Rubbing her temples to soothe a splitting migraine, an off-duty nurse sits alone in the lobby of the Oldemeyer Center in Seaside on a September afternoon as dozens of her co-workers file into a nearby conference room. Many of them dressed in scrubs, the nurses all work at the Community Hospital of the Monterey Peninsula (CHOMP). They are meeting with the organizing director of the California Nurses Association (CNA), a union and professional organization, dating back to 1903, which represents 45,000 registered nurses in 150 facilities across the state.

The off-duty nurse (who declined to give her name) would be inside the conference room too but her head hurts too much. A few days earlier, the hospital administration had announced major changes to the health benefits for all CHOMP employees, including 550 registered nurses. It was a surprise and the news was bad. Under the sudden repackaging, at the beginning of 2003, their insurance premiums would increase slightly. Worse, they''d have to cash out a benefit covering long-term disability, and would receive only a percentage of its value.

To many nurses, this accumulated time-off was like a savings account, in some cases worth thousands of dollars, which they could plan on cashing out upon retirement.

With the September announcement, nurses promptly came unglued. The nurse in the lobby at the Oldemeyer Center says she was stunned.

"The nurses are upset enough that we feel maybe we need some representation," she says. "I''ve been here 20 years and this is the first time the nurses are talking about getting together."

Nurses at CHOMP politely boast about their good reputation, and the nurse with the headache thinks the administration needs to realize that part of CHOMP''s good name can be attributed to the care nurses give patients. The announcement knocked them off their feet. She says they felt that they had not been consulted, just told.

"It came out of the clear blue," she says.

Later in the afternoon, when the day shift got off, even more nurses, including nurses who work days because they have seniority, would fill the meeting room. Scores would arrive. More would show up for follow-up meetings in later weeks.

At the start of 2003, CNA, the largest nurses union in California, is approaching CHOMP''s hundreds of nurses. At the same time, the Service Employees International Union (SEIU) has reportedly been approaching CHOMP''s housekeepers and custodians too. On top of the union pressure the hospital already has some major irons in the fire. Tucked into woods atop the Peninsula on Highway 68, CHOMP is in the midst of a $150 million capital improvement program that will dramatically expand the size and scope of the facility.

In the face of this expansion, as well as pressures from rising health care costs for its 1,844 employees, administrators are fighting to keep the unions out.

Hospital management distributed a series of newsletters "explaining" what unionization means. Executives held open forums with staff. Bulletin boards, which had been open to any posting for years, suddenly became off-limits when union literature showed up; nurses say that photos, thank-you notes and party announcements came down.

The administration has gone so far as to hire a notorious, expensive Malibu-based labor consultant known as The Burke Group, which has been accused by unions of repeated labor law violations and brags about its defeats of union-organization attempts.

Eventually, CHOMP retreated. The changes to the health plan that caused the most trouble were revamped.

Whether or not the nurses unionize will be up to a vote-which could come as early as next week. Soon they will decide if they choose to carry a union card along with their stethoscopes and pagers.

CHOMP describes itself as an "integrated healthcare delivery system," with 200 doctors pulling the levers and switches. The hospital began as a specialized clinic devoted to researching metabolic disorders-with money from the John Deere tractor fortune-and became the non-profit Community Hospital in 1962.

Since then it''s gone through numerous expansions and add-ons. Relying on donations, it added 72 rooms and a mental health center in 1971. Twelve years later, an outpatient and business office wing was added. More changes were made in 1991 with a rehabilitation department; in 1996 a birth center; in 1999 a cancer center. Now the hospital is taking on an ambitious growth plan. It plans to spend $150 million-only $20 million of which from donations-on two new "patient care pavilions," as well as a major upgrade of its current space, creating a total of 227 private patient rooms. There are also plans for a $34 million facility at Ryan Ranch.

In order to pay for it, the hospital at one time said, "We will draw from a combination of the hospital''s reserves, funded depreciation assets, and excess operating revenues generated during the project." So far the hospital has raised $17 million in donations and, says one official. CHOMP now plans to finance the rest of the project with bonds.

