Newton-Wellesley Hospital

National Labor Relations Board - Board Decisions

Jul 3, 1980

250 N.L.R.B. 409 (N.L.R.B. 1980)

NEWTON-WELLESLF. Y H()OSPITAL
Newton-Wellesley Hospital and Massachusetts
Nurses Association, Petitioner. Case I-RC-
16669
July 3, 1980
DECISION ON REVIEW
Upon a petition duly filed under Section 9(c) of
the National Labor Relations Act, as amended, a
hearing was held before a hearing officer of the
National Labor Relations Board. On February 1,
1980, the Acting Regional Director for Region I
issued a Decision and Direction of Election in
which he found appropriate a bargaining unit con-
sisting of all registered nurses employed by the
Employer. Thereafter, in accordance with Section
102.67 of the National Labor Relations Board
Rules and Regulations, Series 8, as amended, a re-
quest for review of the Acting Regional Director's
Decision and Direction of Election was filed by
the Employer, contending, inter alia, that the
Acting Regional Director erred in failing to con-
sider the Employer's evidence that only a unit
which includes all professional employees is appro-
priate.
On February 27, 1980, the National Labor Rela-
tions Board by telegraphic order granted the re-
quest for review as to the appropriateness of the
unit.
The Board has considered the entire record in
this case, including the briefs of the Employer and
the Petitioner, and makes the following findings:
The Employer operates a 335-bed hospital, em-
ploying approximately 1,800 full- and part-time em-
ployees. The hospital is administratively structured
into four major divisions: fiscal services, a school
of nursing, a nursing division, and a fourth division
encompassing approximately 21 different depart-
ments, referred to as general administration. Ap-
proximately 453 registered nurses, including on-call
nurses, work at the hospital, and of these approxi-
matley 405 are in the nursing division. Of the re-
maining 48, approximately 21 nurses are employed
in the school of nursing, and 26 work in the pathol-
ogy department. Finally, one nurse functions as the
employee health nurse, and is assigned to the per-
sonnel department, which is separate from the four
major divisions.
The Employer contends that the only appropri-
ate unit is one which combines the 453 registered
nurses with the approximately 143 other stipulated
health care professionals employed by the Hospital.
This group consists of 12 social workers, 42 regis-
tered medical technologists, 12 respiratory thera-
pists, 27 mental health counselors, 14 physical
therapists, 12 occupational therapists, 14 pharma-
cists, 2 clinical psychologists, 1 rehabilitation coun-
250 NLRB No. 86
selor, 3 clinical dietitians, 2 psychiatric occupation-
al therapists, and I expressive therapist. All these
professional employees are included in the general
administration division, and, with the exception of
the mental health counselors, are supervised, both
administratively and clinically, by supervisors in
that division.'
The approximately 405 nurses who are in the
nursing division are supervised by head nurses,
who report to four assistant directors of nursing
who in turn are responsible to the director of nurs-
ing. Approximately 24 nurses working in the pa-
thology department serve as I.V. nurses; their jobs
involve administering intravenous solutions and
collecting blood samples. Two other nurses are as-
signed to this department as infection control
nurses. The I.V. nurses in the pathology depart-
ment are supervised by a "head nurse (supervi-
sor)." The record does not reveal who supervises
the nurse instructors in the school of nursing.
Massachusetts law requires that there be a dis-
tinct nursing service, under the direction of a direc-
tor of nursing who has centralized control of
hiring, firing, and other supervisory functions. In
exercising this authority over hiring, the director is
assisted by a nurse recruiter who is assigned to the
Employer's personnel department to identify and
interview prospective candidates for nursing posi-
tions. The record reflects that the nursing division
is distinctive in that it promulgates a more compre-
hensive annual report and set of bylaws than do
other divisions. It also prepares its own overall
budget on a divisional basis, unlike the general ad-
ministration branch, in which subdivisions or "cost
centers" (including such individual departments as
laundry, medical records, etc.) compile their budg-
etary needs individually.
