EditorIn an ever-changing health care climate, unions are winning the hearts and minds of America’s nurses. Here’s why…
This is the first in a three-part series on unions in the health care industry and how health care management should respond.
Over the last 30 years, unlike most other sectors of the economy, there has been tremendous growth in the health care industry.
However, with growth comes problems and, not surprisingly, unions see the health care industry as a bright spot on an otherwise dark horizon.
As many unionized employers in traditional blue-collar industries have fallen prey to domestic and global competition, and with union membership in the private-sector falling to historic lows, unions have seen the health care industry as one of a few growth industries to help rebuild a failing union movement.
Unionizing in the health care industry is not closed to any union. Unions such as the Teamsters, the Steelworkers, and even unions typically associated with the construction industry such as the Operating Engineers and the Laborers’ unions all have found the health care industry fertile ground for unionizing workers.
There are, however, three principal players in the health care industry that target health care professionals more than most other unions: They are the American Federation of State, County and Municipal Employees (AFSCME), the National Nurses United (NNU), and the Service Employees International Union (SEIU).
While health care employers may be targeted by any union, the NNU and SEIU have historically been the most aggressive in their efforts to unionize registered nurses, and the NNU is known as being an association of RN-only unions.
Indeed, not only have the NNU and SEIU been the most aggressive, they have also been the most effective at developing their campaign messaging to win over the hearts and minds of nurses at the expense of their employers’ ability to maintain direct relationships with their nursing staffs.
More often than not, the NNU and SEIU’s campaign messaging centers (and relies) on patient care and, as a result, directly appeals to nurses’ sense of helping others and the reason that many became nurses.
Unfortunately, with the constant health care spending cuts, seemingly constant mergers and acquisitions of hospital systems, all the while amidst a shortage of nurses, the health care climate gives union organizers very fertile ground to lure nurses into unions.
Here are five top reasons nurses are unionizing:
Note: The following is not intended to be a comprehensive list of all of the issues that may cause nurses to consider unionization. Rather, it is a listing of the most-common causal factors personally observed during nursing campaigns for more than two decades.
1. A Lack of Voice
With so many changes impacting how health care is administered in the U.S., many on the front lines of health care–especially nurses–are often left feeling powerless, with little or no voice to alter the changes affecting their workplace and, as well, patient care.
Often, decisions are made at the top of the organization. Then, as decisions that are perceived as “negative” are made, they are often handed down (usually in writing) from administration, with little or no input from nurses.
These decisions are typically passed down to busy nurse managers who all-too-often will merely leave the decisions for nurses to read on bulletin boards, in break areas, at nursing stations, or in email boxes (that are often rarely opened).
Nurse managers, who are merely conduits passing along administration decisions, typically do so without providing any of administration’s decision-making rationale, nor taking the time to explain the impact or to allow nurses to provide feedback.
In some cases, nurse managers even (intentionally or unintentionally) undermine their administrators by finger-pointing back up to administration with a (literal or figurative) “don’t blame me, it’s them.”
This top-down communication style almost always leaves nurses frustrated and feeling that they have no “seat at the table” when it comes to the decisions that impact their jobs and their patients’s well being.
Indeed, one survey [in PDF] of 3300 nurses found that “75 percent of nurses do not feel they have enough authority.”
Additionally, “89 percent said they cannot work effectively due to apathetic superiors and a lack of support staff.”
“I’ve been working in a non union job for many years,” stated one RN on an online nursing forum. “The nurses were treated wonderfully until this year. We now have so many changes going on that everyone’s head is spinning. It seems that the fact that we aren’t union has allowed administration to do whatever they want to us.”
“I was anti-union until I became a nurse.” stated another nurse. “My pre-nursing employers treated me so well that I couldn’t understand why anyone would need a union. NOW I know!”
These, unfortunately, are all-too-common refrains during union campaigns–refrains that unions exploit all too well.
2. Staffing
Staffing or, more precisely, understaffing is one of the biggest challenges facing health care facilities today. Whether it is an acute-care hospital or nursing home, understaffing almost always leads to employee unrest.
As health care facilities have seen their budgets cut repeatedly for years, the impact has resulted in maximizing productivity while tightening labor costs.