According to promotional literature geared toward project fund-raising, CHOMP has outgrown its space. The emergency room has a capacity for 12,000 patients a year and treats 43,000. As many as 55,000 patients are expected in three years. The plan is to "quadruple" the size of the ER.

The intensive care unit handles 1,200 people a year and expects 1,750 five years from now. It will be doubled from 10 beds to 20. CHOMP also wants to be able to handle patients needing major heart care.

Due to changes in medical technology, the hospital also complains that there isn''t the square footage in its operating rooms for modern medical machinery. As far as machinery, CHOMP has some of the best. The hospital operates two $2.5 million state-of-the-art devices that pelt tumors with "a photon beam of ionizing radiation." The machines hulk in two cement-and-lead-encased vaults, each with three-foot thick walls and a 15,000-pound lead-filled door. It''s complete with a CD player and ceiling-mounted photo of Lovers Point to calm anxious patients who must go through the procedure alone.

In addition to its high-tech gear, CHOMP boasts-by all accounts justifiably-of its healing environment. To take a walk through CHOMP today is to see what must be as pleasant a place as a hospital can be. Compared to some well-worn city hospitals made of cold steel and linoleum tile and illuminated by sickening white light, CHOMP is cozy. The walls are lined with art of all kinds, from a whole corridor of flowers in vases to modern art to an entire pediatric unit with walls covered in drawings and paintings by the late Hank Ketcham, creator of Dennis the Menace.

In the center of the hospital is a wide open sky-lit atrium, under which is a goldfish pond the size of an outsized swimming pool. Smiling volunteers can be found around every corner. A harp player is brought in to play near the fishpond. In two waiting areas, anxious family members or friends can sooth themselves with digital art galleries, an electronic carousel of masterworks. Although hospitals can be places of heartbreak and pain, CHOMP is as idyllic an environment as can be imagined.

On a Friday just before Christmas, employees were crowded into a large upstairs room for the annual holiday craft fair. Even the hospital president, Steven Packer, was there checking out the goods. From the jolly cheer it was not apparent that the hospital was fighting off a union, causing pressure that made for some awkwardness between staff and management, according to some nurses.

Despite happy events like the craft fair, the possibility of unionization has made for some tension at the top.

Cynthia Peck is a vice president at CHOMP. She has the serious manner you might expect from a hospital administrator. She has worked for CHOMP for 13 years.

Peck doesn''t see the attempt at unionization as something from within, but as an outside intruder, a business move by the union to scoop up the hundreds of nurses. She characterizes the CNA campaign as an "active effort to grow membership."

"We know we''re a target," she says.

Peck says she knows that there have been paid union representatives in the hospital recently. She says she''s never met with anyone from the union, but that they had "feelers" out earlier in the year.

Peck claims there have been attempts before. But unlike almost every other hospital in the state-including Natividad Medical Center, Salinas Valley Memorial and Domincan in Santa Cruz-CHOMP has stayed void of organized labor. "It''s been that way because of the staff''s choice," she says.

Above all, Peck says CHOMP prizes its special culture. She says the management and staff have a warm and open relationship with easy channels of communication. Although the handling of the benefits changes would seem to contradict that, she says it''s that relationship within the hospital that management wants to preserve.

"We believe this is a culture that allows communication at all levels of the organization. I''m an administrator and I get questions and comments from all levels of the organization," she says. "We actually have a policy that encourages that."

Bringing in a third party-that is, union labor negotiators-would jeopardize such openness. Peck says there''s no way to predict what a union mean in financial cost to CHOMP but the culture would be forever shifted.

"Very clearly having a third party intermediary would change that environment. That third party is people who don''t work here-who don''t even live here. That''s not the same as we have now, which is very open communication."

The hospital is proud of its policy, in which "patients come first." It insists on shared values within the organization. Being sure staff is helpful is something Peck says earns compliments from patients and visitors. To counter claims that staff needs a voice, Peck says the hospital management has an open-door policy, a formal grievance policy and regular employee forums where 20 or so staff members are invited to lunch and discussion with management.

