Modern Healthcare: Laboring for union nurses


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from psna enewsletter. karen

cover story in this week's modern healthcare (courtesy email from ana)

laboring for union nurses

from (may 23, 2005)

registered nurses, already pursued by competing hospitals and aggressive recruiters, now face an increasingly crowded field of unions vying for their time, money and loyalty.

the california nurses association won its first election outside its home state on may 13, officially joining two powerful, well-established national nurses' unions and a handful of smaller ones already crossing state lines to bring nurses into the rank-and-file.

competition for the u.s.'s 2.3 million registered nurses may weaken unions and aid hospitals and health systems, say labor insiders and experts, especially when unions target the same employer. that happened in cook county, ill., this month, when 1,800 nurses voted to leave the illinois nurses association, an affiliate of the american nurses association, and join the national nurses organizing committee, or nnoc, the cna's national organizing arm.

the election has underscored the competing ambitions and divergent strategies of labor unions that are organizing healthcare's largest and fastest-growing occupation, which remains largely nonunionized, according to organizers.

with 60,700 members and another 1,800 organized under the nnoc, the oakland, calif.-based cna is not the nation's largest rn union. the service employees international union counts 80,000 registered nurses among its 900,000 healthcare members. the united american nurses, a union affiliated with the american nurses association and the afl-cio, represents 104,000 registered nurses.

in launching a national campaign, the cna has aimed squarely at the ana and uan, arguing neither aggressively promotes the interests of nurses. the california union withdrew from the ana a decade ago-the first state affiliate to do so, followed by massachusetts, maine and pennsylvania-and cna officials are unapologetic about nabbing nurses from their rival.

"this is a victory with national significance," said cna president deborah burger. "we think it's important that we have a union that represents nurses strictly and can then really speak to nurses' issues, which are patient advocacy, workplace safety and improving the healthcare system."

outside of california, nurses in 40 states have signed on to join the nnoc, although they are not officially organized, said rose ann demoro, executive director of the cna. to date, 2,200 such members have joined, according to the cna.

in its meetings and classes across the u.s., the union's board and members tout the nnoc and california's groundbreaking 1999 law limiting the number of hospital patients per nurse. "we're an activist organization," demoro said. "this is not your staid, grandmother's organization, like the ana."

it's not much of a national organization at all, fired back susan bianchi-sand, national executive director for the silver spring, md.-based uan. "from our perspective, there is no national in the national nurses organizing committee," she said. "it's just rhetoric."

the uan operates in 27 states with its own budget, staff and a constitution that gives its members a voice in governance, she said. the cna operates in two states and is raiding other unions to grow, she said.

"of course, the more unions there are, the more it weakens the solidarity and the focus, i think, the focus on the workplace and safe patient care," bianchi-sand said. "but the problem with the california nurses' approach is that they are organizing the already organized. that really is an enormous step backwards for registered nurses." bianchi-sand questioned how well-prepared the california union is to accommodate rank-and-file members in a second state. "we are the biggest union and the most well-positioned," she said. "we are the best choice for registered nurses."

a third significant healthcare union, the seiu, is actively pursuing consolidation of organized labor's rns, said mary kay henry, an executive vice president for the washington-based union. the seiu is among a handful of afl-cio unions pushing for an overhaul of the labor federation that would significantly boost spending on organizing and merge unions.

the seiu approached rn unions in october and march with plans to either build a coalition with a common agenda or merge organized nurses under one union-either a newly formed one or, ideally, the seiu, henry said.

the union represents nurses in 21 states and is organizing in nine others. "we think we've got the infrastructure to do right by our members," henry said. the crisis in healthcare may prompt labor leaders to seriously consider such an option, henry said.

seiu vs. cna

the seiu and the cna wrangled in california over nurses before reaching a truce that henry and burger said might be a model for how the pair of aggressive unions may work together nationally. however, each said their union was the best suited to represent rns. the seiu gains clout for all healthcare workers by organizing across various sectors of the industry, henry said. the cna's burger countered that the cna's efforts on behalf of nurses focus solely on bedside rns' professional and public policy concerns and not the entire industry.

burger said her national union will grow from its grass-roots effort without a top-down imposition of organization. she bristled at the charge that the nnoc, which is wholly supported and sponsored by the cna, couldn't democratically represent nurses in illinois. "it's a continuous, participatory democracy," she said.

