A new direction for nurse unionism

A NURSE I work with recently raised her concerns with supervisors about understaffing and patient safety in the emergency room. While she spoke to two different people on two different occasions, she was given the same exact response: "You're lucky to have a job."

In short, she was told to shut up, keep her head down, and do her job without asking questions. This sort of blatant disrespect to health care workers on the front lines of a broken system is rampant across the industry. In these tough economic times, managers think they can get away with this because of the fear of layoffs amid the bleak economy.

To be sure, the health care industry has continued to create jobs during the recession, and it will see 20 percent employment growth above 2006 levels by 2016. According to the Bureau of Labor Statistics, since the official start of the recession in December 2007, more than 600,000 jobs have been added to the health care industry, even as the economy overall has shed 7.7 million jobs over the same period.

However, the pace of health care jobs being added has slowed in the past year. Some hospitals across the country are seeing cuts in Medicaid payments, while many public hospitals are facing layoffs due to state budget constraints. So although the health care industry is generally seen as recession-proof, 2009 was a high point for mass layoff incidents, defined as 50 or more workers from one employer.

In other words, the recession is hammering health care, too. As people have lost their health insurance following the loss of their jobs, the number of hospital visits have declined, cutting into hospital income. This only guarantees a future crisis, as the health of the uninsured goes unmanaged and deteriorates. The result will be more visits to emergency rooms and public hospitals, which will add further strain to an already stressed system.

It's unclear how the impending health care reform will affect this trend, as its implementation is still years off. But the proposed reforms will ultimately do nothing to fix the underlying problems, since it leaves insurance companies in charge of the system and mandates people to buy their faulty products.

All this means more pressure on health care workers, including nurses. In fact, some 20 percent of the 2.4 million working nurses are already organized, compared to an overall unionization rate of 12.4 percent. While it's not much cause for celebration when this low marker is exceeded, it does highlight the potential to organize many more nurses in the near term.

For nurses, the union advantage is clear. Unionized nurses make an average of 5 to 10 percent more than their nonunion counterparts, get better health benefits, and receive more vacation and breaks. So a newly formed national nurses labor organization--National Nurses United (NNU)--has great potential to grow.

THE NNU was formed December 7 at a special convention in Phoenix. This gathering was the culmination of a process that was publicly kicked off in May of last year, when the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC), United American Nurses (UAN) and Massachusetts Nurses Association (MNA), along with several other nurses' organizations, cosponsored a National RN Day of Action in Washington, D.C.

Between May and December, resolutions adapted by the CNA/NNOC, UAN and MNA approved the formation of NNU. Some of the meetings to discuss the merger were highly contentious, with lively debates taking place within the MNA. An unsuccessful legal action by the Illinois Nurses Association, a UAN affiliate, attempted to block the merger, and three of the seven members of the UAN executive council opposed the unification.

Today, CNA/NNOC represents 83,000 nurses, while MNA has 23,000 members. UAN is 45,000 strong, with 80 percent of its members based in Minnesota and Michigan. As the NNU, they together represent some 150,000 nurses. Although each union will largely retain its independent structure and staff, this is a step in the direction of a complete merger in the future.

Given nurse unionism's history of fragmentation, this unification is an important step toward giving nurses a stronger voice.

All of the unions that now make up NNU have their origin in the American Nurses Association (ANA). While the ANA was established at the turn of the last century, it was only certified as a labor organization in 1949. Its collective bargaining work is one aspect of many, and it is an organization dominated by management.

For example, in many states, the collective bargaining wing of ANA affiliates is subordinate to the association's board of directors, which are often controlled by employers and hostile to unions. Thus, the board of directors of the New York State Nurses Association (NYSNA) in December 2007 voted to disaffiliate from the UAN (and the AFL-CIO), despite a poll showing the membership desired the opposite. Indeed, the inability of the ANA to effectively meet the collective bargaining needs of bedside nurses has led to several splits over the years.

The CNA was the first to leave the ANA in 1996, followed by the MNA in 2001. The UAN was formed as an autonomous affiliate of ANA in 1999, in an attempt to solve the contradictory role that the ANA has played as both a union and a professional organization. But the UAN furthered its independence from the ANA in 2003-04 by establishing its own finances, dues, staff and constitution. Finally, in 2008, the ANA unilaterally terminated its relationship with the UAN.

Parallel to this process was the formation of the National Federation of Nurses (NFN). As the unity within the UAN began to break down, a group of six state nurses’ associations, led by NYSNA, met in Portland, Ore., and founded a new federated organization in April 2009. The NFN claims 70,000 nurses, stresses the autonomy of each member organization, and is aligned with the ANA.

WHILE THIS alphabet soup of division, reunification, affiliation and disaffiliation seems confusing and unnecessary, it should be seen as part of the overall debate in the labor movement about the strategies and tactics that unions should take.

A recent article in the ANA's journal advocated what is known as interest based bargaining (IBB)--a euphemism for partnership with management:

The ANA and its constituent states have used traditional CB [collective bargaining], particularly during nursing shortages, for the past 60 years to improve the economic and general welfare of nurses. Now, in the last 15 years, non-traditional CB, labeled interest based bargaining [IBB], has emerged as a strategy that leads to more satisfying collaborative relationships than those resulting from traditional CB. Based on the recognition of common goals and mutual interests, IBB can foster relationships such as those found in successful shared governance settings.

Representing a contrasting strategy, the CNA/NNOC organized for a one-day strike of 13,000 nurses across 32 facilities owned by Catholic Healthcare West (CHW) in California and Nevada--and the company folded just days before the scheduled walkout. This battle won the nurses a master contract with a common expiration date.

According to the union's magazine, "Despite the recession, the CHW RN bargaining team was able to ultimately extract a contract that included no takeaways. All RNs will receive a 20 percent raise in compensation over four years, in addition to normal step increases."

Since 2001, UAN nurses in Minnesota, Michigan and Kentucky have all struck employers, as well as MNA nurses in Boston.

It would be inaccurate to assert that only the unions that have formed the NNU have gone on strike in the past decade, and those that now make up the NFN have not. But it would be accurate to characterize the NNU as representing the more militant and aggressive of the two nurses' organizations.

As part of the NNU founding convention, delegates marched on the American Hospital Association in Phoenix. Jean Ross, one of the new co-presidents of the NNU, spoke at a nurses' rally:

Hospital associations around the country oppose safe staffing legislation that guarantees patients the care the care they need, and with their allies intimidate RNs when we try to organize a union. That intimidation must stop.

We know that union RNs provide quality care, better care because we have real power on our units, to speak out and advocate for our patients. We also know that America is hurting. As nurses, we see the consequences every day. We know that at the heart of the current crisis is the stagnation of wages, the erosion of living standards and the loss of buying power for American workers that has coincided with three decades of attacks on the rights of American workers to form unions and bargain collectively.

The NNU also set several political goals for itself, including passage of national legislation to guarantee minimum nurse-to-patient ratios and quality health care for all as a human right. Now that NNU is the largest single union of nurses, the possibility of winning such reforms becomes more achievable. But the fact that some 2 million nurses still remain unorganized means that our work is cut out for us.