All registered nurses are required by law to have
been graduated from a school of nursing accredited
under regulations promulgated by the Massachu-
setts Board of Registration in Nursing, and are re-
quired to take a uniform examination as a condition
to licensure. In addition, continuing education in
the form of in-service training addressed exclusive-
ly to registered nurses is required.
Educational and licensure requirements among
other stipulated professionals vary. All must have
college level training and, with the exception of
respiratory therapists, must have received a bache-
lor's degree. Clinical psychologists and social
workers must also have graduate degrees, and they,
i The ELmpl:~cr's a,,o-lo; tci texcuti e ldirector te,,lified that the mental
health counsclorr , too, arte 1upcrvlt¢d adminlslratit cl hb all p asitant ex-
c.utipL dtircLtor ill Iht gencrall a.dnlniltr;tllorl dll iloin. hut the, reccitX
clinical supcrx i\ill from Ihe .lawistanlt director ofr rturrng ill charge or
mcntll health
40()
DECISIONS OF NATIONAL LABO()R RELATIONS BOARD
along with physical therapists and pharmacists, are
licensed by the State.
Registered nurses generally do not have exten-
sive contact or interaction with other professionals
at the Hospital. Each registered nurse necessarily
will have contact with some other professionals
from time to time, but the record shows that this
typically is a function of the registered nurses'
overall responsibility for the patient, which puts
them in a position of constantly monitoring the
care each patient is receiving, thus also monitoring
each patient's contact with other, more specialized,
professionals. The record evidence shows, for ex-
ample, that registered nurses working in the ortho-
pedic wing have some contact with physical thera-
pists working with patients who have orthopedic
injuries or disorders. "Continuing care" nurses, on
occasion, work with social workers in designing
postdischarge plans for patients. Similarly, occupa-
tional therapists have contact with the nurses in
charge of patients receiving such therapy; regis-
tered medical technologists work with I.V. nurses
who spend time in the pathology laboratory as part
of their duties; and respiratory therapists have con-
tact with nurses in many different areas of the Hos-
pital, as they administer respiratory therapy in pa-
tient rooms. At the same time, most registered
nurses have very little contact with the majority of
the other professionals. That is, while the nurses on
the orthopedic wing see more of the physical
therapists than do most other registered nurses,
they almost never see a mental health counselor,
pharmacist, or social worker, or indeed most of the
other professionals. The same is true of registered
nurses in the intensive care unit, emergency ward,
and operating and recovery rooms, who often see
respiratory therapists, but have no contact with
physical or occupational therapists, social workers,
dietitians, registered medical technologists, mental
health counselors, or pharmacists.
The only consistent contact involving functional
integration between registered nurses and other
professionals occurs in the provision of psychiatric
services. The Hospital's programs in this field in-
clude a psychiatric inpatient unit, a psychiatric day
treatment unit, a crisis intervention team, an outpa-
tient mental health department, a psychiatric emer-
gency team, and a geriatric aftercare team. These
facilities are staffed by psychiatric occupational
therapists, psychiatric social workers, clinical psy-
chologists, a rehabilitation counselor, an expressive
therapist, and mental health counselors, in addition
to registered nurses.
The registered nurses and the mental health
counselors both serve as "key persons" in the psy-
chiatric inpatient unit, establishing and coordinating
patient care during hospitalization and assisting in
the designing of continuing or followup care upon
discharge. Key persons from time to time meet
with the various professionals who may be in-
volved in a given patient's care. Registered nurses
and mental health counselors also share or alternate
in certain other duties, such as admissions screen-
ings, and registered nurses co-lead "family issues"
therapy groups with psychiatric social workers.
While the foregoing describes areas of commonal-
ity among nurses and some other professionals in
the psychiatric services area, the record also estab-
lishes that even in this area only the registered
nurses can give medications, change dressings,
transcribe orders, or serve in "charge" positions
(i.e., take charge of the unit during evening and
night shifts, when no head nurse is on duty). Addi-
tionally, when one of the three shifts goes off duty
and a new complement of employees takes over,
"reports" are given to the incoming charge or head
nurse by the departing charge or head nurse, and
only registered nurses may serve this function.