the nnoc is an unincorporated association without its own budget, burger said. its 20 employees are paid by the cna, and burger said she "would not venture to guess" how much the union has spent organizing outside of california. demoro described the nnoc as "the cna extended nationally."

the cna's efforts won't compete with its partners in the american association of registered nurses, a coalition formed by the california, maine, massachusetts and pennsylvania unions that split from the ana, burger said.

in illinois, its newly formed bargaining unit is electing leadership, and burger said it's premature to answer questions about how much members will pay in dues. "right now our focus, frankly, is on getting them a contract," she said. once collected, dues from cook county nurses will help organizing elsewhere in illinois and the midwest. "we're building a movement," she said. "we only want nurses in the nnoc who want to build a movement."

in its disputes with hospitals and lawmakers, notably california gov. arnold schwarzenegger, the california nurses union has gained a reputation for tenacious, sometimes flashy protests. in recent months, the union used television and print ads, marches and protests to target schwarzenegger for his push to relax the state's landmark nurse-to-patient ratios-and even hired a blimp to taunt the governor during the academy awards.

the state's precedent-setting nurse-to-patient ratios have been a strong selling point for the nnoc, said cna spokesman chuck idelson. "staffing is the no. 1 concern of nurses around the country," he said.

jan emerson, spokeswoman for the california hospital association, called the union's high-profile defense of california's ratios a bid to raise the union's national profile, not improve patient safety. the trade group joined schwarzenegger in trying to loosen the ratios, which hospitals say cannot be enforced during a national nursing shortage.

ruth milkman, a sociology and labor professor at the university of california at berkeley, described the california nurses' union as "super active both politically and as organizers."

the union's ratio of members to organizers-940-to-1-was the lowest of any california union in 2001 and 2002, said milkman, who conducted the census of the state's unions. that's a significant investment for a small union, she said. by comparison, the seiu, another aggressive union in the state, had a ratio of 4,500-to-1. "having a lot of organizers means you're organizing," she said. in a national campaign, expect more of the same. "i think they'll be very aggressive," she said. "i think you can expect an aggressive drive all over the place."

san francisco lawyer greg mcclune echoed milkman's assessment. mcclune, a partner with foley & lardner, has represented management at northern california hospitals and health systems in collective bargaining and labor relations for 25 years. the california nurses' union became less willing to "sit back and wait" for organizing opportunities after bolting from the ana, mcclune said. "they became more interested in expanding their base," he said. "that was the most significant change."

upheaval and uncertainty in california's healthcare market during the late 1990s created a climate ripe for organizing, mcclune said. the chronic demand for nurses and turbulent healthcare markets could make for similarly ripe conditions outside the state today, he said.

in illinois, tom renkes credited the cna's win to its aggressive organizing and the illinois nurses association's failure to connect with workers. renkes, who became executive director of the ina roughly two weeks before the 1,800 nurses opted for the california union, vowed the ina would change. "we lost the unit," he said. "that's telling us something. we have to look at it as a message. the message is: `guess what? you weren't here,' " he said.

the defection left the ina with 4,800 to 5,000 members and cut into its finances by an unknown amount, he said. "we have to energize the troops we have and do more," he said. the ina's strength is its ability to work with nurses employed at every level. "we can do it all," he said. "cna can't. they're a one-tunnel-visioned union," he said. "we can do it all and we will."

despite the cna's bullish attitude, one nurse and union-avoidance consultant, susan harris, said she's not convinced one more union targeting nurses will make a difference for hospitals. harris, president of the healthcare division for the burke group, was cna president in 1981 and an ana board member in the 1980s. harris made the jump to consulting after she believed the california union no longer tried to solve workforce problems, she said. the cna is one of many trying to woo nurses. "we'll just have one more player in many more places," she said. "in one way, it's good. the more players, the more they pick at each other."


4,491 Posts

Cook County nurses vote to switch unions

Saturday, May 14, 2005

By Jonathan Lipman, Staff writer

The 1,800 registered nurses working at Oak Forest Hospital and other Cook County facilities have voted to leave the Illinois Nurses Association and join a rival organization run out of California.

Nurses voted 955 to 487 to join the National Nurses Organizing Committee, in what that group says is the largest nurse union vote the country has seen in years. Nurses cast ballots over three days, and results were announced Friday.

"That's an overwhelming mandate, that's a landslide," said National Nurses spokesman Charles Idelson.

The election is the first victory for the group since its formation by the California Nurses Association, organizer Ted Cahill said.

