Long Island College Hospital

202 DECISIONS OF NATIONAL LABOR RELATIONS BOARD The Long Island College Hospital and District 1199, League of Registered Nurses, National Union of Hospital and Health Care Employees, Retail, Wholesale and Department Store Union, AFL- CIO, Petitioner. Case 29-RC-4593 May 28, 1981 DECISION ON REVIEW Upon a petition duly filed under Section 9(c) of the National Labor Relations Act, as amended, a hearing was held before a hearing officer of the National Labor Relations Board. On August 10, 1979, the Regional Director for Region 29 issued a Decision and Direction of Election in which he found appropriate a bargaining unit consisting of registered nurses (RNs), with certain exceptions, employed by the The Long Island College Hospi- tal (LICH). Thereafter, in accordance with Section 102.67 of the National Labor Relations Board Rules and Regulations, Series 8, as amended, the Employer filed a request for review of the Region- al Director's Decision and Direction of Election, contending, inter alia, that the Regional Director erred in failing to find that only a unit of all profes- sional employees is appropriate. On September 11, 1979, the National Labor Re- lations Board by telegraphic order granted the re- quest for review. Thereafter, on September 20, 1979, an election was conducted among employees in the unit found appropriate by the Regional Di- rector, and the ballots were impounded pending resolution of the issues under review by the Board. The Board has considered the entire record in this proceeding, including the briefs filed on review, and makes the following findings: LICH is a nonprofit, acute care hospital located in Brooklyn, New York. It operates out of two main buildings which are adjacent to each other, a clinical facility across the street, and approximately 30 other buildings but all within Brooklyn. Three of these satellite facilities employ at least one RN: the methadone clinic, the alcoholism treatment center, and the kidney center. LICH has 567 beds and approximately 2,200 employees. LICH also op- erates a school of nursing which is housed in an old church building located about a block and a half from the main buildings. LICH is governed by a board of regents, com- posed of a chairman, a secretary-treasurer, and ap- proximately 35 members selected from the commu- nity. Reporting to the board of regents is the presi- dent, the Employer's chief administrative officer, with the responsibility for overall operations. Under the president are six vice presidents and an assistant vice president. There is also an executive management team, comprised of associate or assist- 256 NLRB No. 34 ant administrators of the Employer's approximately 36 divisions, which makes all major decisions af- fecting hospital operations. One member of the ex- ecutive management team is the vice president and director of nursing, Lisa Appenzeller. As director of nursing, Appenzeller formulates and implements the policies and procedures, and acts as the overall supervisor for the nursing department. As vice president of nursing, Appenzeller shares the re- sponsibility for the overall administration of the hospital and oversees the operations of the school of nursing. The Petitioner and the Intervenor' seek a unit of 350-400 RNs, including approximately 320 RNs in the nursing department, 2 7 utilization review coor- dinators, 6-8 RNs in the kidney center, 5-6 RNs in the methadone clinic, 3 RNs in the home care de- partment, and an RN in the alcoholism treatment center. Employee classifications sought include staff nurse, assistant nursing care coordinator, utili- zation review coordinator, home care nurse, audit nurse, and conference nurse.3 The Employer con- tends that the only appropriate unit is one that combines the RNs with the 150-200 other health care professionals, but excluding physicians and dentists. 4 Within such a unit the Employer would include the following professional employees: 17 social workers; 6 social work assistants;5 5 dieti- cians; 5 nutritionists; 8 pharmacists; 9 physical therapists; 3 occupational therapists; 1 recreational therapist; 2 speech pathologists; 48 laboratory tech- nologists; I staff librarian; 1 medical librarian; 1 au- diologist; 2 psychologists; I orthoepist; I biomedi- cal engineer; 2 physicists; 12 methadone counselors; 1 vocational counselor; 15 alcoholism counselors; 7 teachers and assistant teachers in the Lamm Insti- Local 144, Hotel, Hospital, Nursing Home and Allied Health Serv- ices Union, Service Employees International Union, AFL-CIO, was per- mitted to intervene after demonstrating a sufficient showing of interest. 2 When discussing RNs at LICH, we are generally speaking about the approximately 320 RNs in the nursing department, the bulk of the unit sought, unless otherwise indicated. 