Moreover, unlike the mental health counselors,
who exclusively work in the psychiatric services,
several registered nurses have transferred between
the mental health units and other areas of the Hos-
pital. Such transfers are not atypical of nurses at
the Hospital. Approximately 8 to 10 registered
nurses had transferred from permanent assignment
in one area of the Hospital to another within the 18
months preceding the hearing. In addition, there is
a group of registered nurses designated "floaters"
who, as a routine matter, fill in as needed on a tem-
porary basis in a wide variety of nursing units. On
the other hand, there is no evidence that within the
last 5 years any registered nurse has transferred to
any other professional position, or that any other
professional has become a registered nurse. 2
All professional employees including registered
nurses currently are subject to common personnel
policies and employee benefits, although registered
nurses alone are entitled to certain pay differentials
for assuming "charge" duty, and for obtaining
bachelor's and master's degrees. These differentials
can raise the pay of a registered nurse to approxi-
mately $13 per week more than that of other pro-
fessionals in the same pay grade. Registered nurses
work in three shifts around the clock, 7 days per
week, as required by law. This is accomplished by
assigning approximately 97 percent of the regis-
tered nurses on a rotating basis. The remaining 3
percent do not rotate. Respiratory therapists and
mental health counselors also rotate on a three-shift
2 It appcars Ihal in 1974 tyo reglstercd nur,,e hricflN worked as repi-
ratlor) Iherapists. but this praclice has not contillued
410
NEWTON-WELLESLEY HOSPITAL
basis. Pharmacists, while assigned to all three shifts,
rotate only between the day and evening shifts;
night pharmacist assignments are permanent. Regis-
tered medical technologists work day and evening
shifts only, and there is no rotation among the
groups assigned to the respective shifts. All other
professionals are scheduled on only a single day-
time shift, 5 days per week.
In prior cases in this area, the Board generally
has found units of registered nurses to be appropri-
ate. In one case, St. Francis Hospital of Lynwood,
Case 21-RC-14718, the Board, in denying a re-
quest for review of a regional director's decision,
affirmed the finding of a registered nurses unit, de-
spite the fact that the hearing officer had excluded
the employer's evidence in support of a unit includ-
ing all professionals. The Board in the subsequent
summary judgment case3 noted that, by denying
review, it implicitly found the Employer's prof-
fered evidence irrelevant, and therefore a hearing
was not warranted. The regional director had
relied upon the Board's Decisions in Methodist Hos-
pital of Sacramento, Inc.,4 and Mercy Hospitals of
Sacramento, Inc. S The Ninth Circuit Court of Ap-
peals denied enforcement of the Board's bargaining
order in St. Francis, holding, inter alia, that the
Methodist and Mercy decisions improperly estab-
lished an irrebuttable presumption in favor of cer-
tain units and that the exclusion of evidence re-
garding an all-professional unit was improper. The
court found that such a per se rule was not justified
by any foundation laid in Mercy, supra, and that to
the extent such a rule precluded the employer from
presenting evidence of the inappropriateness of a
registered nurses unit, its application raised ques-
tions of fairness and ran afoul of the congressional
admonition to the Board to give due consideration
to preventing the proliferation of bargaining units
in the health care industry. Having thus held that
the Board must examine the particular circum-
stances of the case, the court remanded the case to
the Board for further proceedings. The court noted
that given its finding of procedural error in the
Board's handling of the hearing it "need not pro-
ceed further." It went on, however, to present a
critical appraisal of the Board's rationale in the
Methodist Hospital and Mercy Hospitals cases.
