Unions are increasingly becoming relevant in the nursing profession, impacting on the financial, professional and personal welfare of nurses. Yet whilst some people view them as important to the profession, others view them as unnecessary impediments to the development of the profession (Dube, Kaplan and Thompson, 2016). Indeed since discussions about unionizing nursing emerged in the 1940s, there has been no agreement as to their importance.
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Nursing union membership in the United States is estimated to be at 21% (Spetz, Ash, Konstatinidis and Herrera, 2011) with the largest union being the National Nurses United (NNU) that has 185,000 members. Other nursing unions are the National Federation of Nurses, Washington Nurses Association and Oregon Nurses Association. Some nurses are represented by non-nursing unions including the American Federation of Teachers, United Steelworkers and the Service Employees International Union (Koys, Martin, LaVan and Katz, 2015). There are also professional organizations that represent nurses, such as the American Nurse Association (ANA).
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Often, the roles of nursing professional associations and those of unions overlap. ANA has in the past successfully lobbied for better working conditions for nurses (Staiger, Spetz and Phibbs, 2010) while present-day unions are advocating for more professionalism in the industry through funded training programs for nurses. Overall, nursing unionization should lead to better working conditions, more job satisfaction and better patient outcomes for unionized nurses. Whether these goals are achieved is debatable.
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Advantages of joining a union
The right to unionized membership is enshrined in the National Labor Relations Act (NLRA) of 1935 that grants private sector workers the right to organize and form unions whilst reviewing and prosecuting unfair labor practices such as threat, unfair disciplining and refusal to bargain. NLRA further requires unions to represent employees and to bargain in good faith (Kany, 2007). Amendment to the Taft-Hartley Act of 1947 allowed nurses in not-for-profit hospitals to unionize. Moreover unions are working towards laws that regulate hospitals and other healthcare institutions, especially with a view to requiring employers to protect nurses from harassment and violence in the nosocomial environments and creating government-funded programs for nursing education (Cherry, 2014).
Unions give workers a voice in collective bargaining with employers for better pay. They enable negotiation for fair wages for all unionized nurses, usually with a minimum wage and different rates for different shifts being agreed upon. It is noteworthy that nurses in unionized facilities generally earn 18.8% higher than those in non-unionized facilities through a higher base pay and negotiated shift differentials (Spetz et al, 2011). In situations where the employer implements cost cutting, the wages of unionized nurses remains unaffected, with guaranteed pay increases according to union contracts.
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Unions further guarantee job security unlike most non-unionized workers who are on “at-will” employment (Gerardo, 2017) with the latter’s employment being at the discretion of the employer. Union contracts usually prohibit termination of employment without cause. In situations where disciplinary action has been taken by the employer against a nurse, including termination of employment, unions offer representation to the nurse through suitable counsels, ensuring fair treatment by the employer. Apart from protecting the nurses against unfair dismissal using specified processes to address complaints and grievances, unions protect the nurse from other reprisals by facilitating satisfactory resolutions (Koys et al, 2015).
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Unions also advocate for better working conditions for workers. Notably, poor working conditions have been noted to be driving nurses out of the profession, with the major complaints being stress, overwork and nosocomial injuries (Seago, Spetz, Ash, Herrera and Keane, 2011). Unions promote job satisfaction and a safe working environment for nurses via collective bargaining. Other pertinent issues that unions lobby for include better nurse-patient ratio with a view to reducing overwork, stress and improving healthcare outcomes, deterring the monopsony power of hospitals over nursing (Staiger et al, 2010) and elimination of mandatory overtime.
The roles of nursing professional organizations have become muddled with many of them engaging in the duties of trade unions. This is evident in ANA’s engagement in collecting bargaining. This has led to many nurses urging the professional associations to instead concentrate on advancement of the profession (such as education and research) whilst leaving trade union tactics and functions that aim at the welfare of nurses to the unions. It is as a result of this that ANA formed the affiliated United American Nurses (UAN) in 1999 to engage in the bargaining activities whilst ANA focused on professional development. UAN later combined with the California State Association and Massachusetts Nurses Association to form the National Nurses United (Cherry, 2014).
There are many bedside nurses who feel that professional associations are not representative of the nurses’ interests. An example cited is that ANA is led by nursing executives, managers and educators (Cherry, 2014), a situation that leads to conflict of interest especially where the leaders work in institutions involved in the collective bargaining with the respective union. Further this has led to differing opinions about collective bargaining between the executives and practicing nurses; with the former emphasizing wages and working conditions while the latter include such issues as staffing. Consequently, many bedside nurses are increasingly advocating for unions as more encompassing representatives of their interests and urging the professional associations to focus their resources more on professional development rather than collective bargaining.