3 The Regional Director directed an election in the following unit: All full-time and regular part-time registered professional nurses and persons authorized by permit to practice as registered professional nurses including staff nurses (which include kidney center nurses, methadone clinic nurses and alcohol clinic nurses), assistant nursing care coordinators, utilization review coordinators, staff home care nurses, conference nurses and audit nurses, employed by the Em- ploer at 340 Henry Street, Brooklyn, New York, and its other Brooklyn, New York locations; excluding student loan officers, stu- dent nurse recruiters, nurse anesthetists, staff development instruc- tors, school of nursing instructors and assistant instructors, clinical neuroscience coordinators, coordinator of employee health services, and all other employees, guards and all other supervisors within the meaning of the Act. When discussing the non-nurse professionals employed at LICH, we do not include doctors and dentists unless otherwise indicated. 5 While the parties stipulated to the professional status of most of the classifications listed, there was no agreement on the professional status of social work assistants and alcoholism counselors. THE LONG ISLAND COLLEGE HOSPITAL 203 tute;6 7 nurse anesthetists; and 10 instructors and assistant instructors in the school of nursing. 7 There are approximately 320 nonsupervisory RNs in the department of nursing; the vast major- ity work on one of the 21 inpatient units main- tained by LICH. Nursing care coordinators act as first-line supervisors of inpatient units with the full- time responsibility for the quality of nursing care provided. Nursing care coordinators report to as- sistant directors of nursing, who in turn report to the associate director of nursing, 8 who in turn re- ports to the director of nursing. The director of nursing has the ultimate authority to hire, fire, dis- cipline, and take other supervisory actions. In prac- tice, however, RNs are hired and disciplined by the assistant director of nursing and the nursing care coordinator responsible for a particular inpa- tient unit. The director of nursing is actively in- volved in decisions to terminate RNs, however. State law requires that before becoming an RN an individual must complete a specialized education program approved by the State. All RNs are li- censed by the State of New York Education De- partment and are required to pass a uniform exami- nation as a condition of licensure. State law defines the distinct duties and responsibilities of RNs and requires that they plan, supervise, and evaluate the care provided to patients. Only physicians and RNs, or a person working under the direct supervi- sion of an RN, may administer medication to a pa- tient. The director of nursing is required by law to report to the State Education Department any RN who violates his or her professional responsibility. Violations can result in the imposition of discipline including the revocation of an RN's license. I The Lamm Institute treats children with development disabilities 7 Based upon their lack of community of interest with the other RNs employed by LICH, the parties stipulated that nurse anesthetists, staff de- velopment instructors, and instructors and assistant instructors in the school of nursing should be excluded if a unit limited to RNs is found to be appropriate The parties further stipulated that staff development in- structors should be excluded as supervisors The parties also stipulated that the following employee classifications which are held by RNs should be excluded as supervisory or managerial positions: vice president and di- rector of nursing: director of home care; associate director of nursing; as- sociate director for the school of nursing; associate director for staffing and recruitment; associate director for staff development; assistant direc- tor for nursing; operating room manager; administrative and clinical nurse coordinator for ambulatory care; nursing care coordinator; supervi- sor for utilization review; chief nurse anesthetist; patient advocate: clini- cal neuroscience coordinator; and the coordinator of employee health services. Finally, the parties stipulated that the RNs employed in the school of nursing as the student nurse recruiter and as the student loan officer should be excluded from either an overall professional unit or an RN unit since there is no requirement that those positions be filled by RNs. The Regional Director found that the record accords with the stip- ulations. s There are four associate directors who report to the vice president and director of nursing. The responsibilities of the associate director of nursing appear to relate pnmarily to the day-to-day operations of the nursing department. There is also an associate director for the school of nursing, an associate director of staff development, and an associate di- rector for staffing and recruitment. The Joint Committee on the Accreditation of Hospitals (JCAH), a voluntary agency that surveys the quality of care provided at hospitals, evaluates separately the Employer's nursing department. Among the factors reviewed by the JCAH are the ratio of RNs to patients, the adequacy of the con- tinuing education program available to RNs, and the system for evaluating the performance of RNs. The Health Department of the State of New York, in addition to requiring that RNs undergo periodic evaluations, periodically inspects the nursing de- partment and informs LICH of any failure to meet the requisite state standards. Failure to correct re- ported deficiencies may result in the imposition of penalties. There is a 6-month probationary period for RNs in the nursing department; at the end of that period the decision to retain a probationary RN is made by a nursing care coordinator and