Brookwood Hospital

DECISIONS OF NATIONAL LABOR RELATIONS BOARD Brookwood Hospital Management Corporation d/b/ a Brookwood Hospital and General Truck Driv- ers, Warehousemen and Helpers Union, Local 980, Petitioner. Cases 20-RC-14863 and 20- RC- 14864 September 30, 1980 DECISION ON REVIEW BY CHAIRMAN FANNING AND MEMBERS JENKINS AND PENE.ILO On September 11, 1979, the Regional Director for Region 20 issued a Decision and Direction of Elections in the above-entitled proceeding, finding, inter alia, that a separate unit of all registered nurses employed by the Employer is appropriate. The Employer, thereafter, in accordance with Sec- tion 102.67 of the National Labor Relations Board Rules and Regulations, Series 8, as amended, filed a request for review of the Regional Director's deci- sion as to Case 20-RC-14863, contending that the unit must also include all of the Employer's other professional employees. On October 24, 1979, the National Labor Rela- tions Board by telegraphic order granted the re- quest for review as to the appropriateness of the unit. Pursuant to the provisions of Section 3(b) of the National Labor Relations Act, as amended, the Na- tional Labor Relations Board has delegated its au- thority in this proceeding to a three-member panel. The Board has considered the entire record in this case with respect to the issue under review and makes the following findings: The Employer operates an acute care/skilled nursing facility in Santa Rosa, California, offering rehabilitation and cancer therapy services as well as treatment for voluntary psychiatric patients. Nursing services are separated into two depart- ments headed by the director of nursing and the di- rector of psychiatric nursing, respectively. The di- rector of nursing is responsible for nursing services in the acute care unit, skilled nursing facility unit, and plastic surgery unit. The acute care and skilled nursing facility units are each staffed by four regis- tered nurses and a number of nonprofessional nurs- ing employees; the plastic surgery unit is staffed by one registered nurse and a technician. The director of psychiatric nursing is responsible for nursing services in the psychiatric unit which is staffed by seven registered nurses and a number of nonprofes- sional nursing employees. There are also two single-position sections orga- nized under the director of psychiatric nursing- social services and psychological testing. The social service position, which was vacant at the 252 NLRB No. 107 time of the hearing, was formerly held by a psychi- atric social nurse. However, the only requirement for this position is that the incumbent must be a li- censed clinical social worker. Psychological testing is staffed by an associate psychologist. The parties stipulated that the social worker and the associate psychologist are professional employees. In separate departments not under the adminis- tration of any registered nurse the Employer em- ploys approximately 12 other stipulated health care professionals. This group includes a dietician, a pharmacist, a psychophysiologist, three occupation- al therapists, and six physical therapists. The Em- ployer contends that the only appropriate unit is one which includes both the approximately 17 reg- istered nurses and the approximately 14 nonnurse professional employees. The Employer argues in support of an overall professional unit that its registered nurses and non- nurse professionals share similar wages and work- ing conditions and have an unusually close work- ing relationship because of their assignments to var- ious teams. The Employer operates a chronic pain and an acute rehabilitation team, both of which in- clude registered nurses and various other health care professionals in their membership. The chron- ic pain team is headed by a medical doctor and typically includes day-shift registered nurses from the acute care unit, a physical therapist, an occupa- tional therapist, the social worker, the psychophy- siologist, and the associate psychologist. From time to time, other professional employees such as the dietician or the pharmacist may join the group when their skills are required to meet the needs of a particular patient. The acute rehabilitation team is also headed by a physician and its membership in- cludes one or more physical therapists, an occupa- tional therapist, registered nurses from both the acute care and skilled nursing facility units, the psychophysiologist, the social worker, the dietician, and a pharmacist. The chronic pain and acute reha- bilitation teams operate in substantially the same manner. The teams meet about once a week to dis- cuss the patient's progress and to make recommen- dations with respect to goals, problem areas, dis- charge planning, etc., in order to insure a consist- ent, integrated treatment program for each patient. Between weekly meetings, the team members may have further discussions or personal contact with one another during the course of implementing the treatment program. For example, a registered nurse may work with a therapist by monitoring a pa- tient's blood pressure during the therapy session, and the dietician or a pharmacist may discuss the patient's reaction to some food or medication with a nurse. 