BRATTLEBORO — Management at the Brattleboro Retreat and union members have overwhelmingly ratified a bargaining contract that will raise wages for more than 500 employees at the psychiatric hospital.
The contract raises nurses' pay to a level that hospital representatives say meets or exceeds wages in neighboring Massachusetts and New Hampshire. Mental-health workers (MHW) positions have a new starting wage of $15 per hour. Other union members will see a 3 percent increase.
Over the course of 11 meetings, management and the union's bargaining team built the one-year contract between the Brattleboro Retreat and the United Nurses & Allied Professionals Local 5086, which went into effect on Nov. 1 after a 142–10 vote.
“We believe this new contract, which covers more than 550 Retreat employees, including nurses and mental health workers, sets a decidedly positive tone that establishes a new spirit of partnership between the union and management,” said Meghan Baston, chief nursing officer and senior vice president of Patient Care Services.
The contract comes after a summer where drivers along Linden Street witnessed multiple informational pickets. At the time, union members felt the relationship between them and management had soured.
Union calls contract 'historic step'
“In many ways, this new contract is an historic step forward for the Retreat,” said Daniel Watson, the union co-president.
The contract, he said, “lays the foundation to address many important issues faced by current staff, while establishing competitive wages to attract much needed new front line employees.”
Watson called the contract “a victory for the Retreat, the Union, and especially for the patients.”
In a phone interview, Watson added that, through negotiations, the union solidified solutions to some of its concerns from the summer - for example, management's changing employees' previously negotiated and approved schedules.
The Retreat struggles under a staffing shortage right now, and Watson believes the new contract could be “a good start in bringing new staff in.”
“I think we still have a lot of work to do on maintaining staff, and that has a lot to do with the interactions that will occur between the administration and the union, I think,” he added.
“Doing this work is impossible if you do not feel that you have the trust and the support of the people above you,” Watson continued. “And in some areas this is still lacking.”
“It's not always about what you make. It's about the environment you're working in,” Watson said of improving staff's working experience.
Watson said he feels happy that negotiations kept a proposed 16-percent increase on employees' contributions toward their health benefits in check. After negotiations, that increase stopped at 6 percent.
He is also happy with changes to what he characterized as an “extremely severe” attendance policy, which allowed staff two “no call/no shows” during their entire employment at the Retreat.
Under the new contract, these times of not showing up to work expire after two years, he said. Union members also solidified what management could deem a “no call/no show.”
Addressing pay of nurses, MHWs
Brattleboro Retreat President and CEO Louis Josephson said that as Windham County's largest employer, the hospital employs approximately 900 people, with two-thirds of the staff belonging to the union.
The contract focused on the wages of nurses and MHWs because “they had fallen behind significantly in the market,” Josephson said.
According to Josephson, the country needs more nurses. Within the next five years, estimates suggest Vermont will need 4,000 more nurses, he said.
Josephson feels the contract addresses the Retreat's need to remain competitive in its capacity to retain current staff and recruit new employees, he said.
Brattleboro competes in a labor market with New Hampshire and Massachusetts. According to Josephson, the new contract bumps up nurses' wages to levels competitive with salaries in western Massachusetts and to rates that exceed the market wages in Vermont and New Hampshire by about 10 percent, he said.
Josephson added that minimum wage for MHWs is now $15 per hour. He said that the hospital administration would like eventually to make that rate the standard starting point for all staff, regardless of position.
But at least the hospital can show the MHWs that the Retreat values their work, he said. Ultimately, Josephson hopes this new minimum wage will bolster the number of MHWs.
“That's a big victory for us as well,” he said.
Past contracts included 2-to-3-percent cost-of-living increases, he said. But The Retreat's wages still lagged behind those in the surrounding “laborshed,” Josephson continued.
At a few percentage points a year, those increases didn't help staff salaries catch up to the rates offered for their counterparts working in surrounding labor markets, he said.
“We were really gratified that the union leadership understood that we needed to take a two-track approach,” he said. “We needed to tackle the market issues with the nurses and MHWs while giving an across-the-board increase to the rest of the unionized staff.”
Josephson acknowledged union members' concerns about what they saw as hard-line attendance policies. He also acknowledged that, as a hospital and a business, the Retreat needed to maintain patient care - and that requires staff, he said.
“It is a challenge for us, and there [has been] a certain culture at the Brattleboro Retreat over many years,” he said.
Two-way accountability
Josephson noted that when he arrived three years ago, the hospital launched a new strategic plan that addressed clinical excellence, financial sustainability, and accountability.
Never had he worked where management listed accountability as a goal, he said.
