mum patient care. Assistant area supervisors, who work exclusively on the evening shift,33 are normally subordinate to the area supervisors. In the absence of an area supervisor, the assistants are the most senior nursing services employees on duty during the evening shift, in terms of their authority. On those occasions, the assistants report directly to an asso- ciate director of nursing. They are responsible for assigning, evaluating, and overseeing the work of between 10 and 15 nursing personnel employed in the units within their jurisdiction, including head nurses and charge nurses, sharing this responsibility with the area supervisors, as head nurses normally work only on the day shift. Like area supervisors, assistants have -authority in the interest of the hospitals effectively to recommend the hiring, transfer, suspension,. promo- tion, discipline, and discharge of nursing personnel, including registered nurses, and have exercised that authority in -the past. Additionally, assistant area supervisors are required to have between 18 months' and 3 years' experience as a registered nurse with at least 1 year of experience as a head nurse. Based on the above, we fmd that assistant area supervisors, are supervisors within the meaning of the Act and we shall exclude -them from the unit herein found appropriate. Head Nurses and Assistant Head Nurses: There are 34 head nurses. employed at the two facilities. They work exclusively on the day shift. The Employer asserts, however, that each head nurse has 24-hour-a- day responsibility for the continuity and quality of nursing care provided by that individual's assigned nursing unit and that this responsibility is discharged by counseling with certain key subordinates; namely, the charge nurse, who is the registered nurse "in charge" of the unit during the evening shift, and the night nurse, who plays a similar role- on .the night shift. It is conceded, however, that charge nurses, as well as. night nurses, whom the Employer, does not contend are supervisors, also report directly - to nursing area supervisors or assistants- when the latter make their periodic rounds of the nursing units under their jurisdiction. The duties performed by head nurses fall essentially into three categories: they-oversee the maintenance of records of medical and nursing treatment and related services for which nurses,are responsible; similarly oversee the ordering of supplies and equipment and the maintenance of general housekeeping to promote good surroundings for the patients; and themselves perform direct patient care services. A head nurse may spend as many as 7 hours of an 8-hour shift in direct patient care service. For the remainder of the time, the head nurse attends to administrative duties and oversees the activities of unit personnel, includ ing between 6 and 10 registered ,nurses whom the head nurse assigns to cover patients in accordance with the' latters' nursing care requirements and the levels of professional training and experience pos- sessed by the nurses. Head nurses may write counsel- ing memos or evaluations of the work performed by subordinates. However, these evaluations are limited to factual matters and do not contain recommenda- tions for action of a disciplinary nature. Further, according to the testimony of the Employer's director of nursing, these memos and evaluations are merely "-considered" when decisions concerning disciplinary action are made, normally by the director of nursing, the associate directors,-, and/or- the area- supervisors and assistants. The record also indicates that head nurses do not authorize overtime for unit personnel nor do they_initiate recommendations for unit or shift transfers. Such actions are normally undertaken by the nursing area supervisors,or assistants. Lastly, in relatively few instances do head nurses participate in prehire interviews or effectively recommend the hiring of nursing personnel. The hospitals - employ two assistant head nurses, one in obstetrics, labor, and delivery (maternity) and the other in renal dialysis. Their duties are in all essential aspects similar to those performed by the head nurses in these units. The assistant head nurse, maternity, was appointed to that position to relieve the head nurse of the administrative burden caused by the size of that unit, there being approximately 86 full-time and part-time employees covering the day, evening, and night shifts. The assistant head nurse, renal dialysis, is the only registered nurse employed in 33 The Employer operates three 8-hour shifts, herein designated as the day, evening, and night shifts. -192 DECISIONS OF NATIONAL LABOR RELATIONS BOARD the outpatient section at Sutter General. She oversees the work of one to three employees at that facility, as the head nurse of the unit is located at Sutter Memorial. - In deciding whether health care professionals, including registered nurses, are supervisors within the meaning of the Act, we are- bound to adhere to the traditional standards for determining supervisory status. Further, we are not unmindful of the report of the Senate Committee on Labor and Public Welfare on the "Coverage of Nonprofit Hospitals Under the National Labor Relations Act "34 In this report the Senate indicated that a health care professional does not exercise supervisory authority in the interest of an employer when that individual's "direction" to other employees is in the "exercise of professional judg- ment . . . incidental to the professional's treatment of patients." Based on the evidence adduced in this case, it is clear that head nurses and assistant head nurses perform duties and functions predominantly in the "exercise of professional judgment" incidental to their treatment of