Union Strategies for Improving Patient Care: The Key to Nurse Unionism

Over the past ten years the healthcare industry has become a main target of union organizing efforts. While registered nurses represent the largest group of healthcare professionals, union efforts to organize nurses have met only limited success. Evidence suggests that nurses are more inclined to join a union if they believe the union can help them address one of their most important concerns—the quality of patient care. This paper discusses the significant workplace problems nurses currently face in acute care hospitals and how those problems negatively impact nurses’ abilities to provide effective patient care. The paper also identifies, examines, and analyzes strategies that unions have developed and employed to increase nurse voice and involvement in patient care/nursing practice decisions in acute care settings. Over the past ten years the healthcare industry has become one of the main targets of union organizing efforts. This has occurred, in part, because healthcare is one of the few growth industries in the United States, and occupations in this industry are among the fastest growing in our economy. It is also a promising target for organizing because healthcare employees have been adversely affected by the many problems facing the industry and because healthcare jobs are less subject to outsourcing than jobs in other sectors. While the labor movement has experienced some success in organizing healthcare workers, progress in this industry, from the union point of view, has been less significant than might have been expected. One explanation for the limited success unions have experienced is that the industry presents the labor movement with a unique set of challenges. One of the most significant of these is the traditional reticence of healthcare professionals to join unions (Zerwekh and Claborn 1997; Gordon 2005). If the reservations of these workers can be addressed, the labor movement might be able to substantially increase their numbers. LABOR STUDIES JOURNAL: WINTER 2006 2 Registered nurses (RNs) represent the largest group of healthcare professionals, and anecdotal and empirical evidence suggests that they might be a particularly fertile target for union organizers (Clark and Clark 2005; Department of Professional Employees [DPE] 2005; Gordon 2005). Recent research, however, suggests that their openness to unionization is greatly influenced by the degree to which they believe a union can help them address one of their most important concerns—the quality of patient care (Clark et al. 2000; Clark et al. 2001). Winning a greater voice in this area appears to be one of the keys to organizing this critical segment of the healthcare industry. This paper discusses the significant workplace problems nurses currently face in acute care hospitals and how those problems negatively impact nurses’ abilities to provide effective patient care. The paper also identifies, examines, and analyzes union strategies to improve patient care and increase nurse voice and involvement in patient care decisions in this sector of the healthcare industry. The research linking nurse support for unionization to a union’s ability to win greater voice is reviewed and the range of strategies unions employ in this regard are identified and discussed. Finally, examples of union success in winning greater nurse involvement in decisions affecting patient care are presented. The Healthcare Industry The U.S. healthcare industry is a large and growing segment of the American economy. In 2003, national health expenditures in the U.S. totaled almost $1.7 trillion. This represented 15.3 percent of the nation’s gross domestic product (GDP) (Centers for Medicare and Medicaid Services [CMMS] 2003). By 2010, total expenditures are expected to increase to $2.75 trillion, with 17.4 percent of the GDP going to healthcare, and healthcare expenditures per capita are expected to rise from roughly $5,000 in 2001 to over $9,000 by 2010 (see Table 1). In addition, the healthcare industry is one of the U.S.’s leading employers. In 2002, 6.59 million people worked in health-related professional and technical positions (e.g., physicians, registered nurses, pharmacists, therapists, lab technologists, radiology technicians, etc.) and an additional 3.31 million were employed in support, service, and ancillary jobs (e.g., nurse aides, home health aides, medical secretaries, etc.). These numbers are expected to grow to 8.29 and 4.45 million respectively by 2012. There were 2.28 million RNs employed in 2002; that number is projected to grow to 2.91 million in 2012 (Hecker 2004). The U.S. healthcare industry is also an industry in crisis. Among the factors contributing to this crisis are rising healthcare costs, declining government 3 UNION STRATEGIES FOR IMPROVING PATIENT CARE