"We want to stay union-free, but we recognize it''s our staff''s choice," she says.

In order to bolster that feeling of open communication after the September benefits debacle and concurrent union campaign kick-off, the administration held 18 forums hosted by the "executive team" to explain to staff what the changes in benefits mean. She says about half the staff attended.

Peck maintains that CHOMP''s pay and benefits are nothing to complain about. She touts a marketplace survey that places CHOMP''s salary and benefits in the 75th marketplace percentile, or better than three-quarters of what''s out there.

"We know our benefits are exceedingly competitive," she says.

But CHOMP is vulnerable to the same troubles that plague any American employer today. It has to deal with rising health care costs and although nurses have had a cushy deal in the past, the hospital says it just can''t carry the whole load any longer. CHOMP''s own health care costs for 2002 were $19 million.

For the first time in 15 years, CHOMP raised the premiums it charges its employees, which took effect Jan. 1. Amid double-digit increases elsewhere, Peck says, the employees are being asked to contribute a bit more. A full-time employee with three dependents who paid a $40 premium per pay period will now pay $44.75.

As for the requirement that nurses cash out their accumulated disability pay: the strong reaction to that change caused management to reverse their decision. "We heard from a lot of people who said that has tax consequences for them as well as other objections. About a week later we said, ''Ooops. Nevermind''."

The benefits changes were just inevitable, and Peck says there is "no link whatsoever" between capital improvements and the benefits changes. It''s a fact, she says, that costs climbed 30 percent from 2001 to 2002.

"It''s a nationwide phenomenon," she says.

In a memo announcing changes back in September, the administration told employees, "The patients we serve simply cannot afford to bear the rising cost of this very generous benefit."

About the previous package, Peck says, "We all knew it couldn''t last forever."

In a move they say was designed to facilitate better communication, CHOMP hired the Burke Group. Peck says the consultants told the hospital how to "stay legal" during a union campaign and how to comply with tricky federal labor rules.

"The Burke Group understands the rules in a situation where a hospital is being targeted by a union. They can help put us in the right direction," she says. She compares it to the hospital having to build a garage; it''s not their usual line of work, so they need some outside help.

But Burke''s reputation precedes it. At the Enloe Medical Center in Chico, the consultants-or "union-busters" as the nurses call them-enraged nurses on the verge of unionizing by running local newspaper ads implying that nurses care more about money than patients.

Burke is also not afraid to bend the rules. In 2000, the National Labor Relations Board (NLRB) filed a 26-count complaint against Long Beach Memorial Hospital for a Burke Group-run campaign in a CNA representation election.

At CHOMP, CNA has already filed a complaint with the NLRB, alleging that in the period Burke was in town, union information was pulled off bulletin boards, pro-CNA nurses have been prohibited from using employee mailboxes, and CHOMP management created "an impression of surveillance." The complaint also alleges that one registered nurse was forced to "work a different and more onerous schedule because of her support for CNA and to discourage her participation in the CNA campaign."

Peck says it''s baloney.

"Those claims are completely without basis," she says. "None of these charges are true. We''ve done nothing wrong. We look forward to arguing our position to the NLRB."

Whatever Burke did at CHOMP is vague. The company would not comment about its work for this article. A woman who answered the phone at the Malibu office was tight-lipped.

"We don''t give out that information," she says. "We''re not at liberty to give out information about what we may or may not do."

"They presented us with some ideas," Peck says. Whether or not Burke can be given credit, Peck says management believes the union threat has subsided, as they hoped it would. "We''ve certainly seen a lot less activity lately."

Although the union advocates claim Burke is a union-buster their work at CHOMP was subtle. Peck says anti-union groups do offer a proactive service called "third-party persuasion" but that choice was not exercised.

"We didn''t hire the Burke Group to do that kind of thing. It''s not appropriate in our environment," she says.