748 BROOKWOOD HOSPITAL In addition to the chronic pain and acute reha- bilitation groups, there are smaller teams that meet at least once a week to discuss practical day-to-day treatment problems. These smaller team meetings are regularly attended by registered nurses, li- censed vocational nurses, aides, and therapists. Other professionals, such as a pharmacist or the social worker, may also occasionally attend these meetings if they have worked on any of the cases to be discussed. Based on the foregoing, and the record as a whole, we find that the Employer's team approach to health care does not result in such a community of interest between the regis- tered nurses and other professional employees that only an all professional unit is appropriate. Aside from weekly meetings at which some nonnurse professionals and some registered nurses discuss pa- tients' treatment plans, the Employer's hospital op- erates in a familiar pattern. The registered nurses may have some contact with other professionals in carrying out their primary function of monitoring patient care, but these contacts are no more than can be expected in any modern hospital using an interdisciplinary approach to patient care. The daily interaction between the Employer's registered nurses and other professionals is, for example, simi- lar to that described in Newton-Wellesley Hospital, 250 NLRB 409, 410 (1980). Moreover, there are no psychiatric nurses on the acute rehabilitation or chronic pain teams and only one classification of nonnurse professional regularly attends the smaller team meetings. The attendance of some registered nurses and other professionals at interdisciplinary team meetings does not, in itself, establish any sig- nificant community of interest that would require the inclusion of all these professional employees in a single unit for purposes of collective bargaining. There are, on the other hand, important differ- ences in training, supervision, and responsibility be- tween registered nurses and other professionals. With respect to training, all of the Employer's reg- istered nurses must have been graduated from an accredited nursing school and be licensed by the State of California. All of the other professionals sought to be included in the unit have college de- grees and a few have graduate degrees. Some other professionals, such as the psychophysiologist, must be certified by their own professional society and others must be licensed by the State. With respect to supervision, all of the registered nurses work under supervision of one of the nursing directors. With the exception of the associate psychologist, the other professionals are supervised by various nonnurse department heads. Finally, with respect to responsibility, and with the possible exception of the plastic surgery nurse, all of the Employer's reg- istered nurses act as charge nurses for their units. Unlike any of the more specialized health care pro- fessionals, charge nurses are responsible for overall patient care. The charge nurse is required to moni- tor each patient's condition and to direct non- professional nursing employees in their patient care tasks. Since only registered nurses may perform the charge nurse function, there is clearly no functional interchange between them and the nonnurse profes- sionals. In all the circumstances, we conclude that the appropriateness of a separate unit for the registered nurses has been adequately established. Unlike St. Francis Hospital of Lynwood, a Corporation,' the parties here were afforded a full opportunity to present evidence with respect to the unit issue. Evidence that the Employer's registered nurses work together in teams including other professional employees with whom they share similar wages and working conditions does not, in our view, dis- qualify them from representation. The only remaining question is whether the asso- ciate psychologist and the social worker should be included in the unit with the registered nurses in view of their administrative placement under the director of psychiatric nursing. Since there was no incumbent in the social service position at the time of the hearing, no ruling shall be made as to the proper unit placement of this position.2 The asso- ciate psychologist might appropriately be included in the registered nurse unit except for the fact that he works only 16 to 20 hours per week, he is re- quired to be in the hospital no more than 4 to 8 hours per week, and he arranges his own schedule based on orders he receives from various physi- cians. There is no indication in the record that the director of psychiatric nursing exercises any day- to-day supervisory authority over the associate psychologist. Thus, the fact that he may be admin- istratively responsible to the director of psychiatric nursing does not compel his inclusion in the nurses' unit. We conclude that his representation, if any, should be as part of a unit of nonnursing profes- sionals. Having concluded that the requested unit of reg- istered nurses at the Employer's facility is an ap- propriate one for collective bargaining, we hereby direct the Regional Director to open and count the impounded ballots, and to take further appropriate action as may be required. 232 NRB 32 (1977), enforcement denied 601 F2d 404 (9th Cir 1979) 2 eneral Dtnamiom Corporarion Convair .4erospace Division. San Diego Operations, 213 NIRB 851, 868. fn 35 (1974). 749