Should it be illegal for nurses to unionize in non-profits


    I am an RN coping with a recent debilitating run in with a careless/drunk driver and have returned to college in order to find a new career path. Which finds me doing some intersting assignments.

    This question is posed only as a debate topic for a college level class.

    It is an assignment that I did not want, I hate it, I cannot change it, it is an assignment I must complete as written on the title line "Should it be illegal for nurses to unionize in non-profits (not for profit hospitals). While I would rather be catching up on CEU's during spring break, I find myself spending the last few days in the library working on this arcane term paper. However, when I am in a good mood, I see it as the challenge that it is, and welcome it - becuase it can only help me to prepare for what I will face when I graduate: a lot of tough questions from healthcare professionals.

    I have had little trouble finding info on unions, and non-profits, but am having real trouble finding info on whether or not is should be considered illegal. ANY help from the forum on ideas or places to look would be GREATLY appreciated. ANY ARGUMENT AGAINST NURSES UNIONIZING WILL HELP.

    I have come up with one argument FOR it, and that is the (so called) patient abandonment issue (for example, in the case of a strike). I still need at least five more reasons to argue that RN's and other healthcare professionals should NOT unionize (ESPECIALLY in the NOT FOR PROFIT SECTOR).
    That is a big part of what is making this topic so hard, trying to differentiate between not for profit and for profit and why it should make a difference. I have read that the Health Care Amendments of 1974 expanded coverage of Taft-Hartley Act (not exactly a pro-union act of legislation) to include non-profit, private health care facilities, which makes this even harder. Some of the answers I expect to receive may be general in nature, or based on historical evidence (I have READ some anti-union rhetoric that unionizing may demean certain types of professionals, making them look like "common laborers").

    Thanks for the time. In reality, any suggestions on why it SHOULD be legal are almost as helpful, all I have to do is ATTEMPT TO reverse the argument. Which can be very difficult.

    Finally, as healthcare professionals, we need to be able to look at diverse topics such as this one, even if it seems ludicrous, and come up with articulate answers - it is part of being faced with challenges and being able to overcome them. Most of all, to be able to argue for the "wrong side" of an issue, means you obviously have a complete understanding of the entire issue you dealing with, and can therefore argue your side even better. That said, I welcome private emails on this subject.

    Thank you,

    R.A. RN
    Last edit by neophyte on Mar 17, '04 : Reason: To encourage more responses like that of pieWACKet
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    About neophyte

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  3. by   -jt
    <<Should it be illegal for nurses to unionize in non-profits..... I have come up with one argument FOR it and that is the (so called) patient abandonment issue.>>

    Id like to help you out but I dont understand what you mean about "the pt abandonment issue". What does nurses becoming a union have to do with pt abandonment? And what does it matter what kind of facility a nurse works in? It's legal for all nurses (except supervisors) to unionize. It doesnt matter if they work in a for profit or not for profit. That has nothing to do with the nurses having a voice in their workplace. Why should it become illegal for nurses to unionize in one type of facility but be legal in the other? We have very few (if any) for profit hospitals in NYC. No Tenet, No HCA. Our hospitals are mostly all not for profit. And a lot of them are public city hospitals too. And almost all of our hospitals & the nurses working in them are unionized. Even the NPs, case managers, clinical specialists, nurse educators, nurse recruiters, etc are in our union - not just the bedside nurses. All nurses have the right to have a measure of control over their practice and terms of employment. The kind of facility they work in has no bearing on that.

    The American Nurses Association endorses unionization for RNs for several important reasons. Those reasons dont change depending on whether the hospital can declare profits or not.


    <<<Collective Bargaining Is Your Right
    As a professional nurse you have a big stake in the quality of health care your patients receive. As an employee, you deserve a fair wage and good working conditions. It is illegal for an employer to interfere with an employee's right to unionize. One of the primary responsibilities of all professional nurses is to advocate for safe quality care for patients. Steps nurses can take to insure quality patient care include:

    *Participate in workplace decisions affecting nursing care.
    *Acquire the resources needed to perform your job effectively.
    *Safeguard the standards of practice set by the profession.
    *Protect employment rights
    *secure terms and conditions of employment to attract and retain qualified personnel.

