National Nurses United

healthcare shifts toward telemedicine or virtu- al care," said Melinda Billings, a Kaiser call center RN in Sacramento for 16 years and also a quality liaison. "It's up to us nurses to fight back and make sure we make Kaiser prioritize patients over profits." Why this use, or rather, misuse of call centers? Billings homed in on the motive: profit. Just for 2017 alone, Kaiser added more than 1.1 million new members to its rolls and posted astound- ing profits of $3.8 billion, according to its financial statements. Kaiser nurses throughout the system say that the giant healthcare corporation has only been able to achieve these financial gains through a variety of cost-cutting measures: lowering labor costs by short staffing on registered nurses and substituting in lesser-quali- fied and more inexpensive staff; keeping patients away from the hos- pital or in-person appointments by directing them to online and telehealth services; and by discharging or processing as quickly as possible the patient members who do make contact with the system. Kaiser has long envisioned a future where most patient care is provided virtually, and it has not been shy about promoting that model. By whittling away at the standards and routinizing the care provided by call centers, AACC nurses are worried that Kaiser is only a hop, skip, and jump away from automating the call centers and eliminating a live registered nurse—or human, for that matter— at the other end of the line entirely. In this brave new world, patients would only get to "talk" to a computerized phone menu: Press 1 for chest pain and press 2 for abdominal pain. So why do call center nurses keep on doing what they do even though they feel disrespected by Kaiser, are under so much enor- mous stress and management pressure to work harder, faster, longer, and are in danger every passing year of being replaced or superseded by lesser skilled staff or even automation? The answer is simple: They love helping their patients. "Here at the call center, we touch many lives every single day," said Magtanong-Sigua. "It's the ultimate problem solving job because we get everything. And you can get right to the person that wants the help and fix it right there and then. When I get a mom and baby with fever, I can educate her and tell them what they need to worry about and not worry about versus waiting until the morn- ing for an appointment. They feel good afterward." Roth feels similarly. "You have to be really creative. You can't see, touch, smell the patient, but talking to them can paint an incredible picture. It's an incredibly intellectual and challenging job. Their eth- nicity, culture, age all come into play," said Roth. "You can help them." * * * Kaiser's call centers came about as a result of consolidation of existing nursing advice services provided via telephone from various departments, clinics, and doctors' offices. Back in the day, patients would call these settings directly and a secretary would line up calls for patients needing to speak to a registered nurse. The system was pretty unwieldy, though, and Kaiser in 1997 opened up call centers staffed by RNs where it could route calls from all members. There are currently three main call centers in Northern California: one in Vallejo, one in Sacramento, and one in San Jose. Vallejo is the largest, with approximately 400 RNs; Sacramento is next, with about 375 RNs; and San Jose has about 140 RNs, for a total of more than 900 RNs. There are call centers in Colorado, Maryland, and Southern California as well, though newspapers recently reported that there will be a total of some 700 layoffs of employees between its Baldwin Park, Woodland Hills, and Los Angeles call centers— likely teleservice representatives. The main reason a Feb. 19, 2018 San Gabriel Valley Tribune arti- cle stated for layoffs at the Southern California facilities is to save labor costs by moving the positions to lower-paying areas within California. Because TSRs in Southern California are represented by different unions that have bargained different wages, these workers in effect have tiered wages depending on where they live—what's known as regional wages. This is a model that Kaiser has proposed in this current round of bargaining with Kaiser nurses, but one that CNA rejects for its members. At the same time, Kaiser is establishing additional call centers in other states such as Georgia; in October 2016 Kaiser opened a 150,000 square foot center in Duluth, Ga. that houses up to 1,000 employees. "The move to the new center is part of a national initiative to operate all Member Service Contact Centers as a shared service 26 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G J A N U A R Y | F E B R U A R Y 2 0 1 8 "The people who are not that sick, who have means, who know how to navigate the system, they're all going to go online. The ones who are sickest, who are elderly, who may have English as a second language, are going to call us."

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