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New WWW Based Nursing Journal!
Nurses Empowering Nurses (sm)
Harold Stearley, RN, BSN, CCRN
Staff Writer and Board
Health Care: The Great American Hoax
Volume 6
by Harold Stearley, RN, BSN, CCRN

The Rise and Fall of the Nursing Union 
Appearing in Revolution: The Journal of Nurse Empowerment Summer Issue 1995, Volume 5, Number 2, Pages 56-59. 
As restructuring of our health care system continues, nurses are being escorted out the door faster than ever.  Layoffs for nurses are at an all time high.  While managers speak the psycho-babble of their armchair vocations, replacement of professional staff with unlicensed personnel is escalating.  Elimination of professional staff nurses will, according to management, translate into an opportunity for advancing our professional role as "patient care coordinators."  What garbage, a "sanitation engineer" stills empties the trash.  A "patient care coordinator" still follows the nursing process to intervene in all aspects of patient care - only now we will have more patients per nurse.  We also know, if we direct all of the newly acquired unlicensed personnel, we will be held liable for their actions - or inactions.  Our licenses are in increasing jeopardy, and simply because we are ruled by greedy administrators who value the all-mighty dollar more than compassionate, skilled nursing care.  In light of these recent developments, nurses have turned to professional associations and labor unions for support only to find yet another rug pulled out from beneath their feet.
The Supreme Court ruling on May 23, 1994 effectively demolished the last staff nurse sanctuary which offered protection from abusive management practices.  In the case National Labor Relations Board (NLRB) versus Health Care and Retirement Corporation (114 S. Ct. 1778 - OH 1994),  the Supreme Court upheld a ruling by the Sixth Circuit Court of Appeals stating that the nurses fired from an Ohio Nursing Home were "supervisors" and were not entitled to protection under the National Labor Relations Act (NLRA).  This ruling is far-reaching in its implications, for at a time when staff nurses are being forced to direct an ever increasing number of unlicensed assistive personnel (UAP), they have been classified as supervisors for this direction, and have lost all labor law protection because of their compulsory supervisory status.  This leaves staff nurses at the mercy of "termination-happy" administrators during the most wide-spread cycle of hospital redesign facing this nation.  Is it a coincidence that this major court ruling occurred just when hospitals were restructuring, and desired unlimited ability to indiscriminately put us in the unemployment lines?  Who knows?  One thing for sure, its time someone gave the ANA a "wake-up call" to let them know they no longer represent nurses.  Perhaps they will be relieved, as they will no longer have to bear the criticism of not having represented us in a meaningful fashion.
At the exodus of this noble nursing institution, I think its appropriate to take a look back at nursing's labor movement.  How did we arrive at today's impasse?  Who have fought nurses during their battles for decent wages, staffing, and benefits?  What glimpses of the future can we derive from administration's move to crush our representative bodies?  Maybe we can gain some insight as to just how important it has been for nurses to unite with a common voice.
Many nurses traditionally opposed unionizing.  It was looked upon as being "blue collar", or "non-professional."  There was always the fear that striking, to obtain sane working conditions, would remove nurses from the bedside, thus not even allowing the provision of poor care.  (There has never been a fear that management would voluntarily provide nurses with acceptable working conditions.) In addition, the employees of many state institutions and hospitals were forbidden by law to strike which undermined the power of unions to flex collective bargaining muscle.  Labor laws, initially, were prohibitive and denied nurses the opportunity to form separate bargaining units.  But nurses moved forward to consolidate their labor force, and gain additional leverage.
In 1974 the Taft-Hartley Act was amended by Congress allowing non-governmental, not-for-profit, hospital employees the right to unionize.  The National Labor Relations Board (NLRB) had fought hard for these changes, and continued to fight for nurses to have the right to form their own separate bargaining units.  Having an independent bargaining unit would allow nurses to concentrate on issues specific to the their own profession - as opposed to incorporating issues specific to other hospital departments such as clerical workers and housekeepers.  As of 1991, the Supreme Court affirmed eight bargaining units per hospital allowing nurses to form separate units for collective action. Who do you suppose fought these changes which would favor nurses?  You guessed it, the American Hospital Association (AHA), composed of administrators and physicians, have opposed any legal action which could possibly benefit nurses.  This is why it took so many years, and court battles, for the NLRB to win us these rights.  It's time for nurses to recognize just who their enemies are, and what they do to strip away their power.  To understand the opposition all one has to ask is, why is the AHA so afraid of nurses organizing?