    Advocating for quality care is becoming increasingly difficult for nurses in today's environment of restructuring and mergers, where cost often comes before quality care. Collective bargaining (unionizing) is the most effective way you and your nurse colleagues can protect patients from inadequate and unsafe care. Collective bargaining is professional. Nurses have a legal right to use the collective bargaining process to protect their professionalism.

    ANA believes that the professional nurse has the right to participate in the decision-making process affecting the nurse as an employee and as a professional. Wages, benefits and conditions of employment have a major impact upon the quality of care the nurse delivers. Since the nurse is accountable to the client for the care received, each nurse has the obligation to establish the means to effectively influence and implement the standards of care within the employment setting and to ensure employment conditions which permit delivery of the highest quality of nursing care. A legally binding contract between your employer and your bargaining unit gives nurses a voice in the decision-making, enforcing your right to participate in determining wages, hours of work, pension and benefits, and all other terms of employment, as well as standards of practice. Collective bargaining allows nurses to address the most important issues facing nurses today and to protect themselves and their patients....>>>

    American Nurses Association

    The above goes for all nurses - no matter where they work. Why should only nurses & pts in for profit facilities have those protections? Everybody has the right to them. In this, theres no difference between for profits and not for profits. So I guess the answer to your question is no.
    Last edit by -jt on Mar 16, '04
  4. by   pieWACKet
    Absolutely not.
    Before I anser your question, this paragraph.
    I do not think the term non profits is accurate in what you describe...its is Not for Profit that is the term that fits here. All hospitals work for profit, in order to remain viable. As you no doubt know from your research, the not for profit hospitals are constrained by a non distributive constraint, meaning profits may not be distributed to owners in the form of annual dividends or other earnings-conditioned payments, unlike their for profit counterparts. But the management styles and business practices of both for profit and not for profit hospitals does not vary with any truly perceptible degree, and the educational background of the CFOs/CEOs/Managerial tier is in no way different. While once not for profits were "volunteer" hospitals depending on philanthropy, this is long in the past. The seperation of for profit and not for profit hospitals is solely dependant on the non distributive restraint. Despite that restraint, in the 80s and 90s through to the new millenium, little managerial difference is experienced between the two entities in general and certainly in regards to the nursing labor pool upon which ALL hospitals depend and without which any hospital absolutely can not function. Where " once the voluntary hospital had been small, basic, and locally controlled, the not-for-profit of the 1980s was large and complex....By the 1990s, the not for profits were more likely to be part of a large corporate system, often with distant ownership or control and strong contractual ties to managed care or other (sometimes for-profit) insurers." See Health Policy Analysis Program Webiste [HPAP]. Community Benefits and Not For Profit Health Care, Policy Issues and Perspectives: November 1995. The Catholic Health Association. Madden, Katz et al

    Now in answer.
    The "patient abandonment" argument has been manipulated and over manipulated throughout the history of nurse primary employment in hospitals occuring since the 1930s stock market crash, both with detriment to the nurse providing the labor required of the hospitals dependant on her and the hospital itself, which inevitably faces an inconsistent labour resource pool as a result of lack of vision in regards to their longstanding problem in assuring consistent labor pool. Before the 1930s, nurses were primarily employed outside the hospital arena. Since the nursing shortage has existed since the post WW II era, with periods of spikes and inadequate market adjustment calming a crisis, but laying groundwork for the next inevitable crisis shortage [of which our current Crisis Nursing Shortage is merely a part], one can argue that ALL forms of [constantly recycled and never insightful] attempts to address the shortage have been inadequate, and shortsighted, and, in fact, evidence of conscientious mismanagement in general.
    Unionization is not sought for the right to STRIKE [the cruxt of the 'patient abandonment' manipulation]. Unionization is sought for the right to VOICE. NO strike includes patient abandonment. There are too many failsafes and safe gaurds. Patients are moved out, surgeries cancelled, intake diminished, and ER visits curtailed through many months preceeding the actual strike which by law must be announced as "intent to strike" far in advance of a strikes occurence. What hospitals experience, and the real stregnth of the union, is diminished profit as a result of potential temporary loss of labor resource pool, causing them to pay attention, listen better than usual, and address market demand in addition.

