Industrial Labor Relations Mgmt 4531.

01

Strength In Numbers
Nurses and Labor Unions
Justine Steele

Spring 2011

Justine Steele MGMT 4531.01 Spring 2011

Strength in Numbers Nurses and Labor Unions

The mission is successful negotiation of fair wages, safe working conditions and exemplary patient care. Can the nations labor unions help nursing healthcare professionals meet these mission goals? Battles are currently being fought to preserve and reform the Nations healthcare system. Along with proposed changes to the affordability and accessibility of medical care, healthcare providers will be faced with challenges of patient-to-provider ratios, rising costs, falling salaries/benefits and change in patient care roles. Will quality care be provided and will the compensation and benefits be commensurate to the level of provider care and patient needs for the nursing profession? How can labor unions propose to support the nursing profession in this changing environment? General union philosophy contends that there is strength in numbers. Workers banding together will allow providers and patients mutual benefits from the upcoming changes and challenges. The Nurses The healthcare industry is the fastest growing industry in the nation. Some factors contributing to this trend are the aging of the United States population, the growing numbers of those reaching retirement age and the increase in illnesses which were once primarily diagnosed as adult illnesses (i.e. diabetes, obesity). With increases in the patient count, it is reassuring to know that nurses in the workforce are expected to increase by approximately 22% over the next few years (BLS). The Nursing sector of the healthcare industry has many levels of service, both in the private and public venues, as indicated in the chart below:

Justine Steele MGMT 4531.01 Spring 2011

Data series Home health aides Licensed practical and licensed vocational nurses Medical and health services managers Nursing aides, orderlies, and attendants Registered nurses Note: These employment estimates include employment in both the private-sector and government Employment, 2009 399,600 263,520 34,100 797,110 167,540

(Source: Occupational Employment Statistics) (Occupational Employment Statistics)

Even with the numbers above and the increase in the population of the healthcare industry workers, with the growing patient base, some wonder if there will be enough providers to meet the increasing needs. Some challenges facing the Nursing community are Longer work hours; Reduced compensation/benefits; Changing care taker roles; and Patient-Staffing Ratios.

These types of challenges are conditions that Union organizers look for when approaching a group/class of workers to come together for a common goal. The need for nursing professionals has grown over the past decade. The working conditions, including hours, facilities and wages and benefits, are a focal point of concern in this work class. As mid-level professionals, nurses must succumb to the needs of the patient and the requirements of professionals in managerial roles in order to complete their work effectively. As a result of the necessity for effective, diligent work performance, many nurses have elected to join associations and unions that enable them to meet these needs

Justine Steele MGMT 4531.01 Spring 2011

The Unions Organizations such as the Services Employees International Union (SEIU), or the National Nurses United (NNU) can assist workers in the industry to secure better working conditions, higher pay and increased benefits. In recent years the merger of smaller unions into a larger union or even just a partnership with a larger union, creates the hope that a larger voice will succeed in better outcome. The Service Employees International Union (SEIU) is one such organization. The SEIU boasts of a 2.2 million membership roll (SEIU). The union is dedicated to improving the lives of workers and their families and creating a more just and humane society. (SEIU) The union has expanded and grown through direct membership and partnerships with associations. (SEIU) This organization focuses on three (3) segments of the workforce: healthcare, public services and property services. This concentration allows the SEIU to garner significant influential powers to assist todays service workers in gaining and maintaining competitive working environments. According the SEIU there are five good reasons to join your co-workers in uniting to form a union: # 1 - Working together, union members have the strength to win better wages, affordable health care, a secure retirement, and safer workplaces. # 2 - The "union advantage" is substantial. According to the U.S. Department of Labor, union members are much more likely to have health benefits and pensions.

