Chico David

Again, to clarify: your constitutional rights of free speech are vis-à-vis government action. Not anything your employer might do. There have been a number of well publicized cases in the last year of employers firing people for having a bumper sticker for the wrong candidate on their car - and, unless your state has a law to the contrary, or you are covered by a union contract, it is perfectly legal for them to do so. Hospitals wouldn't go that far, but if they think what you say in a public forum reflects negatively on them, expect problems.

There was another recent posting - thread now closed - by a nurse who got in trouble over a Facebook posting. I have some direct experience with this - as a union steward - and a fair amount of second hand knowledge. Here are a few basic things to keep in mind: 1. Your Facebook "friends" may very well not be your actual friends - in every case that I've dealt with, management became aware of the offending posting when a "friend" of the poster brought it to their attention. And your privacy settings are no protection. 2. You do not have rights of "free speech" related to your work - the First Amendment protects you against the government intruding on your free speech rights - it says nothing about your employer. 3. If you are not covered by a union contract, in most parts of the US you are an at will employee and can be fired for any reason or no reason - except for a very small number of protected reasons like your age or race. 4. If you post something that would make anyone reading it think they might not get good care at your hospital, that would almost always be a legitimate reason for action against you. Here are a few real life examples: "We were so understaffed it was scary" or "If another person comes into the ER just to get narcs, I might punch them out" or "I got so frustrated with one patient I wanted to take her call light away". Yeah, we've all had feelings like that, and we might say them to a real friend face to face - but posting them online for all to see - and, no matter what your privacy settings are, it really is for all to see - is just foolish. Save those rants for your truly private conversations. One last note: Labor law does protect concerted activity. So if your union has a Facebook page and you were having a discussion there about how to improve staffing at your hospital, a negative comment on staffing in that context would likely be protected by law - but the exact same comment in the context of just a general rant likely would not be. So, be careful, be smart, don't cause yourself unneeded trouble for silly reasons.

There are a number of things I could add to this, but will just focus on one: the idea that "bad" nurses can't be fired in a union environment. I've had 13 years in management and 12 years as the chief steward for the union at my hospital, and that idea is just flat false. Here are basic facts: if a manager decides to fire a nurse, they don't have to ask permission from a union to do it - they just do it. Then it's the union's role to attempt to overturn the firing if they think they can and should - sometimes the firing was obviously just and we tell the nurse they need to learn from it and move on - we can't spend our resources on hopeless cases and don't really want to. But assuming we do contest the firing and it's not overturned in the first steps of the process, it ultimately goes to arbitration - a sort of private trial - where the arbitrator applies the tests of "just cause" to the firing: There are several tests, and I don't have them all by memory, but they are things like: Was the offense - or pattern of failure - serious enough to justify firing? Did the employer have adequate notice they weren't doing well? Were they given an opportunity to do better? etc. Both sides get to present their case and the arbitrator decides. So a manager who needs to get rid of a failing nurse and wants to make it stick, just has to apply the same basic principles of documentation we all apply to our patient care: Identify how the nurse is failing, let them know it and document that. Give them clear expectations of what is expected and document that. Give them a reasonable time and document their failure to improve. That's all it takes and that's just the sort of fair process any of you would want to have in a choice that might damage your ability to earn a living. Any manager who says they can't get rid of a bad nurse "because of the union" is really just saying that they are too lazy to go through the proper process to do it right. Finally: For those who work without a union: Can you honestly say there aren't any lazy, ineffective nurses where you work? Of course there are - for all sorts of reasons - managers who don't want to deal with the hassles of firing, nurses who have managed to ingratiate themselves with a manager who overlooks their failures, etc

This isn't exactly unbiased, as I am a volunteer steward for my union, but I also spent 13 years in management, so I do have both perspectives: And I note the thread is pretty old - sorry you didn't get more helpful advice - you've likely made your choice already, but I'll still throw this out for what it is worth. In most unionized hospitals, the top management makes sure their frontline managers are compensated significantly better than the staff nurses, so when the union wins a pay raise, you tend to get bumped up automatically. if you are a manager who likes to "fly by the seat of your pants" a lot, then the rules and procedures in a unionized environment can seem confining. They can be really confining if you like to play favorites - give your special friends special privileges and the like. But if you are basically fair minded and apply the same sort of documentation to management that all of us apply to patient care, you won't find it a big bother to have a few rules around. As the chief steward at my hospital, there are a small handful of managers with whom I have frequent conflict, and the vast majority I never need to talk to. Really good managers often learn to use the union contract to their advantage in dealing with their own superiors - when your boss asks you to do something really dumb that will harm patient care and **** off your nurses, you can say " Won't the union give us trouble over that?" The old canard about the union protecting bad nurses is mostly false. A union contract gives nurses the right to a fair procedure in disciplinary action, but that just means you have to have the discipline to have your ducks in a row, so to speak. If a nurse is being a problem, you need to let them know how they are failing, give them a chance to improve and document that they fail to improve before you take action. Managers who say they can't get rid of the rare genuinely bad nurses "because of the union" are really just saying they are too lazy to go through the proper procedure and do the documentation they need to do. Anyway, hope you made the right choice for you and it worked out well.