With health care costs continuing to go off the scale, and the public outcry for cost cutting, hospitals want to be able to freely cut nurses and nursing wages.  Labor traditionally accounted for at least 60% of hospital costs, and nurses make up almost 50% of a hospital's labor force.  A study of current statistics show that labor costs actually dropped from 67% of hospital expenditures in 1962 to 54% by 1992.  In contrast hospital administrative costs have risen by 180%, and capital expenditures have risen by 36%.  While RNs are being laid off, hospital profits are up almost 20% this year alone, and hospital executives have experienced an average 12% increase in compensation every year for the past ten years.
So while it seems that hospitals are making plenty of money, and hospital administration is making plenty of money, hospitals are lowering expenses by eliminating those of us who provide the direct care for patients. Eliminating expenses (nurses) has not translated into lower costs for consumers, but rather, higher profits for hospital administration at the sacrifice of quality care for patients.  According to Webster's dictionary, a professional is someone who gets paid for their work, and while nurses do work in an altruistic occupation, and give of themselves in many ways, they deserve just compensation for their efforts.  It would appear that hospital administrators have enormous resources from which to compensate nurses - if they were willing to do so.  Losing the power of organized labor will make just compensation a very difficult issue to press.
After the 1991 ruling on separate bargaining units, and recognizing the growth in staff nurse resentment, management journals began advocating ideas to prevent nurses from organizing.  Actually, most of the articles I read offered good suggestions. If you treated your employees with respect, open communication, retained your expert staff, provided nurses with the equipmentthird party malpractice insurance company involved, then this is all the better.  After all, in this manner, the practitioner buys their way outof the crime, there is some restitution, and we do wish to promote the
practice of medicine not discourage it.   It should be noted, however,that this system of civil remedies is not very effective.  The Harvard
Medical Practice Study revealed that of all the of patients estimated tobe injured or killed as a result of negligence only one-eighth ever
discovered they were victimized and filed suit, and only one-sixteenthof those filing suit ever recovered any moom organizing.  Perhaps they foresaw our unions' demise, because arrogance became the management style of choice.  Apparently, administrators were not even concerned with the possibility that staff nurses could form a united front.  They rarely, if ever, acknowledged that we could be strong enough to speak up for ourselves.  Well, many nurses did mobilize to fight for better treatment, and for our patients' right to receive the care that only a nurse could provide.
So what did unionization produce for the nurses who successfully organized?  Better salaries, wages, and benefits - approximately 6% better when compared to non-unionized nurses.  Hospital administrators not only feared organized nursing for this reason, but apparently some "spillover" occurred. Once a hospital unionized, and the nurses received better compensation, the nurses at other area hospitals would receive better compensation due to the increased competition to attract skilled nurses.  It appeared that administrators had good reason to fear us organizing as they actually had to treat us with a little bit of respect, and dignity. They even had to compensate us fairly for our services.  Administrators are rejoicing the Supreme Court's ruling, and those gains in compensation, respect, and dignity have been shelved once again.
In all fairness we must examine the AHA's position on collective bargaining for nurses.  After all, they contested that there were other reasons, other than maintaining the bottom line, for opposing unionization.  The AHA points out that RNs with separate bargaining units tax the hospital system by demanding appropriate ratios between RNs, LPNs, assistive personnel, and patients.  One argument put forward was that by allowing RNs to participate in such decisions they would be defining professional responsibilities for the various categories of health care providers.  Nursing administrators have always wished to reserve the right to dictate our professional roles, and further argue if RNs determined their own roles it would create "competitive loyalties" between the other collective bargaining units when overlapping functions were divided.  Time, and discussion to resolve matters of importance between professional groups, costs money which administration has been unwilling to spend.