Justine Steele MGMT 4531.01 Spring 2011

# 3 - For people of color and women workers, the union impact is even greater. Women workers who are union members earn nearly $9,000 a year more than their non-union counterparts. For African-American workers, the union differential is also about $9,000, and for Latino workers the yearly advantage is more than $11,000. # 4 - In addition to helping workers win better wages and benefits, unions help all workers by giving working families a stronger voice in our communities, in the political arena, and in the global economy. # 5 - By joining together, we can build the strength to hold elected officials accountable, stop the "race to the bottom" by employers who cut wages and benefits in favor of bigger profits, and win improvements such as affordable, quality health care for all. (SEIU) To support this belief, the SEIU has created a division call the Nurse Alliance. The combined efforts of these workers present a powerful force for negotiation and influence. The SEIU believes that the Healthcare industry is important and must have a voice. The Nurse Alliance provides support for nursing professionals in the public, private and home health arenas. The SEIU counts 84,000 nurses among its members. (Bush) In direct competition with the SEIU for the nursing professionals support is the National Nurses United (NNU). The NNU is the largest nursing union in the country. (Ashack) The NNU is a merger of multiple smaller organizations who together have a membership exceeding 155,000. (Ashack) The NNU was formed in 2009 with the purpose of creating a larger more powerful bargaining unit for negotiations. The NNU is a nursing organization and does not

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funnel its funds to other sectors of the industry. This fact has been a driving force in their increasing membership over the SEIU. But unionization has not been easy. As membership has grown, so has the bully on the street mentality. Some associations do not want to be part of such a large organization and may feel that they will be under represented in specific issues, and not all nurses are for unionization. Many feel that unionization with suppress their opportunities to seek promotions, raises and benefits as funds are watered down to cover many professions covered in the services industry. Many cities and States have local organizations or associations which may fill the same need and can focus on the local decisions that face nursing professionals directly where they live and work. The medical workforce has not always opened their arms to the union influences. For example in Texas, the SEIU lists only one (1) local union organization. It is located in Houston, Texas. It is called H.O.P.E. (Houston Organizations of Public Employees). While H.O.P.E. boasts of a 5000 strong membership, this is just representative of municipal workers. (H.O.P.E.) This example showcases one of the issues regarding union membership for nurses as dues paid to the SEIU may be used toward another industry. The SEIU is not the only union organization beginning to target nationwide nursing professionals. The California Nurses Association (CNA), now part of the NNU, has moved into Chicago, has its eye on taking over the Illinois Nurses Association and is testing the waters in Texas. (Selden)

Justine Steele MGMT 4531.01 Spring 2011

The Challenges Overcoming challenges facing the unions in venturing into the nursing labor market are determining factors in the support and development of union activities in local, regional and national venues. Some of the issues to overcome: 1 Union Membership; 2 Issue Identification; 3 Collective Bargaining; and 4 Union Pushback. MEMBERSHIP Membership in unions has been declining. As is evidenced by the number of petitions filed for unionization elections:
Petitions Filed Petitions Filed 2,380 2,082 2,418 2,310 2,492 Won by Union Won by Union 1,036 915 1,028 916 1,064 Lost by Union Lost by Union 535 420 586 614 693 Petitions Dismissed Petitions Dismissed 37 46 48 43 56 Petitions Withdrawn Petitions Withdrawn 725 657 784 998 909

Year

Elections

Year

Elections

2010 2009 2008 2007 2006

1,571 1,335 1,614 1,530 1,757

Justine Steele MGMT 4531.01 Spring 2011 Petitions Filed 4,022 3,618 3,746 4,296 4,145 Won by Union 1,367 1,295 1,395 1,451 1,443 Lost by Union 860 968 1,043 1,116 1,202 Petitions Dismissed 104 83 98 108 137 Petitions Withdrawn 1,637 1,314 1,367 1,488 1,446

Year

Elections

2005 2004 2003 2002 2001

2,227 2,263 2,438 2,567 2,645

(Source: National Labor Relations Board, 2011) The image of the unions is that of blue collar workers, as opposed to professional members. In the healthcare industry, nurses are viewed as professionals. They have certifications, advanced education and undergraduate and graduate degrees. Overcoming the image of the working class organizations is a hurdle that is being straddled in part due to changes in the healthcare system taking place today. With legislation changing how healthcare is provided, it has become necessary for the nurses to protect their jobs by joining together to ensure a safe, fair working environment. First there is union recruitment. Union recruitment can be a very serious issue. Initially the nurses speak with co-workers to assure that they have similar values. Are they unhappy with wages? Do they feel they should have better benefits? Could working conditions improve? By gathering momentum and identifying the needs of the workforce the union can be successful in organizing the workforce together. Secondly, create a leadership team for the membership. The leadership team can organize a meeting (during non-working hours) and keep the