In deciding the instant case, we have been mind-
ful of, and guided by, the considerations raised by
the court in St. Francis. We have concluded that so
much of the Board's St. Francis Decision as may be
read to establish an irrebuttable presumption of the
' 232 NLRB 32 (1977), enforcement denied 601 F.2d 404 (9th Cir
1979)
4 223 NLRB 1509 (1976)
" 217 NLRB 765 1975)., enforcement denied on other ground% 589
F 2d 968 (9th Cir 1978), cert denied 440 IT S 910 (1979)
appropriateness of registered nurse units in all
cases, without regard to particular circumstances,
should be disavowed.Such a per se approach to unit
determinations is inconsistent with the Board's Sec-
tion 9(b) responsibility to decide "in each case"
whether the requested unit is appropriate. More-
over, as the court pointed out, the legislative histo-
ry of the 1974 health care amendments to the Act
requires the Board to give due consideration to
avoiding an unwarranted fragmentation of bargain-
ing units in this industry. A per se rule could result
in the Board's giving insufficient attention to this
admonition of the Congress, and could permit the
splitting of professional or other employees into
separate units regardless of whether the particular
circumstances warranted such a division.
The question remains, under what circumstances,
if any, may a separate unit of registered nurses be
found appropriate? The Ninth Circuit's St. Francis
decision urges that the traditional "community of
interests" analysis, as applied by the Board in other
industries, "is not entirely controlling" in the con-
text of the health care industry. Drawing from Sen-
ator Williams' remarks in the legislative history of
the health care amendments, the court notes his
reference to a "disparity of interests" test and urges
that the health care amendments require not a
showing of similarities among employees in a clas-
sification to support a separate unit but instead a
showing of a disparity of interests among employ-
ees in different classifications which would pre-
clude a combination of those classifications into a
single broader unit. The court stated that there was
a congressional awareness that the Board's tradi-
tional community-of-interest considerations would
be subordinated to the directive against undue pro-
liferation.
Initially, we note that the court's disagreement
with our approach may be largely semantic. The
Board's inquiry into the issue of appropriate units,
even in a non-health care industrial setting, never
addresses, solely and in isolation, the question
whether the employees in the unit sought have in-
terests in common with one another. Numerous
groups of employees fairly can be said to possess
employment conditions or interests "in common."
Our inquiry-though perhaps not articulated in
every case-necessarily proceeds to a further de-
termination whether the interests of the group
sought are sufficiently distinct from those of other
employees to warrant the establishment of a sepa-
rate unit.6 We respectfully suggest that, at least to
s This approach has been fioloh),cd h, the Board not onl vilth regard
to whether the unit ,sought is ilniiall) 3ppropriate. hut .;sIo i. lh regard to
the placement of specific cmploee, ..lthin or ilthoul the unit The in-
411 I
DECISIONS OF NATIONAL LABOR RELATIONS BOARD
that extent, the test of "disparateness" described by
the court is, in practice, already encompassed logi-
cally within the community-of-interest test as we
historically have applied it, and, accordingly, we
interpret the court's direction to the Board to be
one of emphasis or degree, and not embracing a
distinction of kind.
At the time the 1974 amendments were passed,
the Board had utilized the community-of-interest
test for 39 years. It follows that a requirement that
the test not be applied in any manner to the health
care industry would have been clearly expressed
by Congress had that been its intention. Further-
more, given the nature of the subject matter, such
a directive would have been a simple matter for
Congress to state. Yet there is no directive that the
Board resort to any completely new type of analy-
sis. To the contrary, Senator Taft's explanation as
to why the unit limitations in his bill were discard-
ed shows that it was intended that the Board "be
permitted some flexibility in unit determination
cases." 7
This view finds further support in Senator Wil-
liams' statement on behalf of the Senate Conferees
that:
While the committee clearly intends that the
Board give due consideration to its admonition
to avoid an undue proliferation of units in the
health care industry, it did not within this
framework intend to preclude the Board
acting in the public interest from exercising its
specialized experience and expert knowledge
in determining appropriate bargaining units.8
Thus, while clearly acknowledging the committee
report language calling for the prevention of a pro-
liferation of units, both Senators Taft and Williams
deemed it consistent with the Board's continued
application of its own expertise.