I'm well aware that libertarians favor some form of government, but all the libertarian writings I've read claim the government ought not be in the business of regulating things to ensure public health and safety. They would claim that it's your job, not the government's, to make sure that the person taking care of you is safe and competent and the only safety mechanism you need is the right to sue a practioner if they actually harm you, or a company that sells you a defective product that injures you. All of that is standard libertarian doctrine. According to libertarian principles, a government mechanism to license health care practitioners is just a way for those practioners to keep others out of the field and artificially inflate the value of their work. Again, I don't believe any of this silliness, but it's what libertarians claim to believe taken to its logical conclusion: that anyone who wants to call themselves a doctor or a nurse ought to be able to do so and that it's up to the patient do judge if they are competent or not. In reality of course, like most other people, the libertarian claim to favor personal freedom is highly situational and tends in practice to mean favoring freedom for people you approve of to do things you approve of.

And while we are at it, we obviously should do away with licensing for nurses - that's just about the government trying to ensure quality care and public safety and we don't need the government for that - the free market can handle it - just like they handle banking regulation. Licensing just artificially inflates wages and drives up health care costs. If we leave it up to hospitals, I'm sure they wouldn't hire anyone unqualified just to save money. Would they?

It seems to me that it's hypocritical for a libertarian to be going into nursing - or medicine - since both are professions in which a government issued license attempts to assure quality of care and the safety of the public - something libertarians believe the government ought not to be involved in. A libertarian who is true to their beliefs wouldn't participate in such a system. Just a little gentle poke here.

Short form update: both on the organizing front and on the political/social movement front, NNU has been pretty active. More members in more states, including places like Texas and Florida that have hardly been hotbeds of union activity. Making substantial inroads into some of the big for-profit hospital chains, which is important, both because they are widespread and because they tend to oppress their nurses pretty badly. I'd say the biggest disappointment is that the progress toward true unity and integration have come a little slower than I might have hoped. While we are unified in many ways, there is still an understanable reluctance of some states to give up autonomy and move toward true integration. It will come, but not as fast as some of us might have dreamed.

Several quick thoughts: it sounds to me, if I understand correctly, that people at your hospital are trying to set up an entirely independent union, not affiliated with any larger organization There are places with single-bargaining-unit unions that are fairly successful CRONA at Standord University Hospital being an example. But they are the exception. for the most part, a larger union with more power and more structure behind it will be more effective. But not always. In some places the absence of collective bargaining by state nurses associations has led a variety of non-nurse unions - Teamsters, Laborers, Steelworkers and others - into representing nurses. Not always too successfully. As a board member of a nurse union, I can tell you that the complexity of running a union - just in complying with reporting requirements and such - is immense. A big challenge for a new independent organization. I'd be leary of that idea. And, in response to another comment further up: No state can prohibit nurses unions, at least in the private sector. Some states have so called "right to work" laws, which prohibit a contract that makes union membership mandatory for a particular workplace. In those states, unions tend to be small and weak and not common. But there are no states where unions are illegal - even though a lot of managers will lie about that and love for you to think they are illegal.

The whole thought process of German employment is very different than here. The attitude of cooperation appears to cut both ways there - employers try to treat their workers decently and unions try to cooperate with the company. For such a system to work, the attitude has to come from both sides. In the US, the employer considers it their duty and god-given right to grind the workers to the max to maximize profit, so that pretty much forces the union into an adversarial relationship to try to defend the workers. In places in the US where unions have tried to enter into "labor-management partnerships" it has usually not worked out well for the workers. The closes example you could find in health care in the US would be the labor-management partnership at Kaiser. It covers most of the non-RN workers there. You can get very widely divergent opinions on how well that has worked.

So I'll take pity on the poor student and try to help: First, complicated subject. All the below is my opinion - coming from the perspective of someone very involved in a state association that does do collective bargaining. Some state nurses associations choose to do collective bargaining - that is they act as both professional association and union. The most prominent and largest are California (by far the biggest)New York, Massachusetts. Many state associations are only professional societies and don't do any collective bargaining at all. They tend to be dominated by managers and academic nurses and don't necessarily have the same interests as staff nurses - they tend to ally with the interests of management rather than the needs of working nurses. Some state associations that do collective bargaining do a good job representing nurses, others don't do it so well. Because some states don't do it at all and other states do it poorly, that has left a void that has been filled in some cases by other types of unions coming in to represent nurses. Nurses in various places are represented by unions of Steelworkers, Teamsters, Laborers, Service Employees, Teachers and other unions. I have a bias that the needs of nurses are best met by unions just for nurses with nurses in top leadership positions. As nurses leading a nurses union we can speak with a strong moral authority and avoid the kind of conflicting needs that some other unions run into when they represent nurses. For more info, I'd try doing online searches into the websites of and discussions about the California, New York and Massachusetts associations and the National Nurses United.