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membership informed of issues, decisions and results. Union representatives play an important role during the organizing meetings. Once the workforce has agreed that membership is beneficial, notification of management occurs. Establishing and election date and holding the election for unionization is the final step. Many people have misconceptions about unions and may not want to join for fear of reprisal from management. The union goals are to attract the Nurses and arm them with information. The SEIU has been effective in gaining membership in the highest areas of unionization in the healthcare industry. States such as California and New York are highly cohesive and present a solid base for the union to enter the market and provide increased negotiation power. However, even in these areas of a positive union image, the battle for membership is complicated. Many smaller organizations suppress membership drives. After a long fought battle, the CNA (now part of the NNU) succumbed to the pressures of a lawsuit and reached an agreement with the SEIU to refrain from recruiting nursing members of the SEIU. (Bush) The battle for membership is significant because of the dues that are collected. The unions cannot operate without funding support from its membership. ISSUE IDENTIFICATION Issues that are beneficial for collective bargaining can be anything from shift schedules, pay rates, number of shifts required for nurses, pay scales, and the issue most on everyones mind as the national population ages, patient to provider ratios. The individuals that are trained in the medical field spend many years and thousands of dollars on education in hopes that their efforts will be repaid once they are practicing in their field. Pay scales and benefits play a

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predominant role in many union negotiations. The NNU, for instance, has identified its primary lobbying efforts for issues of increased staffing levels to improve nurse-to-patient ratios, providing support for whistle-blowers and improving pensions for nurses. (Rotenberk) From a nationwide perspective, issues identified by the NNU play an important role for the nursing industry. Once issues have been identified, union members can rally together to support each other as they monitor legislative processes and the new laws that will govern how they perform nursing duties. Understaffing of nurses at facilities is another concern facing the industry. In a study conducted by the New England Journal of Medicine, it was concluded that staffing of RNs below target levels was associated with increased mortality, which reinforces the need to match staffing with patients needs for nursing care. (Jack Needleman)

COLLECTIVE BARGAINING One of the ways that the union is supporting the nursing membership has been through its collective bargaining power. Specifically unions have been successful in negotiating hours, patient- to-provider ratios, and increase in benefits. The outcomes of many cases are preceded by months of negotiations. This process is the greatest benefit of union participation. Collective bargaining is similar to buying in bulk. The benefit to the nurses is collective bargaining allows nurses as a group to have a voice in hospital policy. It allows them to negotiate higher wages and better benefits. A bargaining agreement can set base pay rates and add incentive pay, or shift differential pay. The agreement can set vacation time, sick time and personal time. As part of the union, the nurses do not have to attend negotiations. Instead,

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leadership representatives negotiate on behalf of the membership. An important note is that the leadership has the duty to report back to the membership so all parties are informed. This allows all parties to come to a compromise on all issues facing them and to determine the most significant issues and resolve the differences in a manner that would allow the nurses to meet the needs of the patients. Additionally, in cases where negotiations are shut down, unions have successfully held strikes to force management to the negotiation table. The effectiveness of the strike is specifically related to the validity of the issue in dispute. Effectiveness can also be measured by the numbers of the members participating and the support that the unions provide during the strike event. An example of this was in June 2010 nurses in Minneapolis voted to strike when management failed to negotiate regarding staffing levels and placement at one local hospital. The nurses felt that patient care was being affected. (Gomstyn) The strike was a one-day protest in order to force management to revisit and negotiate the nurses concerns. Through this process, the nurses have a voice in the administration of hospitals and healthcare system. Keeping the membership informed of the changes and issues is an important part of the union obligations to its membership. Some unions heavily rely on recruitment to increase membership and collect dues but once the vote is cast, the union is no longer involved. In order to remain an integral part of the union, a good base of leadership should be established. Having the proper representatives to address the concerns and issues that need to be addressed, both with management and union officials, should be a high priority in any new arena of the union domain. Union officials that have active communication with the local associations have a better chance to succeed in the industry.

