Kaiser Permanente Nurse Anesthetists Association of Southern California
A History and Mission

By Mike Churchin CRNA, KPNAA Past President

In 1978 Kaiser Permanente’s (KP) internal structure was strongly encouraging the organization of nurses into existing bargaining groups. At that time, the United Nurses Association of California (UNAC) was the premier nursing union for the Southern California region’s seven Kaiser Foundation Hospital (KFH) Medical Centers. Having been independent employees of the Southern California Permanente Medical Group (SCPMG) for many years, the CRNAs were reluctant to become part of a large union structure despite the organizational pressure and purported benefits. There was some benefit to bargaining contracts as a group and no option to become a part of the physician-only SCPMG.

At the time, several CRNA’s from across the region had been meeting occasionally for Saturday brunch to update each other on activities across the region sharing items of professional and personal interest. Bette Greene, CRNA had kept informal notes (legend has it on the proverbial cocktail napkin). The opportunities at the time were to organize in affiliation with an existing bargaining unit, appeal to SCPMG to remain independent employees or seek an independent organization status through the National Labor Relations Board (NLRB). In an outstanding bit of strategy vs. luck, the notes compiled to date were enough to convince the NLRB of the independent status of the CRNAs. This was a time when independent unions were permitted outside of the AFL-CIO or other national affiliates. The NLRB’s 1979 decision allowed the Kaiser Permanente Nurse Anesthetists Association of Southern California to be formed representing all CRNA’s employed by the SCPMG. Our Association was certified as a regional union, not hospital by hospital as most other nursing unions function.

The first contract collectively negotiated between KPNAA and KP-SCPMG was in 1981. CRNAs working in KFH facilities now had a contract that addressed the unique issues of the SCPMG Nurse Anesthetist. During this time of very traditional and adversarial negotiations, KPNAA voted to strike in 1985 as a demonstration of their integral role in the operating room and negotiating power. Winning concessions was not without sacrifice for the CRNAs and the KP members. Subsequent negotiations, though traditional and occasionally adversarial, have been concluded without strike activity as KP-SCPMG and KPNAA redoubled their efforts at the negotiating table and developed long-standing and overall positive relationships with key negotiators and labor relations staff at the table. We now enjoy a rewarding history of excellent employee-labor relations without strikes or job actions. This relationship has been augmented since 2000 when KP and the Coalition of Kaiser Permanente Unions (CKPU) formed a Labor Management Partnership (LMP) in their efforts to lead healthcare into a new era of labor relations. KPNAA is an active partner in the CKPU and effectively advocates for KPNAA membership at all levels within the KP system through the LMP processes and the high level relationships built in the spirit of improving health care systems to meet the challenges inherent to our industry.

KPNAA has retained outstanding legal representation and bargaining expertise since its inception. In 1992, the KPNAA Board of Directors approved the first ‘business representative’ part-time staff position, which was filled by Bette Greene – a retired CRNA. KP hospitals in Southern California had grown from seven to 10 facilities and the complexities of contract management and preparation for negotiations (every three years at that time) readily justified the application of membership dues for this purpose. Bette proved to be an outstanding advocate for the profession through the time of her passing in 1995. KPNAA offers an annual scholarship in memory of Bette to students at the KP School of Anesthesia for Nurses with the hope that her inspiration and dedication to the profession of Nurse Anesthesia be perpetuated.

Nancy Boyajian, CRNA had worked closely with Bette during these years and assumed the roll of business representative with ease upon retirement. Nancy has gracefully guided several boards of directors through significant changes in KP’s structure as well as firmly advocating for adherence to contract principles and process for our now 300 plus members. She was instrumental in securing the 1994 inclusion of KPNAA in the nascent Labor Management Partnership and the Coalition of KP Unions. Nancy’s vision, along with past presidents and boards has yielded ongoing fruit for SCPMG CRNAs as the partnering structure has grown to reflect our professional status and market sensitivity far more than traditional union processes may have allowed. Within this framework KPNAA functions more like a professional association than a traditional union, while retaining many important collective bargaining rights (and responsibilities!) that have evolved over the course of the labor movement in the U.S.

1998 saw the ‘roll-out’ of the Labor Management Partnership to the medical centers where it had previously been growing among top-level union and management leadership. This era also produced the 11th KFH facility – without CRNAs staffing in their operating rooms. While this decision was incongruent with the Partnership we had been developing, the KPNAA board at the time took it as a significant wake-up call that CRNAs needed full-time advocacy within KP-SCPMG in order to grow and demonstrate CRNA value. Eventually office management and additional representation grew into a management company contract and an Executive Director role for Sandra Even… long known to California CRNAs through her management role with their state professional association.

With this format, KPNAA has negotiated two very successful contracts within the LMP framework of Interest-Based negotiations while advocating for its membership through information sharing and the ‘above grievance’ Issue Resolution process. KPNAA has evolved and embraced ongoing adaptation as KP and the entire healthcare industry flexes and changes to rapid market cycles. Integral to this direction is a streamlined Executive Board that communicates frequently and in depth, a region-wide Board of Directors from each facility that efficiently exchanges information and strategy. Frequent high-level contact with KP and SCPMG leadership maintains strategic alignment and clear understanding of CRNA value in the interest of both employee and employer.

Most recently KPNAA has evolved to the point that our Board recognized the need for member specific education opportunities and the utility of providing continuing education credit for relevant clinical content. Where our meetings had been at small KP venues in the past, KPNAA now enjoys large scale member attendance at annual meetings each January that attract great clinical presenters, key KP speakers and content focused on growing CRNA value within the KP-SCPMG anesthesia care team model.

The KPNAA of today is increasingly intent on fulfillment of its vision: Professional Excellence through Advocacy, Unity and Vigilance. These pillars of professionalism are nurtured in the interest not only of our membership and the Nurse Anesthesia profession but primarily for the benefit of the patients that entrust us with their lives.