The Rise and Fall of the Nursing UnionAppearing in Revolution: The Journal of Nurse
EmpowermentSummer 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.
