Book of Proposals

MNA SLH Contract Negotiations

2024-2025

Our contract negotiations are well underway. We began in November 2024 and have had about 10 bargaining sessions. While our contract expired December 31, 2024, we have a mutually agreed contract extension in place. We have four bargaining sessions scheduled between the end of March and early May. At the end of January, we put our last proposals on the table, including staffing, wages, and other economic issues. Our negotiations have been productive to this point. We have reached more than 10 tentative agreements on individual proposals and have had substantial back-and-forth over others. The most challenging topics lie ahead. There will be give and take as part of negotiations. We have already seen management resist many of our important proposals. Our task is to harness our collective power to effectively navigate that process and get the best possible deal for our nurses. We have prepared this book to provide St. Luke’s nurses a comprehensive overview of all proposals. We urge everyone to read through the proposals and to reach out to your committee rep with any questions. We are seeking your feedback to better understand your needs and priorities for our new contract. All MNA nurses are invited to each bargaining session. This book will also be available electronically at http://www.massnurses.org/STLnurses. We will continue to provide regular bargaining updates in hard copy and on the website. Together we can build on our first contract and secure improvements for all St. Luke’s nurses!

MNA Proposals

MNA Work Schedules Proposal

The principle of our proposal is to maximize nurses’ choice over their schedules to benefit their work-life balance. Our proposal maintains a strong self-scheduling model. Ultimately, for scheduling to work as well as possible, the hospital needs to provide sufficient RN staffing. Our proposal would:

Establish that the order of priority for scheduling would be: Permanent nurses, per diem nurses, and then temporary nurses like MTMs and travelers.
Maintain that the hospital posts needs, and all MNA nurses sign up for extra and overtime shifts on a rotating seniority basis.
Eliminate the six Monday/Friday, Sunday/Thursday requirement.

We negotiated similar language at Tobey, ensuring nurses have the greatest rights and preferences over their work schedules. Management has made a counter proposal on this topic. While we are looking to improve our current contract language, management’s counter is a backward slide that undermines nurses’ ability to have rights and preference over their work schedules. Management’s proposal would:

Take away self-scheduling and give manager’s complete discretion. All scheduling would be based on requests that may or may not be honored.
Continue to require nurses to work six Mondays and Fridays per schedule (or Thursdays and Sundays for night shift nurses). Of those six days, management’s proposal would require nurses to work at least two Mondays and two Fridays (or two Thursdays and two Sundays).
Only allow nurses to request up to 3 days off in a six-week period, with no guarantee of receiving them.

MNA Vacation Planner Proposal

Our goal is to ensure that nurses have maximum access to taking their accrued time off. Our proposal would:

Create a weekly allocation of time off calculated to ensure that all nurses can use all their time. That calculation should be based on fully staffed units.
Allocate time off equally during all non-prime time weeks, including the three holiday vacation weeks, not based on how individual managers decide to allocate time.
Address the significant problem in which 12-hour shift nurses have been denied time off for part of their shift because hours are not being properly distributed per shift.
Shorten the prime-time period.
- Right now, prime time is the second Sunday in May to the third Saturday in September.
- Our proposal would reduce it to Memorial Day through Labor Day.
- Nurses should be guaranteed a week off during the actual peak vacation season.

MNA Reassignment, Release and Reduction in Hours Proposal

We want regularly scheduled nurses to have the first chance at voluntary cancellation. Our current contract language says that agency nurses are to be cancelled first. Often over the last few years, bargaining unit nurses have been denied voluntary cancellation. This would be the new order under our proposal:

Regularly scheduled nurses who volunteer to take time off by seniority in rotation.
Float pool nurses who volunteer to take time off by seniority in rotation.
Agency nurses (travelers and MTMs).
Nurses whose shift represents premium pay (i.e. incentive and/or overtime payment for scheduled shifts above normal work schedule).
Part-time nurses whose shift represents hours above budgeted (control) hours and schedule.
Per diem nurses.
Flex nurses above their base control hours.

Management has its own proposal on this topic.