an assistant di- rector of nursing. When hired, RNs attend a spe- cialized orientation program. The nursing depart- ment also maintains an extensive inservice continu- ing education program for RNs, who are encour- aged, but not required, to attend. There are period- ic meetings in the nursing department for RNs. Nurse anesthetists and instructors and assistant in- structors in the school of nursing are neither in- formed of, nor attend, these meetings. The vast majority of RNs work on inpatient units attending to the nursing care needs of pa- tients.9 Inpatient units are required by law to be staffed with RNs at all times, 24 hours a day, 7 days per week. A typical inpatient unit (A-9) in the Atlantic Avenue building contains 51 beds. 10 Unit A-9 has a nursing care coordinator who has the full-time responsibility for the nursing care pro- vided on that unit. During the day shift (7:15 a.m.- 3:30 p.m.), the unit is staffed by 11 RNs, including a nursing care coordinator and an assistant nursing care coordinator. The staffing requirement for the evening shift (3:15-11:30 p.m.) is three to four RNs, while the night shift (11:15 p.m.-7:30 a.m.) is normally staffed with three RNs. Some RNs are re- quired to rotate shifts, but rotations are usually handled on a voluntary basis. RNs on the night shift receive a shift differential; among other pro- fessionals only pharmacists receive shift differential pay. The normal workweek for RNs is 37-1/2 9 There are several nonsupervisory RNs in the nursing department as- signed other responsibilities. The audit nurse is responsible for determin- ing whether qualit? care has been provided on the basis of patient charts and other medical records There is no evidence concerning the duties of the conference nurse. The audit nurse and the conference nurse appear to work a normal 9-5 schedule. I' A typical inpatient unit in the Henry Street building has 35 beds; however, the record does not establish the normal staffing requirement for a unit that size. 204 DECISIONS OF NATIONAL LABOR RELATIONS BOARD hours. Work schedules are established by nursing care coordinators or assistant nursing care coordin- ators and are subject to the ultimate approval of the associate director of staffing and recruitment. Only the director of nursing can require an RN to work overtime. RNs are frequently shifted from one inpatient unit to another. Because inpatient units must be staffed by RNs at all times, special scheduling arrangements must be made for RNs who are required to work on holidays. The positions of assistant nursing care coordina- tor and nursing care coordinator are promotional positions for RNs and most vacancies in these jobs are filled from within LICH. On one occasion an RN transferred to a teaching position in the school of nursing. Otherwise, there is no job interchange between RNs and other health care professionals employed by the Employer. There is only limited evidence concerning the small number of RNs employed outside the nursing department but sought by the Unions. The three RNs in the home care department are supervised by the director of home care, an RN. The RNs in the alcoholism treatment center, methadone clinic, and the kidney center are hired and supervised by the respective clinic administrators. The director of nursing is not responsible for the work of the RNs outside the nursing department. RNs employed outside the nursing department do not go through that department's orientation program; however, there is some indication that representatives of the RNs employed in these other facilities do on occa- sion attend some nursing department meetings. If a vacancy occurs in an assistant nursing care coordi- nator or nursing care coordinator position within the nursing department, or within a hospital satel- lite facility, any RN employed at LICH is eligible to apply for that position.' 2 Finally, there are the seven RNs employed as utilization review coordin- ators, whose function is to monitor the length of a patient's stay. They evaluate a particular patient's length of stay against predetermined criteria estab- lishing the normal length of hospitalization re- quired for a patient with a particular malady. This process is designed to insure that patients are nei- ther kept for too long, nor for too short a time, in the hospital. Utilization review coordinators are part of the professional standards review organiza- tion and that department reports to the assistant vice president. The educational and licensure requirements for other professionals vary. All categories of health II As vice president of nursing. Appenzeller signs off on the budget requests for the RNs employed in the satellite facilities, but this appears to be a simple formality. 