Andrew Stevens is a former Yosemite ski instructor and mountain guide-professions for which he was a union member. He''s now a nurse manager in transitional care at CHOMP. His wife is a union nurse in Salinas. Of the 100 nurses in his unit, he says, only five or six are enthusiastic union supporters.

"There''s been quite a lot of pressure in both directions," he says. "It hasn''t ever gotten too nasty. It''s not even 50 percent in support of the union because if it was we''d have a vote...No one really knows what the support is."

Stevens, speaking in the conference room in the administrative section (with the head of the hospital''s communications and marketing arm present) says working conditions at CHOMP are "good to excellent." He says he feels like he can talk to management anytime, and would rather not have a union representative speaking for him.

"This place has been very good to me and I don''t see the need for a union here," says.

He acknowledges, though, that management screwed up its unilateral presentation of the benefits changes back in September.

"It was not done as well as it could have been done," he says. "That''s clear."

Others nurses agree with Stevens.

Two days before the New Year, a group of five nurses gathered in a basement conference room. They were either done with a day shift or partway through one. Again, a representative from the communications office sat with the nurses as they spoke about CHOMP and the union.

Molly DeFont, Susan Alfaro and Kathryn Sliter all work in the oncology department. Much of the work is active care of cancer patients through chemotherapy and blood transfusions. Many cases are terminal.

"We''re the end-of-life floor," DeFont says. "When people are dying they come to us."

All three went to the CNA meeting in September. Although all say they''re not against unions, the meeting did not win them over, despite their anger over benefits changes.

At the union meeting, Sliter rose to urge her colleagues not to make any decisions based on emotion.

"I wasn''t received very well. I had a lot of people getting loud and interrupting me before I could complete a sentence. There was a lot of emotion. A lot of emotion," Sliter says. "The downright putrid thing is the idea of a nurse walking off the floor over something like money. I don''t want to be forced to do something against my principles."

"People started yelling at her," DeFont adds.

Alfaro simply thinks a union isn''t needed. After the initial uproar over the benefits changes, the administration has made enough corrections to keep her happy.

"I am satisfied with the changes. There are also some things I misunderstood originally," she says. "I don''t consider myself an anti-union person, but at this time I don''t see a union as a benefit because of the dues I''d have to pay."

The three nurses are soon joined by two nurses from the Intensive Care Unit-Robin Janiszeufski and Kevin Knapp. To them, a union couldn''t make anything better than it is now.

Janiszeufski''s husband is a union carpenter. She was a union member at a hospital in Oakland. She knows of some problems at CHOMP that need fixing, such as nurses having to use paid leave for sick days in the first week of any illness. But she thinks a union is not the answer.

"It''s very important before you step into that realm that you understand what that means. I''ve lived through a union and it''s not a cornucopia. I don''t think we''re being mismanaged," she says. "We need to look at the big picture. This is a very unique situation and I don''t say that to be righteous."

Janiszeufski says she had prior experience with the SEIU in Oakland, and that it was not all pleasant. When union hospital housekeepers struck, the nurses couldn''t cross the picket line as fellow union members. Janiszeufski had to because she was on a core team that worked in the ICU despite the strike. She was also a union negotiator.

"It can get really rough," she says. "I had people assume I was a scab and here I was negotiating benefits on their behalf, negotiating their contract. I was floored. I think we really missed the boat here. I mean we''re not coal miners. Look at the cars in the parking lot and tell me people are really hurting here. Hello?"

For the union, the hospital''s botched move on benefits could not have been timed better. They were already approaching the nursing staff about organizing prior to the announcement. With the one-sided move by management, the nurses fell right into their hands. Maybe.

Union rep Lorna Grundeman is an Intensive Care Unit nurse at Domincan Hospital in Santa Cruz. She''s taking time off to organize the nurses at CHOMP.

"Those first meetings were outrageous. They were crazy. People were so upset that their sick leave was going to be taken away from them and they weren''t being consulted on any of it. They felt like they had no voice."

The proposed changes rattled the nurses because they felt powerless. The union might give them that power. Having contracts and a negotiator would give them the power.