patients and that their "24-hour-a- day responsibility" is addressed to the delivery of continuous nursing care of high quality and not to the general supervision of other employees in subordi- nate positions who share in the aforesaid responsibili- ty, as they possess none of the traditional indicia, of supervisory authority cognizable under the Act. Thus, head nurses and assistants do not have the authority to make effective recommendations with respect to the hiring, firing, transfer, or discipline of subordinates. Neither can they modify established work schedules nor authorize overtime for employees in their respective nursing units. In these circumstances, we find that head nurses and assistant head nurses are not supervisors within the meaning of the, Act and we shall include them in the unit herein found appropriate. Charge Nurses: There are 24, charge nurses at the Employer's two facilities, all of whom work exclusive- ly on the evening shift. The duties of charge nurses are similar to those of the head nurses assigned to their respective nursing units. However, charge nurs- es oversee fewer' subordinates (between three and eight employees, including registered nurses) due to decreased activity on the evening shift 35 On their scheduled days off, charge nurses may select, from among the registered nurses assigned to their nursing units, substitutes to act in their capacity. Like night nurses, who occupy similar positions on the night shift, charge nurses "counsel with" their head nurses and also report directly to assistant area supervisors, when the latter make their periodic rounds of the nursing units. Based on the above facts, we find that charge nurses are not supervisors and we shall include them in the unit herein sought. Clinical Specialists in Mental Health (Nursing) and Renal Dialysis: The hospitals employ two clinical specialists whom the Employer contends are supervi- sors, one in the mental health (nursing) department and the other in the renal dialysis department. All clinical specialists are required to hold a master's degree in nursing, preferably with an emphasis in their particular field of interest. Unlike the others, however, the two here in question assume responsibil- ities -akin to those of nursing area supervisors, according to the Employer, although all share with the area supervisors a common wage range. We find that the record in this case amply supports the Employer's contention. Thus, the clinical special- ist in mental health, an expert in child psychiatric nursing, is responsible for clinical supervision of the Employer's child care staff and has a' variety of nursing personnel reporting to her, including a head nurse, a charge nurse, and several staff -registered nurses. This individual, who is directly subordinate to an associate-director of nursing, has the authority, in the interest of the hospitals, to hire and fire employees and has, in fact, exercised that authority in order to select her own staff. Likewise, the clinical specialist in renal dialysis supervises and administers nursing services in all renal care units, responsibly directing the work of 17 to 20 employees, including head nurses, an-assistant head-nurse, charge nurses, and several staff 'registered nurses. This individual has the authority to hire and fire employees and, like her counterpart in mental health, has used this authority in the selection of her own staff. It is therefore clear that clinical specialists in mental health and renal dialysis possess that degree 'of supervisory authority cognizable under the Act which warrants their exclusion from the unit herein found appropriate. Clinical Specialist in Neonatology: There is one clinical specialist in neonatology who the Employer contends is a managerial employee and as such should be excluded from the unit herein found appropriate. This individual, who concededly exercis- es no supervisory responsibility, is subordinate to an associate director and the director of nursing. She is involved in the development of the Employer's newly established neonatology intensive care unit. In this capacity she is responsible for planning, initiating, 34 S. Rept. 93-766, 93d Cong., 2d sess 6 (April 2, 1974) heart surgery patient, thus assuming no administrative responsibilities during 35 A charge nurse in the cardiac intensive care unit testified that she may that particular shift. This individual also testified that on occasion she has occasionally spend an entire 8-hour shift caring for a postoperative open been "floated out" of her nursing unit to work in other areas of the hospital. SUTTER COMMUNITY HOSPITALS OF SACRAMENTO 193 directing, and evaluating nursing care for the parent- infant clientele of the Employer. Such work includes, but is not limited to, the development of new or improved methods of nursing care and the policies and -procedures applicable thereto. To qualify for such work, a clinical -specialist is neonatology must possess an advanced in-depth knowledge of nursing theories and practice specifically related to the family unit, including an understanding of the relationship and function of the medical and biological sciences. Additionally, this individual must have acquired special knowledge and skills in writing, speaking, and the group process, and must be able to use the interdisciplinary tools involved in the supervision, administration, and management of patient care. The Board, with judicial approval,36 has tradition- ally -defined managerial employees as those who formulate and' effectuate management policies by expressing and making operative the decisions of their employer, and those who have discretion in the performance of their jobs independent of their employer's established policy.37 