Management wants to be able to release nurses in two-hour increments instead of four hours.
They also want to change the order of release, cancelling our nurses who are working incentive or overtime shifts while keeping high-priced MTMs and agency nurses.

The following is management’s proposed order of reassignment, release and reduction:

Reassignment of nurses (float) to other areas.
Nurses whose shift represents premium pay (i.e. incentive and/or overtime payment for scheduled shifts above normal work schedule).
Regularly scheduled nurses who volunteer to take time off based on seniority.
Float pool nurses may volunteer to take time off based on seniority.
Release any Agency nurses.
Part-time nurses whose shift represents hours above budgeted (control) hours and schedule.
Per diem nurses.
Employees in a flex position who are scheduled to work a shift resulting in their higher FTE could be cancelled or flexed down one shift to their minimum FTE.

MNA Per Diems Proposal

Per diem nurses are an important component of hospital staffing and our bargaining unit. Per diems supplement RN staffing, allowing the hospital to add staff during times of high census, as well as providing coverage for colleagues seeking time off. Many of our nurses need this level of flexibility and this different type of commitment to fit their personal lives. We are seeking to preserve this work option while addressing the hospital’s overreliance on per diems. Nearly 30% of nurses at St. Luke’s are per diem nurses, far exceeding the level of per diem use at other MNA hospitals. Currently, there are no checks and balances on the number and utilization of per diems and their level of status at St. Luke’s. We presented discussion topics raising our concerns about the impact of the lack of guardrails around the use of per diems on nurses and staffing. Nurses have told us management is only posting Level II per diem positions that require the most commitment of hours. Based on nurses’ feedback, we are seeking to improve our per diem contract language, including:

Eliminate Level II per diem status going forward.
Grandfather current level II per diem nurses.
Give current Level II per diem nurses the option to drop to Level I within 30 days of ratification.
Increase the per diem differential.

Management also made a proposal on per diems. Their initial proposal focused on establishing work commitments for IR, periop, case management, and cardiac rehab, the wound center, and enterostomal, as well as clarifying seniority language. In a subsequent revised proposal, management incorporated issues we identified and both parties are actively working on overall per language.

MNA On-Call Proposal

On-call hours represent a significant burden on nurses who are required to be available to work hours above their already committed hours. We often see management abusing on-call by boarding patients overnight in the PACU and using on-call in the FCU for routine 24/7 staffing. St. Luke’ is a Level II Trauma Center. Management should provide sufficient staffing to cover 24/7 patient needs without their excessive reliance on on-call. Our proposal would:

Increase on-call pay to the MA minimum wage (currently $15 an hour).
Eliminate mandatory on-call in the FCU because it is a 24/7 service.
Limit weeknight on-call hours for the ASU and PACU to 11 p.m. to 6:30 a.m.

MNA Preceptorship Proposal

Given the much higher percentage of newly graduated nurses in the workforce, we have proposed updated preceptor language to support nurses who are starting off their career in a specialty area. This type of nursing care requires extended learning time and a dedicated preceptor system that provides consistency and stability.

Under our proposal, newly graduated nurses working in a specialty area or PCU would be assigned a primary preceptor who will be responsible to ensure the precepted nurse has successfully completed all core competencies.
Nurses assigned as primary preceptors will receive a $1,500 bonus – $750 payable after 3 months and $750 payable after the six-month precepted period.
Increase the preceptorship differential.
Management has its own proposal on this topic. Their proposal goes in the opposite direction of consistency and stability. Management wants to provide less precepting and less education than they are currently. Southcoast made the same proposal at Tobey and nurses successfully fought off this concession.

MNA Sleep Time Proposal

Currently, nurses are limited to a maximum of two hours of sleep time regardless of how long they are called in for patient care needs on the overnight shift. Our proposal is aimed at guaranteeing that nurses who are called in during the middle of the night and are scheduled for the next day are paid sleep time equal to the amount of time they were called in to work.

