ITHACA, NY – Ithaca has been a hotbed of labor disputes in recent months, including an allegation of union-busting tactics allegedly  being used by Cayuga Medical Center to hinder some of its nurses efforts to form a union.

This dispute led to more than a week’s worth of hearings adjudicated by the National Labor Relations Board, which concluded with a brief session on Tuesday.

The final decision from the administrative law judge overseeing the case will determine whether or not Cayuga Medical Center engaged in unfair labor practices. The decision will take more than a month to come down.

Now that most of the facts seem to be in the open, The Ithaca Voice thought it would be valuable to recap what led to the dispute and how it has progressed:

Seeds of discontent

The effort to form a union has been ongoing for at least a year, but traces of dissatisfaction can be seen as far back as April 2015.

According to the nurses organizing the campaign around half of the roughly 350 nurses at Cayuga Medical Center have signed cards supporting the formation of a union.

While not limited to those departments, the dissatisfaction seems especially prevalent among nurses from the Intensive Care Unit, or ICU, and the Emergency Department.

A job satisfaction survey administered in April 2015 showed that among ICU staff, the rating for trust of the hospital’s administration was only 2.25 out of 5. Scores for Communication Empowerment and Recognition also were below 3. According to ICU nurse and union organizer Anne Marshall, more than 20 nurses responded to this survey.

Claims of being understaffed and disregarded

Several comments left by the ICU nurses reflect an atmosphere of discontent. Several common themes run through the comments:

The biggest issue is staffing — or lack thereof. Several comments indicate the nursing staff is well-trained and dedicated, but understaffed and overworked, which the nurses say contributes to burnout. Multiple comments indicate a one-to-three nurse to patient ratio in the ICU.

A note on nurse-to-patient ratios: nurses nationwide have been pushing for stricter nurse-to- patient ratios, and several states are pursuing legislation. California was the first state to implement specific ratios. California law requires a one-to-two nurse to patient ratio for critical care wings like the ICU.

Due to the staffing issue, several nurses said they cannot provide the standard of care they should be able to.

One comment from the April survey reads: “We have had several near misses and at least two deaths due to not enough staff on the floor to watch patients as closely as we needed to.”

Several nurses note that they don’t feel recognized for their hard work or listened to when they bring issues to their supervisors, contributing to low morale.

Wrote one nurse: “I do not feel cared for as a person when I am consistently being texted several times a day on my day off asking me to work. I have also been guilt-tripped into working, even on holidays… I feel stretched too thin.”

A good place to work

John Turner, Vice President of Public Relations for CMC, offered two counterpoints to the nurses claims:

First, he indicated that the situation in the ICU was improving. In a more recent satisfaction survey of ICU nurses from December, numbers improved across the board compared to the April results. Eight ICU nurses responded to that survey.

He also noted that job satisfaction among hospital staff overall, including in other inpatient nursing wings, was much better.

Results from the Maternity Wing in the December survey were much higher than those from the ICU in either the April or December surveys, with most scores approaching or exceeding 4 out of 5.

The survey, which collected feedback from 657 of CMC’s roughly 1,400 employees, indicated that CMC scored an overall score of 3.89 out of 5 for overall employee satisfaction.

Turner highlighted that CMC rated 4.2 out of 5 for being a “good place to work,” which he believes indicates an overall really positive culture in the hospital.

Turner, who has worked in healthcare for 20 years, said that discrepancies between departments weren’t uncommon in other hospitals.

“You always want to see your line moving up, that’s why we were encouraged after we surveyed again in November,” Turner said. ”But it’s not unusual to see this kind of variation in departments.”


Marshall and another of the union organizers, Scott Marsland, refute the idea that things are improving, however.

According to Marshall, in the last month, eight experienced emergency room nurses left CMC.

“The conditions are so bad and none of us want to work in a place where we’re putting our license in jeopardy and our patients in jeopardy, so we’re looking for places that don’t do that,” she said.

Marshall believes CMC, aside from overworking its nurses, should offer things like retention benefits to help keep experienced nurses.

Turner, however, characterized the turnover rate as standard in the industry.

“It’s very normal. There’s a nursing shortage right now. Hospitals don’t have enough nurses and you’ll see a lot of hospitals… nurses will go to other hospitals, it’s very normal flow for nursing,” Turner said. “If they’re hearing someone over here might be paying a little more…”


Marshall said that the new director of the ICU has been cutting staff even more and not replacing positions, leaving the unit worse off now than a year ago.

Marsland added that the ICU eliminated one of the two ward clerk positions after the last person who held the job left for a better paying offer. Ward clerks are the people who handle the administrative, support and clerical duties of a unit. This means that on weekends and one weekday, nurses are left to handle those duties in addition to their usual tasks.

“It’s hard for me to get my mind around it,” said Marsland. “It’s kind of like saying you’ve got an office with 20 executives and you’re not going to have a secretary.”

Not only does the high turnover deprive the hospital of experienced nurses, but it also requires the hospital to use contract nurses to fill positions, who Marshall and Marsland say are a poor replacement.

“They really have no loyalty or commitment to the hospital or the community. They’re showing up late, they’re leaving early, and they’re not as responsive when they’re here,” said Marsland.

According to Marshall, in the last month, one contract nurse was arrested on a drug charge and another improperly administered medication to a patient, causing the patient to code. “Code” is hospital shorthand for cardiopulmonary arrest that often requires a team to resuscitate the patient.

Marsland related a story of a patient who was admitted in unstable condition and should have been admitted to the ICU. He wasn’t, however, because there was no ICU doctor there.

The patient remained in the emergency department, where he had to re-intubated and ultimately coded for over an hour before dying.

“You can make an argument the patient might’ve died anyway but the way that care went would’ve gone differently if he had an intensive care doctor there in a timely manner. It shouldn’t happen,” Marsland said.

Turner made the following statement about hospital safety and the overall situation at Cayuga Medical Center:

“Cayuga Medical Center strongly disagrees with all of the allegations. Cayuga Medical Center is a safe hospital for patient care. In April, the Leapfrog Group gave Cayuga Medical Center an A rating for hospital safety. We were the only A rating in the region. Our employee satisfaction scores are high, turnover is below state and national averages, and we have a dedicated team of nurses providing high quality patient care 24/7 to our community.”

Michael Smith reports on politics and local news for the Ithaca Voice. He can be reached via email at, by cell at (607) 229-0885, or via Google Voice at (518) 650-3639.