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We, at present, in the 6 years have organized 27 hospitals out of 80 hospitals in the immediate Chicago area.

Again, as I pointed out, every one of those situations were fraught with turmoil, and it should be eliminated. The communities feel it. should be eliminated.

The newspapers feel it should be eliminated. The hospitals say go to the Labor Board when they know darned well the Labor Board does not have jurisdiction.

Then we come back and point out that the Board does not have jurisdiction-they laugh in our faces. The cynicism is really overwhelming on their part. We feel that this is an opportunity to do something to bring some kind of sanity into the hospital field so that nonprofit workers can have some kind of channels in which to indicate the desires of whether they want to go up or down for a labor union to represent them.

Thank you.

Mr. HARDY. I would like to conclude with Leo Geffner, our counsel from the west coast.

Mr. GEFFNER. Just one or two comments.

Mr. McDermott commented on the basic unfairness of the present status of the law, and the example of the Queen of Angles Hospital in Los Angeles.

The Queen of Angels was a nonprofit hospital where employees did not have the rights under the National Labor Relations Act, and the hospital was sold, and it became a proprietary hospital.

Then the same employees overnight did have basic NLRB rights for representation election. As far as the community was concerned, there was no difference in the hospital; the same services, the same facilities, the same staff, the same number of employees, and in fact the same employees themselves.

The problem is also unfair and discriminatory on the other side of the coin.

For many years the Labor Board did not assert jurisdiction over proprietary hospitals. The service employees organized the nonprofessional employees of a hospital in northern California and used that case hospital as an effort to convince the Board to reverse its prior policy.

The service employees filed a petition, and we had numerous hearings, and the Board deliberated for many, many months and eventually reversed its prior policy on a showing that the proprietary hospital was clearly involved in interstate commerce and did have a national impact because of the introduction of medicare and because of the heavy influence of national insurance carriers that carry a substantial coverage of medical costs.

After the Board asserted jurisdiction under the California law, the group of doctors that owned the medical center in northern California obtained a nonprofit hospital charter and the hospital after this long litigation became a nonprofit hospital and then did not come under the National Labor Relations Board even though this long litigation had involved that very same hospital.

So the same employees, nonprofessional employees that had filed this petition, obtained recognition in early 1966 after a year and a half of litigation, just simply because there was a change in title,

then did not have any bargaining or representation rights on the NLRB.

The hospital remained the same hospital, same doctors, same staff, same employees, although technically it was a nonprofit hospital.

One further point. There is a tendency at least in California for small proprietary hospitals to shift to a nonprofit status. What occurs is that the method of distributing income of proprietary hospital changes form and the hospital becomes nonprofit in name only and the profits are attained through the device of higher administrative salaries, special facility treatment where physicians have previously had stock in a hospital and other gimmicks, such as high rents under leases, leased for the holder of the physical holder.

So that this technical difference of nonprofit or proprietary has had a severe impact on employees because of the status of the law has ended up in this unfair discriminatory position.

The question of supervisors, Mr. Asher discussed; we have had numerous problems in terms of these, defining a unit and in the sense that the Board is taking jurisdiction over proprietary hospitals and nursing homes and nonprofit convalescent homes.

We realize it is a problem, particularly in the nursing department, because of the function of the professional, in terms of a nurse performing professional duties separate from administrative duties.

And so if an amendment is in order concerning this question of supervisors in the nonprofit hospitals, Mr. Asher and I would be happy to meet with counsel of the committee and work on language, if we are so requested.

The CHAIRMAN. Thank you very much.

Mr. HARDY. Those are our presentations.

The CHAIRMAN. I have no questions. Thank you very much.

Senator Metcalf, we welcome you. I know you want to introduce our next witness, so I will say nothing further other than to welcome you back to this committee.

STATEMENT OF HON. LEE METCALF, A U.S. SENATOR FROM THE STATE OF MONTANA

Senator METCALF. Thank you very much, Mr. Chairman.

It is a real privilege to come back to the committee and have the opportunity to present one of Montana's most respected and distinguished citizens.

Mrs. Mary Munger, who is going to be your witness, has been a representative and executive director of the Montana Nurses' Association for 16 years.

She was the lobbying representative for the Montana Nurses' Association when we passed the 1967 Montana bargaining law for registered nurses and licensed practical nurses.

As a result of her activities, that became known in the legislation as the blue-eyed nurses' law and she more than anyone else is responsible for that bargaining law, blue-eyed nursing law, and she well deserves it.

After the law went into effect, she participated in her capacity as executive director. She is a skilled professional nurse; she is an experienced executive in the nurses' association and she has participated in bargaining in the nurses' association.

She is very well respected and experienced witness to appear before this committee, and I am proud, and I know Senator Mansfield would be equally proud were he able to be here, to present Mary Munger as a witness before your committee.

The CHAIRMAN. We appreciate very much that introduction.

Mary Munger, we are looking forward to your statement. Let us hope you are as effective here as you were there.