MNA Holidays Proposal

We have proposed adding Juneteenth to our time and a half holiday list and going from three to two floating holidays.
We have learned in the last year that there is not a consistent approach to what counts as the holiday shift for Christmas and New Year’s across hospital units.
- The designated holiday shift for Christmas and New Year’s would be the evening shift on December 25 and the evening shift for January 1.
- For Christmas and New Year’s, no nurse would be required to work the evening shift on both December 24 and 25 or the evening shift on both December 31 and January 1.

Management has its own proposal on this topic. The hospital has identified a similar issue with the designated Christmas and New Year’s holiday shifts and agrees we need a consistent approach.

MNA Medical and Dental Insurance Proposal

All nurses with a weekly scheduled commitment of at least 24 hours would be eligible for individual medical insurance coverage at a 10% contribution level and 20% for all other coverage selections.
The nurse contribution level for all dental plans would be 40%.
Under our proposal plan medical and dental plan designs would not change during the length of our contract.
Any care provided at a Southcoast facility would continue to be considered a Tier I claim (excluding services provided by non-tier I providers selected by the nurse or covered dependents).
The current Health Plan Bi-weekly Premium Savings, Wellbeing and Tobacco-Free options would continue for the term of our new contract. We successfully added this to the Tobey contract.

MNA Temporary Nurse Proposal

The hospital’s overreliance on MTMs and travelers arose out of the pandemic. They are paid significantly more than our nurses and get preferential treatment for scheduling. We want greater limits on their use. Our proposal would limit the amount of time Southcoast can use MTMs, travelers, or any other agency contracted RNs to 13 weeks. Beyond that, the hospital would need our consent.

MNA Negotiation Pay Proposal

To ensure our MNA Bargaining Committee members can participate in negotiations without losing pay, we have proposed that they should be paid for time spent bargaining.

MNA Attire and Appearance Proposal

Currently, the hospital can impose a specific uniform requirement without negotiating. We are seeking to delete that language. If management wants to require a specific uniform, they should negotiate with us over a dress code and uniform allowance.

MNA Staffing Proposals

In our first contract we won enforceable staffing language requiring the hospital to maintain its existing staff grids and make good faith efforts to recruit or otherwise bring in nurses to staff to the grids. Our staffing proposals during these negotiations would strengthen that language, providing both hospital-wide staffing improvements and addressing unit-specific issues.

MNA Resource Nurse with No Assignment Proposal

We have proposed that a resource nurse be assigned on all shifts on every unit 24/7, and that the resource nurse will not have a patient assignment. Further, our proposal requires the hospital to enhance its RN staffing where necessary so that it would not increase patient assignments for other staff nurses.

MNA Stepdown/Intermediate Care Staffing Proposal

PCU, Wilks, and Knowles care for patients requiring a higher level of care. Our proposal would ensure that any patient needing this higher level of care would not be part of an assignment of more than three patients.

This limit would apply regardless of how many patients in a nurses’ assignment are considered stepdown/intermediate level of care.
The proposal is meant to enhance current RN staffing. Our proposed contract language would prohibit the hospital from increasing the patient assignments of other staff nurses.

MNA FCU Staffing Proposal

We are proposing that the FCU be separated into four separate patient care areas (Labor & Delivery, Postpartum, Level II Nursery, and Pediatrics) and that nurses would not be required to train or work outside of their chosen area. Our proposal would also establish an FCU float pool.

Currently employed FCU nurses would, by seniority, choose their primary patient care area or may elect to work in the newly established FCU float pool.
Newly hired nurses would be hired into one of the four separate patient care areas or the float pool.
For the float pool, nurses would be trained to work in two of the core patient care areas and receive the float pool differential (Article 4, Section 4.6).
Nurses would be scheduled to work in their primary patient care area but may volunteer to sign up for extra hours in an area outside their primary area, provided they are competent to work in that area.
We also proposed that there will be 24/7 lactation nurse coverage in postpartum. These positions would not be calculated in the staffing grid.