One of my personal little hobby horses: the biggest thing holding back nurses is nurses. Our self-sacrificial, fearful and co-dependant natures that prevent too many nurses from being willing to stand up for themselves. Every time we go into bargaining for a contract, I hear some nurses say things like "oh, we shouldn't ask for too much, management might not be able to afford it". There's a germ of truth in there, in that one does have to be realistic, but it's management's job to tell us if they can't afford what we are asking for, not our job to think we shouldn't ask. When we were bargaining our first contract, we sent out updates to the nurses about what was happening at the bargaining table. At one of our membership meetings, a nurse got up and said "I don't like to read those updates, because sometimes they say things about management that aren't nice". I remember thinking "I'll bet none of the male dominated unions ever have to worry about that".

Couldn't agree more with that - every person dependent on a health care facility for their survival and well being deserves the quality care that ratios provide. But it's a heck of a fight to get them won. A few miscellaneous comments: I came into the California Nurses Association just at the tail end of the fight for ratios, so I know that story mostly second hand. But I know it fairly well. It was a hard fight and a long one - passed the bill through the legislature once, the governor vetoed it. Came back the following year and passed it again. This time there was a different governor and he signed it. They did indeed enlist the general public in a wide variety of ways - newpaper and billboard ads, community town hall meetings, etc. And a lot of legislators who ought to have been on the right side took some serious pressure to vote for it. Every time there was a major hearing or vote, CNA brought hundreds, in some cases thousands of nurses to Sacramento to rally in support. After it passed and went to the governor, we (I was a member by then) did the biggest rally of all on the steps of the capitol to demand the governor sign it. Then the fight was only half won, because the law delegated the actual setting of the ratios to the Department of Health Services (now Department of Public Health). They held hearings at which the hospital association testified that the correct ratio should be 10-1 and where another union testified that LVNs should count equal to RNs in the ratios. So there was a massive year-long mobilisation around all that process. Finally got the regs in place and then a year later Arnold was governor and he tried to roll them back. That ignited a year-long war in which we sued him (and eventually won) and followed him to every single public event he did for a full year - over a hundred demonstrations. That turned out to be a pretty good learning experience, since no politician since has really dared to mess with them after what we did to him. Bottom line: ratios can be won, but it takes a powerful union, an engaged membership and an informed public - and even then, the time and conditions have to be right.

You may have some sad surprises coming - I just got to listen to the most amazing tape recording - Dave Regan talking to a bunch of local union leaders from SEIU Kaiser just a few days ago. Spinning like mad trying to put a positive interpretation on the fact that SEIU, long before going into bargaining, has already pre-agreed with Kaiser to accept cuts in health care benefits. Making statements like "We have to help Kaiser be more competitive" and a whole lot of talk about "we need to be a 21st century union" - which in SEIU speak means "a union that makes backroom deals with management instead of standing up for its members". He was trying mightily to put lipstick on that pig, but it's still a pig. Kaiser worked very hard - and illegally - to help SEIU win that last election, and this is the payback they are getting in return - of course they wanted a tame union that wouldn't bite back, and they knew just where to find one.

Everybody has their own opinion, but there is one of those knocks against unions - highlighted in the passage above - that I will challenge every time I see it because it is just flat false. Here's the way a termination works in a union facility: (at least in the private sector - civil service in the public sector may be different) Management decides they need to fire an employee and they do. No need to ask anyone's permission or hold any hearings. They just do it. The employee calls their union rep, the rep files a grievance. The rep and the employee meet with management representatives and state their case why the firing is unfair. Management, if they still believe the firing was right, denies the grievance. If the union still believes the firing was unfair and they have a good case, they file for arbitration. Depending on the details of a particular contract, an arbitration can take weeks to months to set up and get a hearing date. The arbitration hearing is held. It's basically a trial with a private judge paid by the two sides. Both sides get to make their case. (all this time the employee is still off work) The arbitrator judges whether there is "just cause" for the firing. If so, the firing is upheld, if not, the employess is ordered back to work - possibly with back pay for the time missed. What is "just cause"? It basically means that the employees faults were serious enough to merit firing, that they were given adequate notice of how they were deficient and given an opportunity to correct it. No employer has to get permission from the union to fire someone - they just do it and the union has to try to overturn it through this long and expensive process. Bottom line: If a manager tells you they can't get rid of a poor worker "because of the union" they are really just saying they are too lazy and inept to do the process properly so it will stand up in an arbitration. That process isn't that hard. It's like the kind of documentation we all do every day. Final thought: if you work in a non-union facility, do you know any workers there who don't do a good job and don't pull their weight? They have no protection there - what's stopping management from firing them? Who knows?