The AHA was also concerned that simply negotiating with another independent union would be costly.  They have deduced that contracting with all of the various hospital unions (8 bargaining units as supported by the 1991 Supreme Court decision) would result in the cost of approximately $360,000 for just one round of negotiations.  Of more concern than this increased cost was the fear that RNs would demand some form of job security.  This would eliminate management's ability to fire us at will, and it seems firing nurses is a convenience hospitals wish to protect - how else do you maintain an average 12% salary increase for administrators every year for the past ten years?
While the AHA has maintained their concerns did not center around cost, it appears that cost was their sole interest, and with the current legal ruling they can take comfort with not having to negotiate with us "bottom of the food chain" RNs.
Arguments concerning divisiveness among staff members never did hold up in light of actual events surrounding nursing strikes.  In the Winter 1993 issue of Revolution, Dawn Chipman describes the nursing strike which occurred at St. Joseph's Medical Center in Joliet, Illinois.  While there were many emotional issues involved, and their final contract may not have achieved all which the nurses desired, the nurses emerged with great feelings of camaraderie and empowerment.  Other local unions offered to intervene on the nurses' behalf, and although the nurses did not approve of the other unions' methods, or accept the additional support, it disproves the AHA's argument of divisiveness between labor groups.  Labor supported labor.  It is more likely that the AHA was, and is, worried about dealing with a strong, united group of nurses who might actually demand what they deserve!  The so-called high cost of negotiations was one reason unions worked - bargaining takes time and money, and with the dollar-clock running decisions favorable to nurses were forced.
If we want to be treated like professionals, have a voice in directing our practice, earn better wages, receive better benefits, and foster camaraderie and empowerment, I would have to conclude we need some form of organized representation.  Yet we have now come full circle.  Nurses fought the battles for over thirty years to gain separate bargaining units.  Nurses resisted great forces of opposition to achieve job security, better staffing ratios, and better wages and benefits.  Yet, in one swift ruling all of those hard earned benefits were lost.  Hospital administrations have not stood by waiting for us to react, they immediately went on the offensive.
The nurses at DePaul Hospital in St. Louis finally attained a vote for a nurse's union in late 1994.  Those ballots are now impounded awaiting a court decision on their right to unionize - brought about by their "supportive" administration.  It seems the management at DePaul spared no cost in fighting the union.  They were willing to spend over $200,000 to produce a movie, which they required all of their nurses to view, showing the AFL-CIO to be a corrupt union.  They were willing to lose a multi-million dollar contract, providing health care to members of the AFL-CIO in St. Louis, just to prevent their nurses from organizing.
Providence Hospital, in Anchorage, Alaska, has waged war against their nurses for trying to unionize. At last check their ballots for a union remained impounded awaiting a decision from the NLRB.  What ever the decision, you can be sure the administrators will pursue a conclusion in their favor.
Then we have Woodbury Nursing Home, in Nassau County, New York, where administrator Frederick White demanded his staff of twelve RNs quit their membership in the State Nursing Association or face dismissal.  The nurses discontinued their membership in fear of losing their jobs.
At Michigan Capital Medical Center, in Lansing, Michigan, administrators simply canceled the election being held on forming a nurses union.  It takes a great deal of effort to organize a ballot for union formation. A vote must be obtained requiring at least 30% of the representative group (thus the nurses) to agree upon having an union election.  The NLRB then monitors the election.  With hospitals preventing elections, or impounding ballots, nurses are not even being allowed the right to consider joining organized labor.
These are a but a few examples of administration's response to the Supreme Court's ruling.  It has become clear what their motives are, and now, more than ever, nurses need to stop infighting and come together on the issues shaping their future practice conditions.   Nurses need to become vocal!  How else will our concerns be heard?  We must lobby for an amendment of the language defining supervisors in the National Labor Relations Act so we can regain our labor representation.
It is our job to inform the public they may no longer be receiving the services which only a nurse can provide.  Once the consumers of health care learn administrators are more interested in profit than in providing them with quality treatment, pressure can be brought to bear on hospitals to provide adequate RN staffing.  After so many years of fighting to achieve decent working conditions, lets not lay down our arms and give up the battle.

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