12 There are nursing care coordinators and assistant nursing care coor- dinators employed in the kidney center and in the methadone clinic. care professionals must have a bachelor's degree. Certain professionals, such as social workers, au- diologists, pharmacists, and librarians must also have graduate degrees in their specialized fields. Some of the health care professionals, such as labo- ratory technologists and nutritionists, are licensed by professional associations; others, such as social workers, the recreational therapist, occupational therapists, pharmacists, teachers in the Lamm Insti- tute, physical therapists, speech pathologists, and the audiologist, are licensed by state agencies. All professional employees, including RNs, are subject to common personnel policies and receive the same employee benefits. They all work a basic workweek of 37-1/2 hours, except nurse anesthe- tists, and have a 6-month probationary period. All professionals are evaluated at the end of their pro- bationary period and yearly thereafter. The same evaluation form is used for all professionals includ- ing RNs. Laboratory technologists are regularly as- signed to work on three shifts and pharmacists on two shifts; the others normally work 5 days a week from 9 a.m. to 5 p.m. The average salary for staff RNs, including utili- zation review coordinators, is approximately $15,000 a year. Salaries for staff RNs increase with seniority and there is approximately a $1,500 differ- ence between the highest and lowest salaries. As- sistant nursing care coordinators average 5 percent more than staff RNs. The salaries of the other health care professionals fall within a wide range. Of those which the Employer would include, the highest average salaries are received by the epide- miologist and physicists (60 percent higher than RNs); the lowest average salaries are paid to teach- ers and assistant teachers in the Lamm Institute (less than 70 percent of the average salary of RNs). Overall, the average salaries paid to other health care professionals generally fall within a range 25 percent above and below the average salary of RNs. LICH applies a "holistic" approach to patient care. That approach emphasizes coordination, co- operation, and interaction among the various spe- cialists in the institution. Consistent with this ap- proach, the Employer maintains various interdisci- plinary committees (approximately 20), all of which include at least one representative from the department of nursing. The purpose of these com- mittees is to increase the coordination among the various disciplines to promote increased efficiency in patient care. " Appenzeller described the Employer's holistic care philosophy as "a multidisciplinary effort [focusing on] the total care of the patient, [and in- voling] constant collaboration and concerted effort " THE LONG ISLAND COLLEGE HOSPITAL 205 As part of its holistic approach the Employer uses an integrated charting system, under which all professional employees involved in the treatment of a patient make entries regarding their observations and treatment on a single chart. Patient charts are kept in the nursing stations on inpatient units. The Employer elicited extensive testimony con- cerning job interaction between RNs and other health care professionals. What this testimony makes very apparent is that most of this contact re- sults from the central role assigned to RNs in ad- ministering to the overall health care needs of pa- tients. Thus, when a patient is admitted, an RN as- sembles a patient admission history, and from this determines whether the patient requires the assist- ance of a social worker, physical or occupational therapist, nutritionist, or other health care special- ist. If the RN determines that additional assistance is needed, she or he contacts the appropriate pro- fessional and arranges for a conference with the pa- tient. For example, if a patient requires the assist- ance of a social worker the RN would then make an entry to that effect on a log maintained on inpa- tient units. That entry would alert a social worker of the patient's needs and, in most instances, the social worker would proceed to discuss the prob- lem with the staff RN assigned the primary respon- sibility for the patient's care before consulting with the patient. If the patient's problem requires more immediate attention, then the RN would communi- cate the need for expedited action. Likewise, if a need for special assistance, such as physical ther- apy, develops during hospitalization, an RN would be responsible for contacting the appropriate pro- fessional. Professionals treating patients and RNs consult on an ongoing basis about the specialized treatment being administered. For example, a phys- ical therapist treating a patient would consult with the RN involved to determine if the patient was re- sponding to the therapy program. Furthermore, sometimes an RN assists in administering therapy. It appears generally that staff RNs have more job interaction with social workers than with any of the various other professionals. Social workers spend much of their time on inpatient units assist- ing patients with discharge planning and working with patients who have psychological, economic, family, or other similar problems. On some inpa- tient units there is an office or work area provided for social workers adjacent to the nursing station. Staff RNs are also involved in assisting patients with discharge planning and often work in con- junction with social workers on such plans. The pattern of job interaction between staff reg- istered nurses and the other hospital professionals involved providing direct patient care, such as the physical therapists, occupational therapists, speech pathologist, nutritionists, audiologist, and radiolo- gists, resembles that between RNs and social work- ers, except that the frequency and length of