The committee report itself makes no reference
to the appropriateness, as such, of registered nurse
units and, as mentioned, Senator Taft discarded his
formulation under which all employees were
always to be included in the same unit. Moreover,
the Board, prior to the 1974 amendments, generally
had found registered nurse units appropriate in the
proprietary sector, and Congress did not direct that
this practice be abandoned.9
quiry is always whether the Interests of these employees are sufficiently
distinct to justify the exclusion
7 120 Cong Rec S12944 (1974), Senator Tarts bill (S2292. 93d Cong.
Ist ess. (1973)) had provided for no more than four appropriate bargain-
ing units in the health care industry: (I) all professional emploisees; (2) all
technical employees: (31 all clerical employees and (4) all service and
maintenance employees
12( Cong Rec S12104 (1974)
See. eg . Doctori' oipiral oJ lModer/o. Inc.. 19 NlRBI X33 (19711
In light of the foregoing, we believe that the leg-
islative history of the health care amendments
clearly does not require the Board to forego a con-
sideration of the community of interest among em-
ployees within the health care industry.' 0 At the
same time, we recognize that any community of in-
terests evaluation must accommodate the admoni-
tion to avoid a proliferation of bargaining units in
the health care field. The Board's efforts to effect
such an accommodation should be manifest, we be-
lieve, from the number of situations in which the
Board has refused to approve units that, in any
other context, would amount to appropriate units.
For example, in St. Catherine's Hospital of Domi-
nican Sisters of Kenosha, Wisconsin, Inc., the
Board gave weight to the legislative history of the
amendments and held that, despite proprietary
health care cases of then-recent vintage, such as
Madeira Nursing Center, Inc.,' 2 separate units of li-
censed practical nurses no longer would be found
appropriate. There had been expert testimony in
Madeira which demonstrated that the role of li-
censed practical nurses in health care delivery had
evolved along distinct lines; nonetheless, the Board,
in St. Catherine's, found that licensed practical
nurses henceforth had to be included in a broader
unit of technical employees, in deference to the
need to avoid undue unit proliferation in the health
care field.
Likewise, in Levine Hospital of Hayward, Inc.,' 3
the petitioning union sought to represent what, in
an industrial setting, would have been a classic ap-
propriate unit-a unit of employees "residual" to
an already-represented complement of service and
maintenance employees. The petitioning union was
not the incumbent representative of this comple-
ment and, as in any such residual unit case, a refus-
al to conduct an election among the residual em-
ployees raised the possibility they could remain for-
ever unrepresented. Yet the Board's recognition of
the demands of the legislative history of the health
care amendments was such that, citing Senator
Taft's caution to the Board to avoid unit fragmen-
tation, we refused to find the unit appropriate. The
Board sought to accommodate its concern for the
future representation possibilities of the employees
involved by expressly indicating that it would be
"' The Ninth Circuit Court of Appeals, in denying enforcement of the
Hoard's bargaining order in Mery lloipiruls of Sucramento, vupra, ob-
stered that "The use of this [community of interest] doctrine is entirely
proiper in those cases w'here the appropriate bargaining unit is disputed."
589 F 2d 968. at 973 (1978} The court's denial of enforcement was pre-
mised on the Hoard's failure Io give controlling weight to a stipulation (of
the parties il the case invling ai clerical unit The ,opinionl did nrot ad-
dress the issue of sepalrate unitS fr registered Ilurses
" 217 Nl RB 787 (1975)
Z 203 NI RH 323 (1973)
:: 219 NI.RH 327 (1975)
412
NI A' )N-%WV I IA SI FE H()SPI Il'AI
willing to entertain a petition for their representa-
tion filed by the incumbent representative and, in
the absence of that, a petition by any labor organi-
zation, filed at the appropriate time, seeking the
representation of all service and maintenance em-
ployees.
The Board for similar reasons concluded that a
unit of pharmacists was not appropriate in Kaiser
Foundation Hospitals.14 Although the pharmacists
did share a community of interest among them-
selves, this was deemed insufficient to warrant their
organization in a separate unit. Instead the Board
held that the pharmacists must be represented, if at
all, in a unit including all professional employees.
