Granada Hills nurses vote to form a union. (Up Front).

Nurses -- in fact, the entire staff -- at Granada Hills Community Hospital are the most recent health care workers at a Valley facility to catch the union fever, spurred by a swelling nursing shortage at hospitals here and across the country.

All 450 employees at Granada Hills recently agreed to join the Service Employees International Union, one of the largest and fastest-growing health care unions in the country. That includes nurses, doctors and food service and janitorial workers, all seeking better wages, more benefits and bargaining power on management-related issues.

The facility is now one of five hospitals in the Valley with an SEIU-represented health care staff. Staffs at Northridge Hospital Medical Center, Encino/Tarzana Regional Medical Center, Los Robles Regional Medical Center in Thousand Oaks, Pacifica Hospital of the Valley and L.A. County-Olive View Medical Center in Sylmar all have joined the SEIU in the last four years.

The 350 RNs at Glendale Memorial Hospital, run by San Francisco-based Catholic Health Care West (CHW), ratified their first contract in November 2001 and are now represented by the SEIU's largest competitor, the California Nurses Association.

Union activity in the health care industry is relatively new: Until a couple of years ago, only 10 percent of the country's hospital workers were union members. Today the figure is closer to 45 percent. The SEIU represents roughly 755,000 health care workers in California, 110,000 of them nurses. CNA represents roughly 7,500 RNs at 20 hospitals across the state.

Many in the industry say unions provide the best medicine for hospitals in competition for a scare commodity -- nurses and other workers -- with nearby already-unionized facilities, where wage and benefit packages are more attractive, and workers have a stronger voice on administrative issues.

Several Valley hospital administrators declined to discuss any issues involving finances and union contracts. For the most part, hospital officials prefer to hold those cards close to the vest, for fear of losing leverage when contract negotiations come around.

Registered nurses at Northridge Medical Center ratified their first contract with the SEIU in April and it seems to be making a difference. Although it's hard to quantify the impact after such a short period of time, retention and hiring levels are said to be improving significantly.

"We've never had a bargaining unit here with any of our employees and I think how it's impacted us is way too early to determine," said Teddi Grant, vice president of marketing. "I can say that we have been recruiting and retaining nurses at a very high rate for about six months. We brought a nurse recruiter on board who's brought in 122 nursing staff since the beginning of the year, which is outstanding. We've also seen our attrition rate go from about 23 percent to about 13 percent."

Prior to joining the SEIU, nurse salaries at Northridge were based on years of service and level of education. That's no longer the case. Newly hired nurses at every level can now make $23 an hour. Previously it was $21.50.

But it's not just the union contracts attracting workers. In an effort to address the shortages, union and non-union hospitals alike have been running an aggressive recruitment campaign that often includes signing bonuses and awards for referring new hires.

In addition, many hospitals are also putting more resources behind continuing education programs for their employees. CHW, for example, recently boosted its tuition reimbursement fees from $1,000 to $3,000 per employee per year. Other programs, such as a long-distance education program, which workers can participate in from home, and increases in pay for overtime, night and weekend shifts are also slowly being implemented at many facilities.

But incentive programs and the constant battle to keep salaries competitive do impact a hospital's bottom line. And, according to Jim Lott, executive vice president of the Heath Care Association of Southern California, the nursing shortage is still in full throttle and, from his view, unionization has done little to slow it down.

"Our association takes a look at retention levels and other employment issues and we see no distinguishable changes between union and non-union facilities," Lott said. "The turnover rate in Southern California is about 21 percent and we actually see higher numbers of turnover rates at union hospitals because they are drawn to other facilities offering better packages."

Lott said nurses in Southern California are receiving average annual wage increases of about 8 percent, compared to the average of 5 percent for most other industries, adding, "this is happening with and without the unions."

Salaries for entry-level nurses at most Valley hospitals range between $28 and $31 an hour.

Lott said personnel expenses now amount to roughly 62 percent of a hospital's budget and that is increasing by an average 2 to 6 percent each year.

"What this means is you have hospitals running to fill vacancies while also trying to cope with the constant competition from other facilities," Lott said.

And, from workers themselves.

On May 30, California Nursing Association members at every CHW hospital across the state, including Glendale Memorial, organized a one-day picket march to push for changes to their contracts.

According to David Johnson, CNA Southern California regional manager, his members want CHW to bring wages and pension contributions into line with larger facilities, such as UCLA Medical Center.

He said the contract Glendale Memorial and the union negotiated in 2001 set wages for entry-level nurses at about $28 an hour, while the pay at UCLA is closer to $30 an hour.

"The nursing shortage has increased since we ratified our contract at Glendale Memorial, and the bar has gone up," Johnson said.

Mark Klein, vice president of corporate communications for CHW, declined to discuss ongoing negotiations with the union. "Nurses represent the very core of our caregiving, and in the last year we've signed 17 contracts with the CNA," said Klein. "We are now in discussion with them about these things and I'd prefer not to speculate."

Also at issue at Glendale Memorial and other facilities are nurse-patient ratios. In January, Gov. Gray Davis passed new statewide guidelines, but they have yet to be fully implemented and, according to the CNA's Johnson, it could be a year before they are.

His union is also pushing for CHW facilities to begin following the guidelines now.

Like many RNs who have unionized, Joanne Shaw, who has worked at Granada Hills Hospital for 13 years, said she and her colleagues agreed to join the union in order to negotiate for better wages and benefits.

"We've always been like a family here," said Shaw. "But over the last several years we felt we were let down by management. We haven't had pay increases for five years and had our pay cut in the late 1990s."

But at the top of her list of concerns are nurse-patient ratios, which have dropped to such low levels at Granada Hills, she said, that nurses from one department were often floated to another to fill in, even if they lacked experience and or certification to perform the additional work.

"Several times I felt like my license was in jeopardy," Shaw said.

Repeated calls to Granada Hills representatives went unreturned.

The nurse-patient ratios would vary for different departments. For example, the ratio would be at least one nurse for every four patients in emergency rooms, and one nurse for every five patients in medical and surgical units.

Shaw said Granada Hills workers will spend the next few weeks electing bargaining representatives and preparing contract terms to present to administrators. She declined to say whether she was a candidate.

In the meantime, the union war will go on.

Lisa Hubbard, a spokesperson for the SEIU Local 399, said other Valley hospital workers are ready to negotiate. Which ones, she would not say.

"Our biggest challenge is having enough time to get to everyone," Hubbard said. "There are nurses and other staffers at hospitals across the San Fernando Valley waiting like planes on a runway to go through the steps of forming the union."