MNA PACU and OR Positions Proposal

St. Luke’s is designated as a Level II Trauma Center. The hospital needs to have extended periop coverage but instead has relied on on-call. We believe that a Level II Trauma Center ought to have sufficient RN staffing 24/7 to meet the heightened needs of trauma patients. As a result, we have proposed the following:

Post and fill sufficient RN positions to staff PACU 11 p.m. to 7 a.m. Monday to Friday.
Post and fill sufficient RN positions to staff OR 3 p.m. to 11 p.m. Monday to Friday.

MNA Wage and Economic Proposals

Even though St. Luke’s is a major urban hospital with a Level II Trauma Center, a jam-packed FCU and operating rooms, and one of the busiest emergency departments in Massachusetts, nurses here are paid significantly less than nurses at other area hospitals. This disparity has a real impact on nurses and our patients. The hospital has about 80 RN vacancies as nurses move to other MNA-represented hospitals in Southeastern MA where they can earn a higher hourly wage and reach the top of their wage step scale in fewer years. We have made a series of proposals to address this problem.

The SLH Wage Disparity

MNA Wage Proposal

January 1, 2025: Create a new 19-step, 4% wage step scale (up from 2% between steps) based on RN license year. The scale would go from $40.37 to $81.79 in year one. January 1, 2026: An additional 5% across-the-board for every nurse. The scale would go from $42.39 to $85.88 in year two. *These proposed increases are in addition to nurses getting their annual hire date anniversary step raises.

Wage Scale Compression Issue

As part of our first contract, both sides agreed to drop the first three steps of our wage step scale in July 2022. This was meant to increase the lowest wage rate and help with RN recruitment. However, management has used this change to pay many nurses less than they should be based on their licensure year. This has created an issue where nurses with more years of experience are being paid the same or even less than nurses with fewer years of experience. This is demoralizing and hurting the hospital’s ability to retain nurses.

At the time of this “compression” of the wage step scale in 2022, nurses with 2020, 2021 and 2022 licensure years all went to $34.49, the step 3 rate at the time.
Currently, management is hiring nurses with a 2022 licensure date at step 3. This puts them below other 2022 licensed nurses, who were at step 3 in 2022 and have since moved up at least two steps.
In some cases, nurses with a 2021 licensure year who moved to step 3 in 2022 have advanced three steps and are on step 6, while newly hired nurses who were licensed the same year are only on step 3.
As part of our overall wage proposal, we are seeking to address this issue so that nurses are placed fairly on the scale and provided with a wage rate appropriate to their years of experience.

During bargaining, nurses have shared how much they earn now, how much more they would make at Tobey and their hourly rate under our proposal. Below are two stark examples from MNA Bargaining Committee members:

Victoria Rogers, licensed in 2018: $42.01 currently. Would make $49.24 at Tobey and $53.13 under our proposal. Additionally, because of how the bottom of the scale was compressed, Victoria only makes a small amount more than nurses licensed years after her.
Terri deMedeiros, licensed in 1998: $62.43 currently. Would make $70.01 at Tobey and $81.79 under our proposal. Even though Terri has been an RN for 27 years, she is still not at the top of the current wage scale. If she worked at any other MNA hospital, she would have long ago been at the top.

MNA Differentials Proposals

Evening Shift: $2.80/hr to $5.00/hr Night Shift: $5.00/hr to $10.00/hr Weekend: $2.50/hr to $5.00/hr On-Call: $5/hr to MA minimum wage (currently $15/hr but this would track any increases) Preceptor: $1.75/hr to $5.00/hr Resource: $2/hr to $5.00/hr Float Pool: $3.00/hr to $5.00/hr Multi-Site Float: $7/hr to $10.00/hr

MNA Incentive Pay Proposal

We have proposed the following contract language to address both chronic unsafe staffing and the hospital’s arbitrary approach to enacting incentive pay.

Incentive pay will be in effect if the RN open shifts on a unit or shift exceeds 20%.
Incentive shifts should be scheduled in advance as part of the scheduling process whenever possible.
Incentive pay is to be paid for an extra shift worked in a given week beyond the nurse’s regular core hours.
All nurses scheduled and working an extra or overtime shift which subsequently becomes designated as an incentive shift shall receive incentive pay for the shift.
Incentive Pay shall be $40 per hour.
If RN open shifts on a unit exceeds 30% or more, the Hospital will offer incentive pay at $50 per hour.