(Registered nurses already were represented in a
separate unit.)
In Duke University,'S the Board considered a pe-
tition for a unit of switchboard operators at the
employer's medical center. Despite a specific find-
ing that these employees shared a distinct commu-
nity of interest-based on their separate supervi-
sion, location, and job duties, and their lack of im-
mediate contact with other employees-the Board
dismissed the petition, stating that such a unit,
given the legislative history of the health care
amendments, was "Congressionally foreclosed."'6
Board Members have not, of course, agreed in
all health care unit determination cases about
where the fulcrum should be set to effect the cor-
rect balance between employees' community of in-
terests and the legislative admonition against prolif-
eration. 17 Notwithstanding these differences, all
Board Members recognize that some balance must
be struck. Furthermore, the Board herein unani-
mously reiterates the opinion first expressed in
Mercy Hospitals that, giving full and due regard to
the legislative history of the health care amend-
ments, registered nurses can, and in this case do,
'4 219 NLRB 325 (1975)
Is 217 NLRB 799 (1975).
16 This listing of cases in which the Board has departed from applica-
lion of a community-of-interests standard is intended to be demonstrative.
not exhaustive For example, in Otis Hospital, Inc., 219 NLRB 164, 166
(1975), the Board departed from its historic practice in the manufacturing
industry of conditioning acceptance of a unit stipulation combining office
clericals and service and maintenance employees upon the further exist-
ence of a collective-bargaining history including both groups The prac-
tice stemmed from the Board's traditional view that the two groups did
not share a community of interest. Yet, in Otis, in recognition of the de-
mands of the health care amendments' legislative history, we decided that
all unit stipulations in the health care industry would be acceptable, with-
out regard to bargaining history, provided the stipulations did not con-
flict with statutory provisions or purposes. See also N.ew York University
Medical Center. 4 Division of New York University. 217 NLRB 522, 525
(1975).
17 Compare. e g . the views of Chairman Fanning and Member Trues-
dale with those of Member Penello in .4Alleghcen General IHopital, 239
NLRB 872, enforcement denied 608 F.2d 965 (.d Cir 1979I. as well as
the views of Chairman Fanning and Member Jenkins with those of
Member Penello in 'Vathan and Miriaam Barnlerr Memorial Hospital 4roc'i-
ation d/b/a Barnert Memnorial tltipiral Cinter. 217 NLRIB 775 (1975)
possess such a community of interests as makes
their separate representation appropriate. 8
It is appropriate to observe at this point that the
record in the instant case differs from that in St.
Francis, in that here all parties were permitted to
elicit evidence bearing on the appropriateness or
inappropriateness of the requested unit. The record
is replete with detailed descriptions of the Employ-
er's supervisory and administrative structure, as
wvell as lengthy testimony about the duties, training.
and working conditions of the Employer's profes-
sional employees in the various classifications.
With respect to the registered nurses, the vast
majority (approximately 90) percent are administra-
tively separated in a nursing division as required by
state law. They are subject to common supervision
by head nurses, the assistant directors, and the di-
rector of nursing. There is, quite simply, no other
group of professionals for whom an exclusive sepa-
rate administrative structure of such scope and
comprehensiveness has been established, or who
are subject to such an elaborate hierarchy of spe-
cialized supervision.
As detailed more fully above, the registered
nurses work in close and continuous contact with
one another, as opposed to the generally less fre-
quent contacts of limited duration which they have
with most other professionals. The nurses have
similar education, training, and experience, and
must possess the same license. Because of their sim-
ilar yet somewhat generalized skills, they have the
opportunity to transfer and interchange throughout
the various units of the Hospital, and the record
shows this has occurred. It is apparent that more
specialized professionals, such as pharmacists, must
remain more closely tied to their normal working
areas and equipment, and thus do not share with
the nurses the problems inherent in ever-changing
assignments.
Only nurses may serve in a "charge" capacity
and give and receive "reports" when shifts change.