CNA also does legislative work on behalf of nurses, such as setting statewide patient-to-nurse ratios. That sounded good, too.

Sally Robins, a nurse in the psychiatric unit says nurses should have written guarantees. "We have nothing in writing," she says.

"That''s what''s so frustrating to the nurses. We are professionals and we deserve that."

For Beth Kean, a CNA organizing director based in Oakland, the CHOMP nurses are an impressive bunch. "It''s a very, very determined group of people," she says. "I think the nurses feel a lot less confident that the administration has their interests at heart and that''s why nurses unionize.

"Their major concern is they don''t have a voice and they want what a contract allows you to do, and that''s sit down and negotiate."

One thing Kean complains about in the revised health plan is a provision that short-term disability leave does not take effect until the eighth day of illness. Until then, a nurse has to use sick time.

"It''s very draconian," she says. "It''s a big cost-saver. Typically people are only sick for a day or two."

It''s not clear, however, how well the campaign is proceeding. Although a majority vote would suffice, Kean says the union will not take a vote until it has at least 65 percent of nurses signed up.

"It''s going very well," Kean says, although she declines to give specific numbers. "I''ve been working with CNA for a long, long time and I''m confident we''ll get to an election."

"It''s like a democracy. Without a union there isn''t a democracy and management has the last say. Always."

One of the CHOMP nurses who is pushing for union representation is Angel Look. She is a labor nurse in the family birthing center. She''s worked at the hospital for 16 years and makes $41 an hour. She''s never been in a union. Contrary to the impression that the union threat has subsided, as articulated by management, Look says a vote is coming.

"Everybody is still fired up about it," she says. "We''re getting to the point where we might be able to call a vote soon.

"Everybody up there is pissed because across the board, everybody got their benefits cut back."

It''s the Saturday afternoon before Christmas and Look has just come off a day shift. It was not a very noteworthy day. No births, but plenty of chatter about the union. She chuckles because the birth center-where women give birth and babies are tended to in a nursery-has somehow become a "hotbed" of union organizing. For one thing, she says, a well-liked housekeeper in her unit was laid-off for a day for allegedly giving employee phone numbers to union organizers. It didn''t go over well with Look and her colleagues. They contacted the union right away, which filed a complaint.

"They picked on the wrong person," look says.

Peck says no such thing even happened.

Look says things had been going along pretty well for a while. Life at CHOMP was living up to its reputation as a good place to work. She says, though, that she noticed in recent months a more corporate feel where there wasn''t one before. All of sudden there was pressure to be more efficient, to save money. When Look''s unit hung up a congratulatory sign for a co-worker they were told to take it down, she says.

Look worries that if hospitals do not treat their nurses well, there won''t be any. She suspects a connection between the pricey construction project and the benefit cutbacks.

"If you''re spending all that money you''ve got to cut elsewhere to pay for it," she says. "They''re going to have this huge thing open up and they won''t have any nurses to staff it."

As for management''s attempts to placate staff with its "Open Dialogue" newsletters, Look says she and her co-workers get a kick out of them. The newsletters set out to explain union issues in a Q&A format, but none of the nurses supposedly writing out questions are ever named. Look says no one she knows has ever written a question and the anti-union angle is nothing more than "propaganda."

"No one has ever said, ''I think I''m going to write a question''," she says. "Somehow all the answers are in management''s favor and they make the union look bad, like it''s going to take over your life and make all your decisions for you."

Management insists that all the questions are genuine.

Not only have the open dialogues been a source of humor, but management''s retroactive approach to open communication got some cackles too.

"Then they started the open dialogues and that was what the joke was, ''Why didn''t they ask us what we want before the changes, not after them.'' It''s all so phony now. It''s plastic. There''s nothing genuine in it."

Although she''s made it 16 years without a contract, without guarantees, the benefit switcheroo has her and others pushing for CHOMP''s 550 registered nurses to join the other 45,000 California Nurses Association members around the state.

"The most important thing is we''ll have a say and we''ll have a contract that backs it up. There''s some security with that. Without it, they can jerk us around as much as they want."