the contacts is less substantial. Laboratory technologists, the largest group of non-nurse professionals, work in hospital laborato- ries under the direction of the vice president for materials management, where they perform the lab- oratory tests required for hospital operation. They have little direct contact with patients. As part of their overall responsibility, RNs review laboratory reports and contact a laboratory technologist if a test result appears to be very unusual, indicating the possibility of an error or some other problem. If there is an urgent need for a particular test result, an RN communicates that information to a laboratory technologist. Finally, if a specimen or test result is misplaced, an RN contacts a labora- tory technologist and together they search for the missing material. Contacts between RNs and other professionals involved in indirect patient care fall into a similar pattern. For instance, if an RN has a problem with patient care equipment, the biomedical engineer is contacted. The epidemiologist is responsible for in- fection control and might be contacted if a patient has an infection problem. In addition, the epidemi- ologist engages in periodic discussions with RNs about methods of controlling infection. Physicists consult with RNs about problems relating to radi- ation therapy and procedures to be followed to avoid overexposure to radiation. Pharmacists dis- pense medications prescribed by doctors. LICH uses a unit dose system under which a physician orders, and a pharmacist stocks, enough medicine to last a patient 24 hours. Pharmacists also set up patient medication profiles, obtaining any pertinent information from RNs. Pharmacists spend a signifi- cant amount of time on inpatient units, providing floor stocks, clearing leftover medicines, insuring that narcotics are locked away, and seeing that other established procedures for handling medi- cines are being followed. Dieticians spend most of their time working on the preparation and serving of food; however, if a patient has a particular di- etary problem, an RN might confer with a dietician about the matter. Finally, there are the professionals employed in LICH's satellite facilities. This group of profession- als includes the teachers and assistant teachers in the Lamm Institute, the recreation therapist and the psychologists who also work in the Lamm In- stitute, methadone counselors, and the alcoholism counselor. These professionals have few, if any, 206 DECISIONS OF NATIONAL LABOR RELATIONS BOARD contacts with staff RNs except for the ones as- signed to work in the satellite facilities. In reaching his determination that a unit limited to RNs is appropriate, the Regional Director noted that LICH employs a holistic approach in patient care which results in regular contact between reg- istered nurses and other employees in the hospital. However, relying on Mercy Hospitals of Sacramen- to, Inc.,14 the Regional Director held that RNs are entitled to be represented for the purpose of collec- tive bargaining in a separate unit. He eschewed any discussion as to whether the holistic approach ap- plied at LICH and the other factors raised by the Employer have created such a close community of interest between the RNs and other professional employees as to require their representation in a single overall professional employee unit. Subse- quent to the issuance of the Regional Director's de- cision, the Board, in Newton-Wellesley Hospital,15 reexamined the considerations to be applied in de- termining the appropriateness of a separate unit of RNs and concluded that "an irrebuttable presump- tion of the appropriateness of registered nurses units in all cases, without regard to particular cir- cumstances, should be disavowed" because "[s]uch a per se approach to unit determinations is incon- sistent with the Board's Section 9(b) responsibility to decide 'in each case' whether the requested unit is appropriate."' 6 At the same time, however, the Board reaffirmed its position that, "giving full and due regard" to the legislative admonition against proliferation of bargaining units in the health care industry, RNs can possess such a community of in- terest as to make their separate representation ap- propriate. The ultimate determination turns on whether the interests of RNs "are sufficiently dis- tinct from those of other employees to warrant the establishment of a separate unit."17 Here, we find that a separate unit of RNs is ap- propriate for collective-bargaining purposes. The overwhelming majority of RNs, over 80 percent, are administratively separated into a department of nursing. That department is overseen by an RN and its complete supervisory hierarchy is composed of RNs. No other group of professional employees functions within a single homogeneous administra- tive structure equivalent in size or scope. In addi- tion, there is no other professional group subject to a comparable intraprofessional hierarchy of super- visors, ranging from first-line supervisors to the vice president and director of nursing. RNs have similar education and training and are subject to a uniform state licensure requirement. By 14 217 NLRB 765 (1975). " 250 NLRB 409 (1980). ' Id. at 411. Id. at 411 contrast, the educational and licensing requirements for other professionals vary