Thus, managerial status is conferred only upon those in executive-type positions whose interests are closely aligned with management as true representatives of management. Accordingly, we have held that professional employ- ees are not the same as management employees merely because their professional competence neces- sarily involves a consistent exercise of discretion and judgment in a manner which may affect an employ- er's business direction or established policy.38 The touchstone in a given case is whether or not a professional employee either exercises the type of discretion indicative of managerial status or, having some responsibility for authorship, participates di- rectly in the employer's policymaking process. The record in the instant case shows that the clinical specialist in neonatology performs work which goes beyond that incidental to professional training and experience and, in- the development of the neonatology nursing unit, actually involves the formulation of policies and procedures affecting nursing care. To be sure, the role of this specialist is subordinate to those of the associate director and the director of nursing. However, it is clear that the degree of responsibility entrusted to this individual, by reason of her interdisciplinary qualifications and skills, aligns her more closely with management, in whose interest she acts, than to other employees whom the Act protects. In these circumstances, we find that the clinical specialist in neonatology is a 36 N.L R.B. v. Bell Aerospace Company, Division ofTextror, Inc., 416 U.S. 267 (1974). 37 Palace Laundry Dry Cleaning Corporation, 75 NLRB 320 (1947), Eastern Camera and Photo Corp., 140 NLRB 569 (1963). 38 General Dynamics Corporation, Convair Aerospace Division, San Diego Operations, 213 NLRB 851 (1974). managerial employee and we shall exclude her from the unit herein found appropriate.39, Clinical Specialist in Coronary -Care: There is one clinical specialist in coronary care, immediately subordinate to an associate director and to the director, of nursing, whom the Employer contends is a managerial employee. Among other things, this individual teaches a course in coronary care accred- ited by the University of California which is- attended both by the hospitals' employees and by registered nurses employed elsewhere. This teaching responsi- bility involves evaluation of student progress. The clinical specialist in coronary care also serves as a "-resource person" for "policy and procedure plan- ning and decision-making in all cardiac monitoring areas." In this respect, however; the record shows only that she has participated in discussions concern- ing the location of the monitoring station in the cardiac intensive care unit and has assisted in identifying those aspects of a patient's condition to be monitored. Based on the foregoing we find the record insuffi- cient upon which to make a determination as to the managerial status of this employee. Accordingly, we shall allow the clinical specialist in coronary care to vote in any election held in this case, subject to challenge.4° Patient Care Coordinators: There are two patient care coordinators who work with the medical staff, other health care facilities, and the patients them- selves to insure successful delivery of health care services and to facilitate the readjustmentof patients to the home environment, or to other hospitals or intermediate health care facilities. These individuals work "independently, and without close supervision" but within the framework of the Employer's estab- lished health care policies. Among other things, the work entails evaluating hospital care in accordance with patients' needs; planning posthospital care for patients about to be discharged or transferred to other health care facilities; and, when necessary, conferring with patients, their families, and recipient health care facilities to assure delivery of required health care, as established by physicians' orders. Patient 'care coordinators are subordinate to nursing area supervisors but may also report directly to an associate director or to the director of nursing. It is clear on the above facts that patient care coordinators do not formulate and effectuate' man- agement policy. Neither do they exercise discretion in the performance of their work which is independent 39 Members Fanning and Jenkins would not find the clinical specialist in neonatology to be a managerial employee and , accordingly, would include her in the unit 40 Members Fanning and Jenkins would not find the clinical specialist in coronary care to be managerial and would include her in the unit at this time 194 DECISIONS OF NATIONAL LABOR RELATIONS BOARD of the Employer's established policy. Indeed, these, employees admittedly work within the framework of existing management policy in accomplishing their professional tasks. In these circumstances, we find, contrary to the Employer's contention, that patient care coordinators are not managerial employees and we shall include them in the, unit sought.