STATEMENT OF MARY MUNGER, R.N., VICE CHAIRMAN, COMMISSION ON ECONOMIC AND GENERAL WELFARE, AMERICAN NURSES ASSOCIATION; ACCOMPANIED BY ALICE L. AHMUTY, R.N., DIRECTOR; ANTHONY BATTORE, M.D., EXECUTIVE SECRETARY, COMMITTEE OF INTERNS AND RESIDENTS, NEW YORK; AND MICHAEL HOROWITZ, ATTORNEY

Mrs. MUNGER. I am Mary Munger; I am vice chairman of the Commission on Economic and General Welfare of the American Nurses' Association.

I am here to present testimony on H.R. 11357 for the ANA. I would like to introduce at this time Alice Ahmuty, who is the executive director of our economic and general welfare department.

The other people who are at the table will be introducing themselves. Senator, I do have a statement and have submitted it. It is a rather lengthy statement of testimony regarding this legislation, and I would like to have it submitted in total for the record. I just have a brief summary that I would like to follow today.

The CHAIRMAN. We appreciate that and your full statement will be made a part of the record and inserted at the end of your testimony and we will be glad to have your summary.

Mrs. MUNGER. The American Nurses' Association has supported the amendment to the National Labor Relations Act for several years to extend coverage to the employees of nonprofit hospitals. We have a long record of this kind of support.

The ANA believes that the protection of the right to organize and bargain should be extended to all health-care employees, professionals, and nonprofessionals.

As you probably know, the ANA supports collective bargaining as the means by which professionals as well as nonprofessionals will be able to influence not only the standard of employment where they work, but also to participate in the discussions about nursing practice standards.

We believe this would be the most effective means to do this.

The ANA is concerned, however, as was pointed out by the gentlemen who preceded us about the determination of the appropriate bargaining unit should the NLRA be extended to cover nonprofit hospitals.

In the determination of the appropriate bargaining unit the problem arises out of strict interpretation of the term "supervisor" as defined in section 2(11) of the NLRA, when applied to the work of a professional nurse.

By law-and this is by State statute-nursing practice act, patient care supervision, as principal duty of the registered nurse, but this does not mean that the registered nurse controls the work of others

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in a bureaucratic sense. It rather means that registered nurse shares her professional knowledge with other members of the nursing team in determining the best way to meet patient need.

By legal definition of nursing practice, the registered nurse is required to assume responsibility for exercising independent judgment and discretion in relation to patient care needs, a responsibility which is at the very core of the nurse's professional status under the NLRA. It would make no sense and would defy Congress' express intention that registered nurses be accorded rights as professionals under the act to hold that the act of patient care supervision, which goes toward registered nurses' professional status, are also-have the effect of making her a supervisor under the act.

There is a need to differentiate between the exercise of independent judgment as part of the work of a highly skilled occupation directed toward quality patient care and in the exercise of independent judgment for purposes of personnel administration.

It is no exaggeration to say that proper regard for this distinction is vital for the protection of professional employees' rights under the NLRA.

Within the authority structure authorized health care services, professionals have unique status and responsibility. The right of health care professionals to bargain, of which registered nurses constitute the largest single body, approximately 486,000 in this country in all categories of hospitals, require special protection in the law.

We have on this point had conferences with representatives of organized labor as well as with the gentlemen who are here representing the interns and resident physicians, and we have agreed on the need to change the definition of supervisor in NLRA to accommodate to the uniqueness of the professionals under the act.

The report on H.R. 11357, the House report, is not sufficiently clear on its legislative intent when it states on page 5 of the report that nurses with only nominal supervisory duties should not be considered as supervisors.

As one of the gentlemen earlier stated, job titles really do not apply the kind of authority that the title might imply, and there is a need then to look at what the nurse is actually doing, rather than by making a judgment about her supervisory responsibilities on the basis of the title.

The bargaining rights of registered nurses and other professionals may be jeopardized unless there is a change in section 211 of the NLRA. The ANA, therefore, suggests that 211 of the NLRA be amended to qualify the definition of supervisor as it relates to the responsibility of nurses and other professionals for patient care.

In the testimony, in the full text of the testimony, this issue is dealt with primarily in much greater length, Senator, so I will not go into it any further here.

The CHAIRMAN. Thank you very much.

(The prepared statement of Mary Munger follows:)

AMERICAN NURSES' ASSOCIATION

STATEMENT ON

H.R. 11357

to the

Subcommittee on Labor

of the Committee on Labor and Public Welfare

of the U. S. Senate

by

Mary Munger, R.N.

August 16, 1972

I am Mary Munger, R.N., Vice Chairman of the Commission on Economic and General Welfare of the American Nurses' Association. Accompanying me is Alice L. Ahmuty, Director of our Economic and General Welfare Department. The Association is the professional organization of registered nurses in the United States. It has constituent associations in all fifty states, the District of Columbia, Guam and the Virgin Islands.

As the Association representing the largest group of professionals providing health care to the American public, the American Nurses' Association welcomes this opportunity to present its views and comments on this proposed amendment to the National Labor Relations Act, which seeks to extend its coverage and protection to employees of nonprofit hospitals.

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