substantially. Furthermore, the RNs at LICH share unique functional responsibilities. They are assigned the prime responsibility for overall patient care. This unique responsibility requires that RNs remain in close and continuous proximity to patients and uti- lize a wide variety of patient care skills. It is this unique function that most clearly separates RNs from the other professionals. No other group of professional employees has such continual patient contact, nor is any other group required to apply the diverse patient care skills required of RNs. While a few other professionals, such as social workers and physical therapists, have regular con- tacts with patients, they are not required to remain continually on inpatient units and they perform a much narrower range of specialized health care tasks. In fact, the majority of the health care pro- fessionals have only limited personal contacts with patients. In addition, RNs can be and are trans- ferred throughout the various inpatient units of LICH. They also have separate promotional oppor- tunities. Finally, there is no functional integration between RNs and any other group of professional employees. 18 The holistic approach to patient care as applied at LICH has not resulted in any significant modifi- cation of the distinct and unique patient care role assigned to RNs. In carrying out their primary function of monitoring the overall care provided to patients, RNs are required to have some contact with virtually every other category of employee, not only professionals, employed at LICH. Howev- er, such contacts are the norm in any modern hos- pital employing an interdisciplinary approach to patient care. Moreover, the holistic approach to patient care at LICH, when reduced to its basics, actually con- sists of the use of interdisciplinary committees de- signed to assist in hospital planning and to increase overall coordination of effort. This is exemplified by the use of the integrated charting system. Any large institution must develop mechanisms to en- hance communication and cooperation among nu- merous disciplines working towards a common goal. In a hospital the size of LICH, with its many departments and specialities, the formation of such interdisciplinary committees is merely a natural re- sponse to attempt to solve the problems in planning and coordination inherent in the operation of such a complex institution. However, the existence of these committees in reality has only a minimal ' Compare Mounl 4ir IFoundation d/b/a Mount Airy Psychiatric Center, 253 NLRB 1003 (1981) THE LONG ISLAND COLLEGE HOSPITAL 207 impact on the day-to-day job responsibilities of RNs. For, although a member of the nursing depart- ment serves on all of the committees, in many in- stances the representatives assigned to a particular committee is a supervisory or managerial RN. The number of rank-and-file RNs actually serving on the committees is quite small compared to the overall number of RNs employed at LICH. Fur- thermore, many of the committees meet only spo- radically. In practical terms, the real impact of these committees on RNs stems from the improved hospital operation that results from the integrated planning and increased coordination of effort that the committees are designed to achieve. Thus, in our view the factors that establish a separate and distinct community of interest among RNs are not affected in any significant way by the existence of these committees. Similarly, while the integrated charting system results in a few more frequent contacts between RNs and other professionals than would occur oth- erwise, that system does not create any true func- tional integration between RNs and any other group of professionals. Nor does it diminish the widespread specialization of tasks and responsibil- ities that characterizes the functions of the respec- tive professionals. Rather, the use of an integrated charting system simply recognizes that all forms of patient care are directed towards achieving the same end, the patient's recovery, and that increased communication between professionals concerning the different types of care being provided facilitates that end. Hence, rather than establishing a uniform community of interest between RNs and other pro- fessionals, the integrated charting system is itself an acknowledgment that patient care in a modern hos- pital is divided among diverse groups of profession- als with very separate and distinct skills and re- sponsibilities. In sum, we do not believe that the holistic approach to patient care, as interpreted and applied here, has in any significant respect affected the factors establishing a separate community of in- terest among RNs. In addition to the RNs in the department of nursing, the unit sought includes much smaller groups of RNs employed in various satellite health care facilities operated by the Employer. In Newton-Wellesley, supra, we considered the appro- priate unit placement of a number of similarly situ- ated RNs. There we concluded that while a sepa- '1 See Brookwood Hospital Management Corporation d/bh/a BrooukLard Hospital 252 NLRB 748 (1980). where we found that although the em- ployer applied a "team approach" to patient care, which included Seekly meetings among team members, that did not create such a close commlu- nity of interest between