This has caused many departments in hospitals (and other care facilities) to run with the minimum amount of nurses tending to patients. While this, by itself, is frustrating to many nurses, the problem is further exacerbated when a nurse(s) calls out.
When this happens, too often, nurses are often required to work extra hours (very often, mandatory overtime) or “float” to other departments where the shortage is occurring.
If this were only an occasional occurrence, it might not be such a problem. However, in a large number of health care facilities, understaffing and mandatory overtime is an every-day occurrence that happens week-after-week, month-after-month, and year-after-year.
After a while, nurses become fatigued because they’ve worked so much mandatory overtime that they begin to resent the fact that “management” cannot manage their staffing needs.
This resentment is often also coupled with concern that understaffing and fatigue could lead to mistakes with patients–which is injurious to not only the patients, but also the nurse’s job security and career.
According to one recent survey, 90 percent of the nurses surveyed said they do not have adequate time to “to properly comfort and assist patients.”
“Nurse staffing and fatigue directly impact patient care and safety,” writes Nadine Salmon, MSN, BSN, IBCLC. “As patient advocates, nurses have a responsibility to ensure that their patient load is realistic, manageable and most importantly, safe for the patients.”
In California, where many of the state’s RNs are already unionized, employees of one health care facility recently testified at the California Labor Commissioner’s Office against their employer stating that “they were not able to take meal breaks or rest breaks because of chronic understaffing in their departments.”
3. Mandatory Overtime
The issue of mandatory overtime as a causal factor for union organizing is often directly related to understaffing in health care facilities.
While mandatory overtime may be an effect caused by a larger staffing issue, it often becomes elevated to one of the primary causal factors because of the fatigue it causes among nurses.
Although a number of states have either passed legislation or instituted regulations on mandatory overtime in the nursing industry, others have not.
In those states without protections against mandatory overtime, it is not uncommon for understaffed units to over-utilize mandatory overtime to cover shifts.
Even where managers may schedule staff appropriately, if a call-off occurs, all-too-often nurses are then required to cover shifts and, often, at the last minute.
Most employees across the majority of industries will accept mandatory overtime in emergencies. However, when it becomes the norm, employees often become frustrated and resentful.
In the case of nurses, frustration and resentment is often coupled with concern over patient care as well.
4. A Lack of Adequate Equipment or Supplies
To a nurse (or other health care practitioner), there is sometimes nothing more frustrating than tending to a patient and lacking the adequate supplies or equipment to help that patient.
In many hospitals, lack of supplies is not usually tied to a lack of money to buy the supplies. Rather, a lack of supplies is often due to a “systems management” issue—either persons (or systems) responsible for distribution of supplies not getting available supplies to certain departments on time, or managers not pushing hard enough to ensure their departments are fully supplied.
One researcher reported in the Harvard Business Review that “problems with the supply of equipment and materials,” which the researcher referred to as operational failures, “disrupt care and waste up to 10% of nurses’ workdays.”
Although unions, by and large, cannot solve these types of issues, the lack of supplies or equipment are, nevertheless, irritants that are often piled onto other issues within an organization that union organizers will use with great effect during campaigns.
5. Compensation Inequities
Across much of the country, while nurses are fairly well compensated, compensation can become fodder for union organizers when hospitals do not ensure that the wages paid to nurses keep up with the market or, in the alternative, when hospitals create compensation “equity” issues. This often happens as hospitals raise entry-level wages to address staffing issues in a tight labor market.
For example, some health care systems offer signing bonuses–sometimes as high as $25,000–to attract nurses to work for them.
When this happens, while it may be well intentioned in order to address staffing issues, resentment can build among existing nurses who find their own compensation being matched or even surpassed by new nurses.
This is often referred to as ‘wage compression.’
Although wage compression is not a difficult problem to resolve, if nurse managers and their human resource departments do not stay on top of the pay levels existing within the organization, it can lead to dissension within a department or organization.
No single causal factor
While every nursing campaign is unique, there are certain similarities in health care that unions have found to be effective issues to center their campaigns on.
Typically, it is not just one issue but several issues that cause nurses to find unions attractive.
However, if health care administrators can recognize what the causal factors are before they become issues, the chances are, they will be able to better inoculate their nursing staff from a union’s message.
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