Management Proposals

Management Wage Clause Edits

Management has proposed a series of what it calls “housekeeping” edits to the wage scale section of our contract. MNA Response: We will address this as part of an entire economic proposal package.

Management Assault Pay Proposal

The hospital wants to be able to document a nurses’ inability to work to receive assault pay. MNA Response: We sought further clarification regarding what the hospital intended with “a nurses’ inability to work.”

Management Tuition and Certification Reimbursement Proposal

Under its proposal, management would simplify reimbursement to a nurse receiving up to $2,500 per calendar year and add certifications. They also want to have a third-party administrator handle the reimbursement process and implement a minimum grade of C for undergraduate courses and B for graduate courses to qualify for reimbursement. MNA Response: Nurses provided feedback about the challenges of navigating the third-party vendor for reimbursement.

Management Leaves of Absences Proposal

Management made a proposal regarding imposing new requirements on nurses about communicating about their protected leaves or risking the leaves converting to unprotected status. MNA Response: We have rejected this proposal.

Management Seniority Proposal

Management has proposed “housekeeping” edits to existing per diem seniority language. MNA Response: We are seeking further clarification of their proposal.

Management Vascular Access RN Grade Proposal

Management wants to move vascular access nurses to the Grade B scale. MNA Response: We are holding on this proposal in conjunction with our entire economic package.

Tentative Agreements

We have reached tentative agreement (TA) with the hospital on the following proposals. These agreements do not take effect until the full contract is agreed upon and ratified by our MNA nurse membership.

Restricted Call – Management Proposal

Change the hourly restricted call rate from $14.25 to match the MA minimum wage (currently $15.00). This rate will increase when the minimum wage increases.

Bereavement – MNA/Management Proposal

Add the parent and grandparent of nurse’s children and stepsiblings to the existing list of relatives applicable under bereavement leave.

Contact Hours – MNA Proposal

SLH will make available enough contact hours online and within the Southcoast system to satisfy the Massachusetts BORN minimum requirements.

Annual Competencies – MNA Proposal

SLH will provide annual in-person competencies on site. Multiple sessions will be offered at least two separate dates per service line, with enough capacity to accommodate all bargaining unit nurses.

Day Light Savings – MNA Proposal

This TA places current practice into our contract. Nurses will receive 1.5x pay for the extra hour worked during fall back and will be paid their full shift during spring forward.

New Hire Orientation – MNA Proposal

We agreed to adjust our current contract language to better match current practice. SLH will provide a conference room during each biweekly new hire session and will schedule all new bargaining unit nurses to attend.

Vacancy Posting – MNA Proposal

We have proposed that first preference will go to nurses regularly employed in the department where a vacancy exists when ability and qualifications are equal.

Updating Union Recognition Clause – MNA/Management Proposal

We have proposed adding “OR RN Service Line Coordinators” to the recognition clause of our contract. This would reflect current practice and solidify their membership in our SLH MNA bargaining unit. Management has proposed adding “RN First Assist” positions.

Restricted Call – MNA/Management Proposal

Increase restricted call MA minimum wage, tracking any increases to minimum wage.

Accrual of Earned Time – Management Proposal

Instead of the current 19 years of continuous employment, management has proposed that nurses will receive the highest level of ETO accrual after 18 years.

Gender Inclusivity – Management Proposal

This proposal would change pronouns in the contract to be gender inclusive and non-binary.

Military Leave – Management Proposal

This proposal would set a 30 day per year limit (the current limit is two weeks per year) on Southcoast’s supplementing a nurse’s military pay/allowances for military reserve training. The hospital pays the difference between their military pay/allowances and their regular weekly straight-time salary.

FMLA/PFML – Management Proposal

This proposal removes language specific to the date of ratification because it is connected to first contract ratification.