Both sides in the showdown between Christus St. Vincent Regional Medical Center management and the union that represents nurses and technical workers at the hospital are attempting to rally public support as negotiations over a new three-year contract reach an impasse.

The union began to picket the hospital this week. Meanwhile, the hospital has been purchasing advertising in newspapers with slogans such as "Christus St. Vincent is safely staffed and open for business."

On Friday, Aug. 1, St. Vincent top managers and board members convened in a room on the bottom floor of the hospital. They had invited reporters with Santa Fe's print media to explain the role of the quality control committee, an 18-member group comprised of staffers and board members that analyzes clinical and patient outcomes to help improve care at the region's largest hospital.

The lunchtime meeting came a day after a three-year contract between the hospital and its nurses and technical workers expired in the wake of a standoff between Christus St. Vincent management and District 1199 of the National Union of Hospital and Health Care Employees over provisions for a new contract. The union represents some 400 nurses and 100 technical workers at the hospital, and Monday members began picketing outside the hospital with clergy and others.

The negotiations over contracts that will cover about 500 employees at the region's largest hospital center around a fundamental question: What constitutes safe levels of staffing that ensure the best patient care and good working conditions?

District 1199 is asking management that staffing levels for nurses meet the 50th percentile when compared to similarly sized hospitals, meaning that the amount of hours a nurse spends directly with patients per day would be higher than at half of peer institutions and lower than at the other half.

The union also wants a mechanism etched into the new contract that would allow a third-party arbitrator to enforce that language if staffing levels dipped below the mark. For technical employees, the union wants staffing levels at the 33rd percentile. The union even told the hospital that it would forgo about half the pay incentive offered by management in exchange for its desired staffing levels. Christus St. Vincent didn't take the bait.

Those turns of the screw show there's more debate about staffing levels than pay. The union previously put on the table an offer that would have nurses staffed at the 40th percentile along with a mechanism to enforce that contract language. Yet union members told District 1199's negotiating committee they don't want to settle for the 40th percentile. So union delegates upped the ante and asked for the 50th percentile. Hospital management, which recently offered the 40th percentile without an enforcement mechanism, responded by reverting to a previous proposal that doesn't include any specific number for staffing levels.

Bruce Tassin, Christus St. Vincent CEO, says the percentile isn't what matters in providing safe staffing for the 300,000 patient the hospital serves annually.

"It's not about the number of bodies on a unit. It's about efficiencies," he told reporters at the Aug. 1 meeting. "It's about processes. It's about how you work as a team."

He says he couldn't answer how much it would cost the hospital to agree to staff nurses to the 50th percentile. Management will only say they want to remain financially flexible to ensure a good response to national health care reform.

Chief Nursing Executive Christine Kipp offers another puzzling factoid: "Several years ago, when we had a higher level of staffing…our quality numbers were actually lower and our patient satisfaction numbers were actually lower."

Fonda Osborn, District 1199 president, isn't having it.

"She's the one responsible for this mess," Osborn says of Kipp.

Osborn was sitting in a lawn chair pitched on a sidewalk outside the hospital Aug. 11 as union delegates and supporters solicited honks from passing cars, waving signs that read: "If RNs are outside, something is wrong inside," and "Santa Fe deserves safe staffing." The picket, Osborn says, is good practice for a full-blown strike.

Osborn rejects at the notion that there's no direct correlation between patient safety and the percentiles for staffing levels. The union distributed pamphlets referring to research and newspaper reports that back up the idea that lower nurse-to-patient ratios means lower patient safety levels.

It's an issue the two sides have been debating since 2011, during the last round of contract negotiations that ended in a three-year agreement on paper but never an agreement about how the hospital should staff its units.

"Here we are," Osborn remarks on Monday's picket line. "Still the same issue."