- In-Service Coordinators: -The three in-service coor- dinators, who the Employer contends are managerial employees, are responsible for directing the in-service education of the nursing staff, including registered nurses, at both facilities. This work involves the planning, organizing, and implementing of orienta- tion programs for newly hired or reassigned nursing personnel; assisting in the evaluation of their poten- tial for service in the various nursing units of the hospitals; conducting continuing education programs for registered nurses; and training them in new nursing procedures. In carrying out their responsibili- ties, in-service coordinators instruct staff , in the policies and procedures governing the delivery of nursing care; may "assist with revisions" of such policies and procedures to fill new needs; and may consult with physicians, nursing area supervisors, and head nurses to identify and eliminate deficiencies in training. - To qualify for this position, in-service coordinators, who are subordinate to the associate directors and to the director of nursing, must possess advanced knowledge of general nursing theory and practice and have acquired special knowledge and skills in writing, speaking, and the group process. They must also be familiar with the organization and functions of all departments and with the policies and procedures of the hospitals. It is clear that in-service coordinators manifest a high degree of professional competence requiring consistent use of discretion and judgment in the training of other professionals. However, the record in this case does not show that such discretion may be exercised independently of the Employer's estab- lished policy nor does it demonstrate that these individuals in fact participate directly in the Employ- er's policymaking process. In this respect, the job description pertaining to in-service coordinators states merely that they may "assist with revisions" of management policy. There is no indication, however, as to the form such "assistance" takes. In these circumstances, we are unable to determine whether or not in-service coordinators are managerial employ- ees. Accordingly, we shall allow them to vote in. any election held herein, subject to challenge.41 Clinical Practice Coordinators: The hospitals' four clinical practice coordinators work primarily in the in-service education program as instructors, in a formal setting, to provide additional training in certain specialized areas, such as intensive care and surgery. With the in-service coordinators, to whom they are subordinate, clinical practice coordinators assist in the screening and selection of volunteers to participate in these specialized training programs. On these facts, we find, contrary to the Employer's contention, that clinical practice coordinators are not managerial employees and we shall include them in the unit herein found appropriate. Environmental Control Coordinators: The two envi- ronmental control coordinators are responsible for monitoring all facets of patient care at Sutter General and Sutter Memorial, respectively, in order to detect and control the spread of infectious diseases. They are supervised by the associate director of nursing at each facility and by the director of nursing. As members of the environmental control committee, these individuals monitor and evaluate the infection control techniques used by the various departments of the hospitals and suggest methods of improving existing techniques. Additionally, they work with the in-service coordinators in preparing and presenting training programs dealing with infection control. Although environmental control coordinators possess no supervisory responsibilities, their findings may result in disciplinary action if they point to careless- ness as a cause in the spread of infection. On the above facts, we do not agree that environ- mental control coordinators are managerial employ- ees. Accordingly, we shall include them in the unit herein sought. Based on the foregoing, we find that the following employees constitute a unit appropriate for the purposes of collective-bargaining within the meaning of Section 9(b) of the Act: All registered nurses employed at the Employer's two facilities including head nurses, assistant head, nurses, charge nurses, patient care coordinators, clinical practice coordinators, and environmental control coordinators; but excluding assistant area supervisors, clinical specialists in mental health (nursing) and renal dialysis,, and the clinical specialist in neonatology, guards, managerial employees, and supervisors as defined in the Act. ORDER It is hereby ordered that the petition filed in Case 20-RC-12306 be, and it hereby is, dismissed. 41 Members Fanning and Jenkins would not find the in-service coordina- tors to be managerial employees and would include them in the unit at this time. SUTTER COMMUNITY HOSPITALS OF SACRAMENTO 195 [Direction of Elections42 omitted from publica- tion.]43 CHAIRMAN MURPHY and MEMBER FANNING, concur- ring in part and dissenting in part: We join our colleagues in their fmdings concerning the unit placement of employees in disputed profes- sional, supervisory, and managerial categories. We also join in their unit determinations except insofar as they find that engineering and maintenance depart- ment and biomedical repair unit employees do not constitute a separate appropriate unit as sought in Case 20-RC-12306 and that only an overall service and maintenance unit is appropriate. We would find on the record before us that the aforementioned engineering and maintenance department and bio- medical repair unit employees have separate interests justifying the establishment of a departmental unit in view of their separate supervision, functions, and conditions of employment. These employees perform duties and functions similar to those in Riverside Methodist Hospital. 44 42 Inasmuch as the units herem found appropriate are at variance with many of those sought and as, at the time of the hearings, no party could have determined with any degree of certainty what unit or units in this newly covered industry would be found appropriate, we hereby direct that the Regional Director ascertain the parties' showings of interest in the units herem found appropriate and that elections be held subject to the determined adequacy of such showing. 43 Excelsiorfootnote omitted from publication. 44 223 NLRB 1084(1976).