    Unionization is a right, a hard gained right, and to mess with that right is well, shortsighted and certainly adversarial. One might even be tempted to call it unamerican. No nursing strikes occurs spuriously; the groundwork for strike strongly protects all patients currently or during the period of percieved strike, reliant on the hospital. It can be easily argued that management is responsible for creating an environment unable to assure its labor resource pool and that in abbrogation of their weighty responsibility they create the episodes of patient abandonment possibility, the responsibility for which they then foist on the labour pool upon which they are dependant, while ignoring their own role in its formation.

    My answer for your "no it should NOT be illegal" [beyond the implications of what it means to suppress this current right]:

    According to all polls, whether conducted by the American Nurses Association or closely aligned groups, or the American Hospital Association and any closely alligned Management Lobbying arms, nurses complain PRIMARILY of two things. The first is easily born out in our free market economy. They feel they are underpaid. Borne out by free market economy reality, The wage/benefit ratio for work expected/performed is not adequate to meet market imperative. The second reason, though, is masked in many terms, but is one best described as "lack of voice" [you can refer to my ever expanding and as yet incomplete webpages at if you wish].
    Nurses throughout the country experience a lack of voice...and Nurses UNIONIZE as a result. Lack of voice involves both how the employer preceives and pays the nurse and his/ her work, AND how the general hospital hegemony disregards or ignores the concerns of nurses and nursing.

    If you make the argument that nurse unionization SHOULD be illegal, be prepared to answer to the many bedside nurses NOT present in your managerial class, why it is there is no voice for the nurse in hospital management. Look at hospital boards of directors, and consider that there is no representation there for the 70%+ on hands nurses on which that hospital is dependent. While there is always a practising Medical staff member on the board, there is NEVER a practising bedside RN on the board. Any hospital board boasting an RN has one who is long aligned to management, and far removed from the bedside and the very population which you currently address.

    In short, to suppress the right to unionize will NOT address the lack of nursing voice, it will be perceived as, and in fact will, diminish the ONLY vehicle currently present to express bedside nursing voice, thus contributing to the shortage, while also proving the managers inept and bullying. It will not encourage new members to the profession, neither will it assure the continuity of the nurses currently employed. It will be the bite your nose to spite your face movement which could be the death of the non profits, for it leaves the for profits competitor the only entity with that vehicle currently the only form of adequate nursing voice.

    Rather than suppress the right to voice, which is how nurses percieve the choice of unionization when that difficult choice is made, your class should discuss how it is you will create voice, and thus not have to argue for or against unions at all.
  5. by   Agnus
    As far as the pt abadonment issue goes. There is a federal law that states nurses must notify the hosp 10 days in advance of any strike. this allows the hospital to relocate patients in another hospital and to divert admissions.

    Of course not all patients will be relocated but enough can be to deal with the issue. Your reasearch should show that nurses regularly leave picket lines to care for patients when nessary.

    Proft or not for profit should not be the issue.
    If you "make illegal" for not for profit then you have essentially given not for profit hospitals cart blanch to do what ever they want. Too often when nurses strike it is for better conditions that have a direct effect on the patient.

    If a hospital is well run and treats staff and patient well there is no talk of bringing in a union. It is only when things become unbearalbe that they come in. If nurses cann't bear thier conditions do you think this might effect patient care? Do you think this might effect the number of nurses willing to work there?

    Management does not like unions and this is understandable because they are restricted in what the can do with a union in place. If management does the right thing by nurses there is no questions that nurses will not even bring up the idea of union.

    I have worked in both for profit and not for profit. Interestingly the not for profit was financially richer than the for profit. And the not for profit is the one where a union was brought in and was badly needed. The for profit treated staff well without a union.

    The money spent (yes I do have this knowlege) by the not for profit for expansion and technology and ADVERTISING, is astronomical. Interestingly the for profit did no comercial advertising. All marketing was extreemly low key, and relyed on word of mouth. The care received at the for profit was far better.

    I have worked at a Skilled nursing facility that was for profit and one that was county owned. The SAME things existed there that I just described with the acute hospitals.

    Non profit and not for profit are misleading terms. IT dose not mean they do not make a profit. It only means that they are limited to reinvesting profits back into the business , that is earnings and dividends are not paid out to share holders.