Charlene Jones, of Richton Park, who has worked at Stroger Hospital for 12 years, said nurses have tried three times to split away over concerns the Illinois Nurses Association was not responsive to member concerns.

They only found success when they looked for an organization independent of the AFL-CIO, the national organization that oversees most large unions, Jones said. The Illinois Nurses Association is an AFL-CIO member.

In California, National Nurses has had success in forcing hospitals to increase nurse-to-patient ratios, which Jones said has been a chronic problem at Cook County's three hospitals and many clinics.

"We've been worried," Jones said. "Nurses were working in units where they were clearly not competent in that area."

Like other county employees, nurses have been working without a contract since November. Jones said members were unhappy with their last contract and felt they were getting little information about this round of negotiations.

The Illinois Nurses Association has seen discontent rise among members and tried to stem the tide with a major shakeup in recent weeks, association executive director Tom Renkes said.

"I think what happened has happened over the last couple years, it's been a slow erosive process," said Renkes, who was named to his post last week. "We have a new face of INA and we just have to carry forward."

The Illinois Nurses Association will still represent about 3,100 nurses in union negotiations across the state, Renkes said.

The organization is meeting with attorneys to plan its next step, Renkes said, and has not ruled out a court challenge to the election results.

Cahill said nurses would start electing their representatives to the new National Nurses organization immediately and the group would not wait for the election to be certified by the Illinois Labor Relations Board.

"The Illinois Nurses Association needs to recognize that we have a clear mandate and not waste their limited resources on frivolous legal delays," Cahill said. "They delayed this election eight months."

Jonathan Lipman may be reached at or (312) 782-1286.


1,173 Posts

If they come to Pennsylvania, I'm in. :)


35 Posts

the workers are the union, period.

once we remember that, we will stop skwabbling and realize who we should be fighting.


3,322 Posts

Specializes in Critical Care. Has 15 years experience.

Unions are a double-edged sword. Can they help improve things? Probably. Is it worth sacrificing control of my career? ummmmmmmmmmmmmmmmmmm (long thought there), No.

What good does it do to get a union to negotiate a raise for me if the only one that benefits from that money is the union? And once the union gets involved with 'making things better for everyone', then what incentive is there for my peers to become better nurses. Unions entrench to the lowest common denominator. If I wanted to be or work with people with no aspirations beyond the lowest common denominator, man, I picked the wrong profession.

I'm not saying that those who are in unions are or appeal to the lowest common denominator. I'm saying that I believe that I can and have negotiated better than average BECAUSE of things that I have done to make myself a more valuable nurse over the years. When I give that power over to a union, I lose that ability because my individual value get supplanted by the sum total value of the masses: I lose the ability to 'stand out'.

I'm not knocking unions completely; I can see some merit. But every bit of merit that I can see with a union, I can envision without one while there is a shortage - real or perceived. My salary had doubled in the 12 yrs since I started working as an RN - I don't think I need a union for that trend to continue.

And as far as staffing issues go, Texas BNE (BON), at least, instituted a 'safe harbor' program to force hospitals to peer-review poor staffing decisions. And my employers over the years have paid more than lip service to safe staffing, even if the outcome isn't always perfect. The story is yet to be told about how well the California staff ratios will work in actual long term practice - and I'm not convinced that they are workable (ala N.Dakota's all BSN law - wasn't workable and so repealed).

As far as the intangibles with management that personally annoy me the most about the way nurses are treated (the nurses are our biggest liability instead of asset mentality) - I don't see how an adversarial relationship with my employer could possibly improve that.

Do I think that nurses would greatly benefit by a national organization that strongly advocates for ALLl nurses and promotes nursing issues without caving to straight left wing mentality? Absolutely. Show me that organization and I'll sign up. Unfortunately, it doesn't exist.

But there is a difference between a national voice and an indentured servitude to a union that may or may not have my individual best interests at heart.

Thankfully, in Texas, unions are a take it or leave it proposition. For the time being, ummmmmmmmmmmmmmmmmm, I'll leave it.




350 Posts

Specializes in ER (new), Respitory/Med Surg floor. Has 3 years experience.