Their responsibility for constant, around-the-clock
care of a particular group of patients is unique. The
ongoing monitoring of each patient's condition
places the registered nurse in a distinctive and
highly responsible position regarding the overall
well-being of the patients. By contrast, other pro-
fessionals, such as pharmacists, registered medical
technologists, and dietitians, when compared to the
IA In agreeing with his colleagues. Member Pencilo emphasize, his .pre-
cific belief that bargaining unit, cornpo,ed excluively of registered
nurses can and in this case do pos.ess an "cceptionlal, high degree of
community of interests" and therefore meet the sitandard for separaic rep-
resenation which he heliees is required hb the leglsl:ltlxe hislor. of the
health care aImendmentts
411
I)D CISI()NS ()I NA I()N AI LABI()R Rt I A II()NS B()ARI)
registered nurses, have limited personal contact
with most patients.
Lastly, the record establishes that the Petitioner
represents employees at 43 other health care insti-
tutions in Massachusetts which come within the
coverage of the Act. In all 43 cases, the bargaining
units consist solely of registered nurses. 9
In all the cirumstances, we conclude that the ap-
propriateness of a separate unit for the registered
nurses has been adequately established. In so doing,
we have paid special attention to two aspects of
the case to which the Employer alludes in support
of its contention that its registered nurses must be
joined with its other professional employees: the
close working relationship between registered
nurses and other professionals in the psychiatric
services units; and the separation from the 405
nurses in the nursing division of the I.V. nurses as-
signed to the pathology department and the nurse
instructors in the school of nursing.
The evidence shows that the nurses in the psy-
chiatric units have frequent and substantial contact
with other professionals. As detailed above, the
record shows a greater level of functional integra-
tion among psychiatric nurses and mental health
counselors than exists with other professionals in
other areas of the Hospital. The mental health
counselors are clinically supervised by the same as-
sistant director of nursing who supervises the regis-
tered nurses in this area, although they are adminis-
tratively supervised by Richard Ziegler, one of the
Hospital's assistant executive directors, who also
supervises several other groups of professionals.
Thus, an argument could be made that the mental
health counselors should be included in the unit of
registered nurses.
The line is not an easy one to draw, but it is our
conclusion that given a choice between placing the
mental health counselors in the registered nurses
unit and placing them in a unit of all nonnurse pro-
fessionals, the latter is more consistent with the
purposes of the Act. Even though the mental
health counselors perform work similar to that of
the nurses, the two groups are not equivalent.
Mental health counselors cannot give medications
or change dressings, and do not transfer between
the mental health services and other areas of the
Hospital, as the registered nurses were shown to
do. Unlike the nurses, the mental health counselors
are not licensed, do not take any uniform examina-
tion, and are not registered in any manner. While,
as indicated, they share clinical supervision with
the nurses, they are administratively responsible to
IH Our reference to this area pattern should not be construed as an in-
dication thati, absent it. we would reach a different result In our vies, it
serves as additional support for the unit determination we make here.
a different chain of command. Lastly, though it is
by no means controlling, we note that Petitioner
does not seek to represent them. We conclude that
their representation, if any, should be as part of a
unit of nonnursing professionals.
A somewhat similar analysis leads us to include
in the unit the approximately 21 registered nurses
who serve as instructors in the school of nursing,
the 26 nurses assigned to the pathology depart-
ment, and the employee health nurse assigned to
the personnel department. It is arguable that, but
for the legislative history, a separate unit of nursing
instructors would be appropriate, much as a unit of
pharamacists might be. Their separate location and
duties, distinct immediate supervision, typically
higher levels of training and expertise, and doubt-
less other factors as well, all suggest such a possi-
bility. The congressional admonition precludes
such a result, however, and we must decide, there-
fore, whether these nurses are more properly in-
cluded in one of two units-one composed of the
nurses at the Hospital or one which includes the
remaining professionals. Although the nurses in
question are not part of the nursing division as
such, they do have the same license as registered
nurses, and utilize their similar educational back-
ground in the performance of their duties. Signifi-
cantly, if there is diversity between them and the
other nurses, there is an even greater diversity be-
tween them and the assemblage of nonnurse profes-
sionals. Thus, while their community of interests
with the Hospital nurses may not be so great as
that shared among the Hospital nurses exclusively,
it clearly appears greater than any community of
interest they would share with the remaining non-
nurse professionals. In these circumstances, an ag-
gregation of all of the Employer's registered nurses
in a single unit 20 seems the better course.