    Very oftern non profits actually make more than for profit.
  6. by   pieWACKet
    I have thought all day about your dilemna on how to present why it is that nurses in the not for profit sector should not be allowed to unionize, despite all your intuition [and my own] that this endeavor runs against core sentiment and stronger arguable reality response and outcome. I must tell you, my mind draws a near blank, because I am a bedside RN deeply commited to the right to unionize.
    But when I try to put myself in the mindset of a manager, seeking to make this argument, a few ideas DO occur. They will not, however, make your argument stronger for this project, i fear...for they are too weak to bear out.

    To make these points I must put aside the idea of not for profit vs for profit for a moment, and consider nursing as a whole [again, the primary labour pool of any hospital for profit or not for profit, representing 70% plus of their entire labour resource pool]. I am sorry I can not help you without doing it in this way; But I am at a loss to do otherwise , although not for profits will figure more strongly in some of the arguments given below.

    Again, I do not agree with any of these arguements, and so , i am not a good source for arguments you seek.

    I will provide my few weak positions in response to your task, and provide why I think them weak.

    1. Nursing is an essential labour resource upon which the entire population depends. It is an entirely necessary profession and so subject to rules and laws defining it as essential. The general society at large can not function without nurses in times of peace or harmony, and more so in times of distress and chaos, and so, the right of nurses to unionize must be curtailed. This is a result of the understanding that unionization carries with it the right to strike, and so, the right of the nurse to remove herself from the essential labor she provides. As a result, and because nursing is an essential labour resource, unionization can not be encouraged.
    a. if nursing IS an essential labour resource, why do not more nurses state they feel essential to the entities in which they are employed, and why is it this sentiment held by nurses transcends periods of nursing abundance or shortage thus creating an environment in which nurses seek radical voice [ie, unions] ?

    2. Nursing is an essential service profession, and those seeking employment within it understand it as such upon consideration, education, indoctrination, and service to that employ. As an essential service , all nurses understand through the vehicles above mentioned that their own desires are subjugated to the needs of the population they serve. It is a giving profession, and must adhere without fail to the provision of their service. Therefore, unionization must be curtailed, as a result of nursing's responsability as an essential service profession, and the underlying understanding that ALL nurses share in, and will adhere to this understanding.
    a. This is a misguided understanding of why nurses, and potential nurses, seek employment as RNs. While desiring to be needed and seeking the 'secondary gains' of a service professional, these professionals seek out nursing as a legitimate, socially conscientious, respected, and adequately compensated service profession...they seek nursing as a reasonable outlet for their socially responsible imperative. Socially responsible imperative does NOT translate to service as a professional no matter what the conditions demanded by the employer.

    3. As the majority of funding for hospitals comes from the government in the form of medicare and medicaid, the hospital has the right to curtail nursing unionization and the threat of loss of income that unionization entails. Government, as the primary source of payment for nurse labour pool, must be held accountable to encourage the viability of nursing, without allowing the threat of loss of income by hospitals that unionization provides.
    a. way off. hospitals receive income and choose where to spend and argue the right of that income source. Pharmaceuticals claim far more of the hospital coffer than nurses do, and pharmaceuticals are not limited by the right to strike, not being labour intensive segments of the hospital expense sectors, yet they recieve a large portion of the hospital coffer as a result of their "essential service" and significant lobbying arms.

    4. The people, the same people mentioned in the constitution , need and depend on nurses. The people and their well being supercedes the advantage to nursing that unionization allows.
    a. do i need to tell why this is wrong? i think you and i agree in general, and will not expound.

    5. Not for profits are volunteer organizations not seeking or demanding profit orientation. Their potential in the free market system is curtailed. As a result, those working within their entities must adhere to rules apart from those adhered to in the uncurtailed free market system
    a. my first post addressed this. Not for profits are strongly aligned with, and subject to the mandates of , for profit entities. No real difference exists between them.

    Does this help at all?
  7. by   neophyte
    Does this help at all?
    The question is rhetorical in that, yes, your comments give me more to work with. The fact that they are fragile arguments because of their near indefensible position is of little import: they are enough to aid me in a debate, however irrational, set in a classroom.

    I forgot to say, THANK YOU.
    Thank You.
    Last edit by neophyte on Mar 18, '04 : Reason: I forgot to say thank you