A week after a “last, best, and final” labor offer fell through, Stanford Hospital & Clinics and Lucile Packard Children’s Hospital are still at odds with nurses there.

The Committee for Recognition of Nursing Achievement (CRONA), the union that represents Stanford’s nurses, said on its Web site that 2,302 nurses voted against the offer last Wednesday. The organization represents some 2,700 nurses.

The large consensus led the union to officially reject Stanford’s latest proposal.

CRONA President Lorie Johnson submitted a letter to the hospitals last Friday expressing the nurses’ dissatisfaction with the hospitals’ final offer.

“We call upon the hospitals to return to the table with us as soon as possible, and to come to the table with an open mind and willingness to bargain over all issues . . . We ask the hospitals to present a new proposal that considers and responds to CRONA’s last offer,” Johnson wrote.

Robert Dicks, a spokesperson for Lucile Packard Children’s Hospital, said he was surprised by the nurses’ overwhelming rejection of the proposal.

“Twenty [negotiation] sessions have enabled us to arrive at an offer that includes four-percent wage increases for all nurses in their first year and some additional increases for subsequent years, along with a $3,000 signing bonus if no strike notice is given,” Dicks said.

“We arrived at what we believe is a very fair and generous offer,” he added. “We’re disappointed and find it hard to believe that the nurses have not signed it.”

Nursing New Wounds

According to Peter Nussbaum, CRONA’s lead attorney, there are three major issues at hand: paid time off, professional development and union representation.

Under the hospitals’ final proposal, nurses are not permitted to accumulate paid time off over time. Nussbaum said aggregating paid sick days is an important option because employees would have something to draw from when emergencies arise.

“Unlike most employers, the hospital does not provide employees with separate amounts of guaranteed sick leave, vacations [and] holidays,” Nussbaum said.

He speculated that the hospitals aim to limit the amount of paid time off that nurses can keep . . . a claim that Dicks strongly denied.

“Their paid time off ranges from 26 to 39 days in a year,” Dicks said. “We feel that that range of paid time off is quite significant.”

Adding fuel to the fire is the debate over the Professional Nurse Development Program (PNDP). Within hospitals, nurses have the ability move up a four-step ladder; employees at nurse-four status are the highest-ranked.

“Within each one of those classifications, there are steps that you progress to over time and it affects your benefits [and] salary,” Nussbaum said. “Most of the nurses at Stanford are in the highest two categories, three and four.”

Under the proposed standards, many of these high-ranking nurses could be demoted. The new criteria would make it “very difficult for nurses to achieve and to even maintain their nurse-three or four status,” Nussbaum said.

But according to Dicks, the new PNDP criteria are in line with standards at other hospitals and institutions.

“We feel like we made an offer that provides for some extraordinary nursing development processes and programs,” Dicks said.

Nussbaum also expressed concern that the hospitals aim to “seriously weaken CRONA, both financially and in terms of the role that it has played.”

Stanford’s nurses do not want to lose their representative at the bargaining table, he said.

Resuscitating the Debate

Though the two parties do not see eye to eye on many issues, they do agree on one point: a strike by the nurses is undesirable.

Nussbaum acknowledged that strikes are always a possibility when negotiations turn sour. He does not believe, however, that the situation has deteriorated to such a degree that a strike is the sole recourse.

“We don’t believe that we’re at that point, and we hope we never get to that point,” Nussbaum said.

As a precaution, Stanford Hospital & Clinics and Lucile Packard Children’s Hospital have made contingency plans for a possible strike.

“If the situation requires, we will continue delivering quality care to patients and families,” Dicks said.

CRONA has not ruled out the option of re-starting talks.

“We will do everything that we can to get these negotiations back together . . . negotiations involve a give and take, and that has not been present on the hospital’s side,” Nussbaum said.

Since the proposal failed to gain approval last week, both parties are working under the expired CRONA contract from 2007, as stipulated by federal labor law.