The requested unit of registered nurses which we
have found appropriate includes approximately
three-fourths of the Employer's professional em-
ployees. The record in this case thus accords with
our casehandling experience over the past 6 years,
during which registered nurses have usually consti-
tuted by far the largest segment of a hospital's pro-
fessional staff. Although unit size is not a control-
ling factor in Board unit determinations, the size of
the unit encompassing all registered nurses and the
Board's precedent of refusing separate representa-
tion for any other groups of professionals referred
to in the record ensures that collective bargaining
among the Employer's professional employees will
occur in a maximum of two substantial-in-size, sep-
20 We note that among 43 Massachusetts facilities mentioned above in
which Petitioner represents registered nurse units, several have schools of
nursing. In each such case. the nurse instructors are included in the unit
414
NF\ tI'()N-\%ljI I 1'S [1 ' I()S.I'I 'A1
arate units. This result wtell serves the congression-
al adnmonitionl against unit proliferationll.2
1II( SiCIr llt l l I%1t g ll> .1 Ill .t l i Ithlt I 1 ti tlist' 1) 11 hut I itr rtti .lt h , IIl i lIr
J o i lt Jtl 1 L,' Jl'lJl It pl I .anl ' rTC; Ill I 1L J ( Jl' rOl ½fliltl 1Ig IIl (1C.,III1 I1 .1I
x LrlAcc \ ( I llitl llil g. 'l l (11 II II g J l ' tlhl il'llllctlll 1111I hrlct, fillel
h% il ~ lik( 14111gzt ")I t'lllp 111.1[1 t111~11%. illlu J tl, hL'r IIot IL'Fi'SILd t pointll' I ronl
htl1'1l, .%I IIJi\c giHII'dl .1 Nt llt pCrIP CO'llX til hltl t1he r'ill' , ()of' c.111
pit In, t' 1I tiI c Ltil C t II t iid l'lrs t1i. lilt im pIti of odlr untl du rmili
tIlil ii ) l t t h i tl n th ir AIlth ugh irlih s idtll iuidtli Memlc lbtrs Il1 ditflter
Ihbtut s thclhrtr ilt ll; 1 11ts i n hittlt httr i1[ tlli l t t iti tII C i t hi flits: hbt'
tpprprliallt' Itl hl' ldtltstrs I ft.ur i c. lxI. Itr t'C'it. "se cmpasilt tPill
(I) Sc .grLtt titit txctlt ltclv cimnpoctl o if rctgiltrctl Inurcs art vitlhll
illl nllalolilllir il I (2) th. palrli tllar inailmllllUnl Cik'h I If t o u .(IlJd al11k\: i%
prtCLlSt'J tl;lt hth FlakitI r l ,ll lnll hL Jls t
'
` ,k C l"II.II) fotrcwCe ail% cirTlm-
%talICCt It Cn l illl~)n (of flItlrs iS/It Jm o ld Lal't' Ilk til Conclutde' (flat
.ilfl ;Iddillonall kinlii are approprilate II 1J11% In lU1IrF
We do not hold that registered nurse units are
always appropriate, While many of the characteris-
tics of nursing service at the Employer's facility
may be common to other health care institutio(ns
some aspects are sure to \ :ry. Certainlly, to the
extent another case mirrors this one, in all or most
relevant respects, we %would expect to reach the
same result; but that is not to say that other cases
will not be closely examined on their particular
facts, and for whatever significant differences may
be showni to exist.
Having concluded that the requested unit of reg-
istered nurses at the Employer's facility is an ap-
propriate one for collective bargaining, we hereby
direct the Regional Director to open and count the
impounded ballots, and take further appropriate
action as may be required.
415