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UNION PUSHBACK In right to work states, such as Texas, unions have a harder time establishing a foothold in industry. Many hospitals and hospital systems take union intervention very seriously. Management will specifically fight against unionization of its employees. Managements argument against unions is primarily a control issue. Relinquishing the right to hire or fire at their discretion is a concern to Management. Additionally, in many unionized areas, the cost of operations has increased for management/owners due to the union participation in labor issues. Management does not want to hire extra staff, increase wages or pay additional benefits at a time of severe budget concerns. With the healthcare laws being re-examined and insurance eligibility being legislatively determined the concern of management would seem to be valid. Even nursing employees have fought to keep unions out of their workplace. In 2009, the Cypresss Fairbanks Medical Center nurses proposed a decertification vote against the CNA (now part of the NNU). There were enough members opposed to continuing unionization that a vote was put forth to the membership. In what some nursing staff considered a severe blow to their independence in the work place, the nursing staff voted 113 to 97 to keep the union representation. (Affairs) CONCLUSION The changes in the healthcare industry will surely mean changes in the way patient care is performed. The nursing industry will be better served joining together to make sure that they are not overworked or underpaid. The benefits of having union representation and

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collective bargaining power will allow the nurses to perform patient care to the best of their abilities. With the complicated healthcare legislation passed by the United States Congress, nurses who have the benefits of union membership will be better afforded the ability to be prepared for the changes. Organizing together, nurses will be able to help shape the way that the industry meets the challenges of the next decade. In banding together through unions such as the SEIU, the resources available for lobbying efforts on a national level are greatly increased. Union influence can assist nurses at the local level to seek the best benefits for themselves and their families. Additionally, nurses can receive benefits such as legal advice and representation, availability to credit unions, insurance discounts, educational discounts and scholarships as part of union membership. As evidenced by the increase in nursing professionals and the increase in patients, the unions have an important role for the healthcare worker. The combined efforts will create an industry that will be able to meet the growing needs of the American population without sacrificing pay, benefits or patient care.

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Works Cited Affairs, Office of Public. NLRB. 28 April 2010. 30 April 2011 <http://www.nlrb.gov/search/nlrbsearch/cypress%20fairbanks%20medical%20center>. Ashack, Elizabeth A. U. S. Bureau of Labor and Statistics. 23 February 2011. 17 April 2011 <http://www.bls.gov/opub/cwc/pr>. Bush, Haydn. "Nursing unions reach pact after era of rising tentions." H&HN: Hospitals & Health Networks 11 April 2009: 83-84. Gomstyn, Alice. "Thousands of Nurses Strike in Minnesota." 10 June 2010. ABC News. 30 April 2011 <http://abcnews.go.com/Business/Media/thousands-nurses-strikeminnesota/story?id=10875712>. H.O.P.E. HOPE Local 123. 2008. 17 April 2011 <http://www.hopetx.org/about-us/>. Jack Needleman, Ph.D, Peter Buerhaus, Ph.D.,R.N., V., et al. "Nurse Staffing and Inpatient Hospital Mortality." The New England Journal of Medicine (n.d.): 1037. Occupational Employment Statistics. 2009. 18 April 2001 <http://www.bls.gov/oes>. Rotenberk, Lori. "Nurse super-union sets agenda, aims to get staff ration laws passed." H&HN Magazine December 2009. SEIU. SEIU.org. August 2008. 29 April 2011 <http://www.seiu.org/a/ourunion/fast-facts.php>.

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Selden, Jonathan. Austin Business Journal. 19 September 2005. 17 April 2011 <http://www.bizjournals.com/austin/stories/2005/09/19/story4.html>.

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