My hospital recently supposedly hired a large law firm that's specialty is eliminating unions. It makes me nervous. The union consists of members we select. I really can't tell if it makes my job better or worse. The way my management is i really feel if there was NO union or something to support the nurses we'd be run right over. But at other times it feels we are run over and then we file a grievence and don't really see much change. I have talked with other nurses that have been at my hosptial over 25 years prior to a union and they said you would not believe how it was without the union, forced overtime, lousy medical benefits, and not much vacation. Our union has it so I had about 80 hours worth of vacation accumulated about 1.5 years, 48hours a year, and 8 hours for EACH holiday for holidy time, 3 personal days. So it seems great to me. My problem is staffing's becoming an issue. High pt turnover rate, more acute pt's (ex lots of stepdown from ICU). Our union is having us tally our staffing for each night and giving copies to them so i don't know what we'll happen. Here's the major test that will win me over. We also have a contract wiht the hospital for several years and now it's about time for more negotiations. Oh boy!

My one friend said unions were needed back in the time of coal mines, and the same with affirmative action but I find that ridiculous. I can see unions gaining too much power and actually loose sight of who it's representing (my dad was part of the steel union or tried to run for one sector and it was literally like the MAFIA!!!). However we get treated with such crap short staffing, and what if there was no union you know how many times i'm asked to do double shifts now what if they could force me to stay! It's not a law to not do that in pa now but my union prevents it. And affirmative action i know we've come a long way but you mean to tell me all discrimination is irradicated? I don't thinks so ok sorry I KNOW so!!! And you know what it took getting into nursing to see it too outright with some of my coworkers and working with some of the mds i was shocked! So just becareful about trying to eliminate these past measures that people seem to feel should be stopped.


3,322 Posts

Specializes in Critical Care. Has 15 years experience.

Everytime I have time to care for MY patients, I'm thankful I can do so without getting a letter from CNA threatening my job if I don't give my hard earned money over to them. On my check stub, there is no deduction for 'union dues'.

And I work day in and day out with the same ratios as in California - 2:1 in Critical Care.




4,491 Posts

It is truly a blessing to be able to nurse.

If not for the education and collective patient advocacy possible with CNA I would no longer be nursing.


9 Posts

And once the union gets involved with 'making things better for everyone', then what incentive is there for my peers to become better nurses. Unions entrench to the lowest common denominator

I have to disagree with this comment. I am motivated to become a better nurse each day because that is the type of person I am. Most nurses I know are like this. They are professionals who take pride in what they do and want to do the best they can.

I worked in a hospital for several years that the union was trying to get into. I worked next to nurses who were pro union, nurses who were anti union, and those who were undecided. We never got to vote because the union pulled out???? Regardless, the nurses I knew who were pro union were some of the best nurses, the nurses I knew who were anti union were great nurses also. These nurses would be motivated to do everything they need to be the best they can be. I think for many nurses what we do is an extension of ourselves and we work hard and educate ourselves because of that, no matter how poorly we are treated by administrators and other nurses.

I am sorry, I may have taken things wrong that you posted. I guess I just found your post to be judgemental and insulting. And I'm not even pro union. Maybe I just misunderstood what you were trying to say??? But, I will stand by the fact that there is no outside management, or any other person that makes me strive to be the best nurse I can be. I do it because I am proud of what I do. And if I worked in a union state there would be no less motivation for me to work as hard as I do. Maybe things should be "better for everyone" because as a whole most of us really do take pride in what we do and we do work VERY hard. Maybe we deserve things to be better.


4,491 Posts

I think most of the nurses working at Cook County were fine, hard working, caring nurses when members of their former union. I assume the same superior nurses will remain so when represented by their newly chosen union.

Anyone who was " difficult" will likely remain so.

I hope those nurses find the support they were seeking so they can improve care to the people of Chicago. AND begin building a movement to improve healthcare.

An article:

CNA Efforts Expand Beyond California's Borders

by George Lauer

July 11, 2005

California nurses are taking their show on the road, getting rave reviews from colleagues in other parts of the country, criticism from competitors and worried looks from hospital administrators and politicians.

Invigorated after winning its first union election outside California, the California Nurses Association has some lofty goals that don't stop at the state line or with better pay and working conditions for rank and file members. The California union is on a quest, spearheading what it hopes will become a national movement to change the way health care is delivered in this country.

"When you look at the way the women's suffrage movement evolved, you'll see some similarities I think to what's going on in health care right now," Deborah Burger, president of CNA and one of the leaders of the union's national campaign, said.

"It didn't happen all at once. It happened state by state, region by region with people slowly seeing how things could be instead of how they'd always been," Burger said....

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