RNs and other professionals as to require their representation in a single unit rate unit of such residual groups of RNs might be appropriate if the determination turned solely on an analysis of community-of-interest factors, the con- gressional admonition against unit proliferation pre- cluded such a result. Therefore, given the choice between placing such residual RNs in one of two units-one composed of RNs or one composed of the remaining professionals-the better choice was to aggregate all RNs in a single unit. In part, this conclusion was based on the similarities in educa- tional background and duties among all RNs, and, in part, on the even greater diversity that existed between the residual RNs and the various non- nurse professionals.2 0 Here, insofar as can be deter- mined from the limited evidence submitted con- cerning the duties of the relatively small number of RNs employed outside the nursing department, their interests appear to be more closely aligned with those RNs employed in the nursing depart- ment. Accordingly, we conclude that the unit of RNs sought constitutes an appropriate unit for col- lective-bargaining purposes within the meaning of Section 9(b) of the Act.21 20 See N.ewton- Welleehy Ilospital. upra 21 As previously nted, the parties stipulated that if an RN unit is found appropriate then the instructor and assistant instructors in the school of nursing and the nurse anesthetist, should be excluded from such a unit because of their separate community of interests. There is substan- tial evidence indicating the instructors and assistant instructors and the nurse anesthetists do have significantl 5 distinct interests from the other RNs employed at LICH Thus, the record shows that the school of nurs- ing instructors and assistant instructors have no patient care responsibil- ities The bulk oif their inle is spent in the separate school of nursing fa- cility providing classro,rolln Intrticl tn to nursing students They do. hou- ever. spend tip to 10 hours a wreek in the hospital facility supervising stu- dent nurses working on ipatient units as part oIf the school's clinical pro- gram. The school of nursing is separately supervised by the assisciate d- rector of the school of nirsing who reports to the vice president f nurs- ing The nurse anesthetists are assigned to the department of anesthesiol- gy and report to the medical director of that department In order to qualify as a nurse anesthetist, an RN must become a certified registered nurse anesthetist which requires an additional 2 years of education in an- esthesiology and passing a national examination given by the American Association of Anesthetists Nurse anesthetists operate an anesthesia ma chine in the operating room and do not perform the other services regu larly performed by RNs he operating room is located in a separate area of the hospital, away from any nursing stations. and nurse anesthetists have little contact with ther RNs Nurse anesthetists work a 40-hour workweek and are paid an average of several thousand dollars a year more than other RNs Unlike RNs, nurse anesthetists are authorized to administer medicatllion ithout a signed doctor's order There hase been no transters of staff RNs into the position of nurse anesthetist It is the Hoard's general policy to accept a unit stipulation as long as the stipulation is not inconsistent ith any statutory provision or eslab- lished Board policy . ir Erprcs International Corporation. 245 NLRB 478 11979); White Cloud Products. Inc.. 214 NLRB 516 (1974); and Bernhord- A.4lmann l'exai Corporation. 122 NLRB 1289. 129! at fn 4 (1959) Since Newton-Wellesley, In those instances in which the Board has beeln con fronted with an issue insoling the unit placemenit of non-nursing dep.rt- ment RNs. the Board has generally aggregated all RNs ithin a single unit As nted in our presrious discussion, the general reason for adopting this approach is that vhile such residual RNs may have separate interests from the other RNs, onelhcless their hackground training, and duties usually give tIhnl a closer cnlnlinlts of interest to tother RNs than to the non-nurse pr fssiona s nempllcd in a hspital. lowcer, hcin. as here. the parties stipulate that irtain reiduial groups of RNs shouldi be C oninucd 208 DECISIONS OF NATIONAL LABOR RELATIONS BOARD Having concluded that the requested unit of RNs at the Employer's facility is an appropriate one for collective bargaining, we hereby direct the Region- excluded from any RN unit based on separate community of interests, and the record accords with the stipulations, there is no statutory require- ment or established Board policy that conflicts with the acceptance of such a stipulation. Such a stipulation presupposes a distinct community of interests between those RNs to be excluded and those included within an al Director to open and count the impounded bal- lots, and to take further appropriate action as may be required. overall RN unit. Furthermore, accepting that stipulation does not conflict with the congressional admonition against proliferation of units since the residual RNs can be grouped for representational purposes with the other health care professionals. Therefore, since the record accords with the parties' stipulation, it is further reason for finding the RN unit sought here appropriate.