Josephson said that, in time, he came to understand accountability as twofold.
First, management had to become more transparent with the staff and the community. Josephson said this transparency included owning the mistakes management had made and creating an “open culture.”
“But similarly, with staff, we needed them to be accountable,” he said.
In another business, an employee can give short notice or just not show up, he continued, but caring for psychiatric patients comes with higher levels of responsibility.
Josephson said that over several months, he saw a “direct correlation” between staff calling out with very short notice and the number of staff the hospital mandated for overtime - that is, made to work beyond the end of their respective shifts to fill staffing shortfalls.
“So that is really the worst of all scenarios: when you've worked a long shift at the Retreat, and your colleague calls out very shortly before they're scheduled to come in,” he said.
In this scenario, the hospital “has no choice but to turn to you and say, 'Sorry, you're doing a double shift today,'” he said.
“We're not looking to ding people” for the normal surprises of life, such as a sick child or a car breaking down, he noted.
The hospital wants to treat these situations fairly, Josephson said. Overall, a small minority of staff call out with little notice, he said.
'A good starting point'
Watson said that, traditionally, bargaining agreements span two to five years, and both the union and Retreat management originally wanted to negotiate a three-year contract.
But as more issues came to light, both parties started to see challenges on the horizon - challenges such as staffing shortages and problems stemming from the creation of a new 16-bed unit.
“I said at the onset that I didn't want to make promises I couldn't keep,” said Josephson, who believes that the current contract represents a good starting point and provides a foundation on which to build next year's contract.
Josephson believes that within nine months, the Retreat administration will have a better understanding of a few critical issues and what these issues mean for the hospital.
“In my view, it's in the employer's best interest to have a longer contract,” Watson said. “It allows them to focus more on the day-to-day running of the facility.”
“There's a lot that goes into negotiations and we're going to be right back at it next summer,” he added. “But I can understand where their stance is in having to come back to the table and not wanting to tie themselves in if they're uncertain.”
'Prioritizing Vermont and Vermonters'
During the last legislative session, the governor's office and Secretary of the Agency of Human Services Al Gobeille approached The Retreat, saying that Vermont would require more inpatient beds for what the state calls “level one” patients, explained Josephson.
These patients, who sit at the acute end of the spectrum, are usually the people waiting for hours in emergency rooms waiting for placement in a psychiatric program, he said.
“We stepped up,” Josephson said. “We prioritize Vermont, and we prioritize Vermonters.”
The Legislature returned with $5.5 million in capital money, which will allow The Retreat to open a new level-one unit.
Josephson said while he thanked the state for the capital funds, he warned Gobeille that a “shiny new unit” represented only part of the equation. A new unit would also require staff, and that staff would require better wages and benefits.
The new unit will fill one gap in Vermont's mental-health system, needs that continue to evolve as the state adapts its approach.
Since Josephson arrived in Vermont three years ago, he said, he has fielded the question: how many mental-health beds would meet the state's need?
The answer is complex, he said.
In Josephson's opinion, the state might not need the new 16-bed unit if it had an overall “robust continuum of care” - for example, more supportive housing for people with “persistent mental health” requirements.
For Josephson, that would be the way to go, and he believes that Gobeille agrees.
If the University of Vermont and other hospitals move forward in the next four years with adding more beds, then these new 16 beds at the Retreat could transform into a step-down program for people leaving inpatient programs, he said.
“I would be very much in favor of that, because we don't want people in inpatient care unnecessarily, and we need a safe, secure place where they can get the support they need,” he said.
The Retreat treats people in moments of acuity, he said. Once stabilized, the patients move to other programs that, unfortunately, are unable to fully support them.
The situation creates a revolving-door effect as patients bounce back to the Retreat, Josephson said.
Josephson said that he wants staff input on the new unit. “I'm a real believer in a shared-governance model” and hearing from the people working closest with the patients, he said.
Mending fences
Josephson said staff's observations are usually “spot on” and as a manager, it's his job to incorporate it into the daily operations. He hopes the collaboration of the one-year contract carries over into the next negotiation cycle.
Despite that acknowledgment, many union members still sense a rift between staff and management.
Watson said that after union members approved the contract, the administration released a statement, expressing hope for improving the relationship between union and management.
“And that is the union's goal,” Watson said. “As long as it's in the best interest of the members, I will support improving our relationship.”
How does Josephson plan to repair relationships?
Josephson reminded staff that he inherited and was bound by the initial three-year contract - a contract, as he understands it, that union members voted for but with many reservations.
He hopes people realize that when he was able to negotiate anew, he took a different track.
“I hope we can really build on that,” he said.