There are unions that extend the benefits to their members to include insurance cover and special mortgage rates. Some also offer education grants with a view to professional development. The unions may also offer apparel and travel discounts especially for interstate workers.
Disadvantages of joining a union
Nursing is a profession and professionals should not be members of unions. This is based on the premise that professionalism and unionism should not mix; an issue that has been a point of debate in nursing since the 1940s (Kany, 2007). It is argued that nurses should utilize professional bodies such as ANA to present their issues. ANA’s primary goals are to advance the nursing profession, represent nurses’ interests and improve America’s health. The association has been involved in collective bargaining and media campaigns with regard to wages, working hours and working conditions; albeit with a caveat of non-strike action so as to adhere to nursing professionalism. Instead the association advocated for informational picketing, media campaigns, sick calls and mass resignations. Some professional associations viewed these tactics as ineffective, consequently resorting to strike actions (Seago et al, 2011). Notably all these are some tactics employed by unions, leading to nursing unions being viewed as replicating the roles of the professional associations.
Yet the tactics and responses used by unions such as strikes are not compatible with the values, standards and ethics of nurses. When nurses strike, they abandon their patients, conflicting with their professional values and ethics.
The rise of unionism in nursing has led to nurses joining different unions. This creates division in nursing that should otherwise be a unified profession (Kany, 2007). The concomitant discord at the workplace creates a variety of emotions among nurses that is taxing individually and collectively (Cherry, 2014). Due to the myriad unions, nurses are unable to work together for the advancement of the nursing profession. Hence rather than unions, nurses should employ political lobbying, public campaigns and education through professional associations to advance their interests (Kany, 2007).
Unions further reduce professionalism among nurses due to natural causes and outside forces (Staiger et al, 2010). Natural causes that negatively impact on nursing professionalism include political, social and economic trends while such outside forces as the healthcare industry also have a negative impact on the professionalism. Moreover, unions focus on the collective standard, rather than the individual standard, with the latter focus being core to professionalism. Unions focus on equitability and fairness among workers rather than individual excellence, negatively affecting the nursing profession.
To join a union in states that do not have the “Right-to-Work”, nurses pay dues that are usually a percentage of their salaries to the unions. This has been a bone of contention for many nurses who feel that the dues impinge on their financial remuneration (Dube, et al, 2016). It has made many nurses reluctant to join the unions. Suffice to say that the dues are usually offset by the better pay package unions are able to negotiate for their members.
Whereas it is illegal to lay off an employee for organizing or joining a union (Spetz et al, 2011), it is difficult to prove that the employee was fired for these reasons. The employer could hence fire employees who join a union or a strike, permanently replacing them on one pretext or another, with the employee and or union being unable to prove that the employee was fired because of the union action.
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Unions call for strike expecting all members in the profession to join in; otherwise they are labeled as traitors. While some unions have a strike fund, many do not with the workers having to strike with no pay. This becomes unsustainable for both the worker and the union, rendering the strike ineffective in the long run. Indeed many strikes in the healthcare industry fail to achieve their purpose e.g. the nurses’ strike at Quincy Medical Center in Boston in 2013 where the hospital temporarily replaced the union nurses leading to the nurses resuming work without achieving their strike’s objective of a better contract (Dube et al, 2016).
While unions guarantee pay raises and step increases, these are usually based on such other factors as the period the nurse has been on the job, seniority and even favorable appraisals. This may lead to dissatisfaction and distress for nurses who expect pay raises based on union guarantees and exemplary performance.
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Bottlenecks and stifling working relationships often punctuate the working environment of union nurses. This is because the manager and the employee may feel the need to document and mediate even the simplest agreements and disputes with a view to meeting union requirements (Gerardo, 2017). Such a working atmosphere stifles the work of the nurse and healthcare outcomes.
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To unionize or not to unionize
Whether to join a union is a personal and professional decision. Notably professionalism and unionism can exist side by side; a view supported by various professional organizations including ANA, who, despite previous maneuvers to deter unionism, currently support the right of each nurse to choose whether to belong to a union and to engage in collective bargaining as reflected in their position statement and Code of Ethics for Nurses with Interpretive Statements (American Nurse Association, 2018). Various studies have been inconclusive regarding the effect of nursing unionization on working conditions, job satisfaction and patient outcomes. However, most studies conclude that unionization leads to better remuneration. Unions are also advocating for more professionalism in the industry through government-funded nursing education. It is because of these reasons where unions are putting efforts to advance individual and collective development of nurses that I personally encourage nurses to join unions.
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