Collective bargaining : A nursing dilemma

Richard U Miller Collective bargaining : A nursing dilemma Is professionalism compatible with collective bargaining? Can a registered nurse belong to a labor organization? Should a professional association such as the American Nurses Association (ANA) represent nurses for collective bargaining, particularly if this brings prospects of work stoppages, picketing, and otherjob actions traditional to labor unions? Questions of this type go back at least 50 years. Although there are some partial answers, the dilemma of professionalism vs collective bargaining has not been satisfactorily resolved. It now looms as the paramount issue facing registered nurses in the 1980s. In this article, we shall look at how other professionals have confronted the dilemma, which groups are seeking to represent registered nurses, and whether health care professionals face problems in collective bargaining that other workers do not. Finally, we shall attempt to foretell where collective bargaining trends will carry nurses during the 1980s. Richard U Miller, PhD, is professor of business and industrial relations, University of Wisconsin, Madison. He received a doctoral degree in industrial relations from Cornell University, Ithaca, NY. From 1974 to 1978, he was director of the Industrial Relations Research Institute at the University of Wisconsin. This article is adapted from his presentation at the 1980 AORN Congress in Atlanta. Collective bargaining for all health care employees, whether professionals or not, is a phenomenon of the late 1960s and 1970s. Although California nurses were represented for bargaining in 1946 and more than 50 Minnesota hospitals were under contract by 1948, collective bargaining grew slowly. For example, in 1961, only 3% of hospitals in the United States had labor agreements with any of their employees. By 1970, the comparable figure was about 15%, and in 1975, 20%. The unionization of nurses strongly parallels the general growth of bargaining coverage. In 1964, 9,000 RNs were under contract; in 1969, 30,000; and in 1979, 125,000 to 130,000. There are also geographical similarities. Presently and historically, much of the bargaining has occurred in the Northeast, Far West, and upper Great Lakes areas. In 1974, amendments by Congress to the federal labor law (Taft-Hartley Act) gave a major impetus to the growth of collective bargaining. This brought the private health care sector under the jurisdiction of the National Labor Relations Board (NLRB). Among other provisions, the amendments guaranteed the right of workers in private profit and nonprofit health care institutions to organize for bargaining, set up procedures for resolving representation disputes, and legalized use of strikes and related collective action. Prior to 1974, health care labor rela- AORN Journal, June 1980, Vol31, No 7 1195

M ore than 30 labor organizations have a foothold in health. tions were largely left to the states to regulate. Only 11 states had established a legal basis for bargaining. Moreover, few of these states provided unrestricted bargaining. For example, Minnesota and New York granted the right to organize but also required compulsory arbitration as a substitute for strikes. Thus, the federal law was a significant step in creating the legal conditions under which groups such as registered nurses could adopt collective bargaining should they choose to do so. But the federal law also brought into sharper focus the health care professional s dilemma. Is collective bargaining compatible with professionalism? The dilemma is especially complex for registered nurses since most are women. Social beliefs that women should be submissive, supportive, and obedient are intertwined with the norms of the profession, which emphasize selfless devotion to duty, first priority to patients, and rejection of economic gain over professional commitment. One observer concluded, A nurses union would be almost, if not quite, as absurd as a mothers union. Yet, conflict over roles and values is not unique to nursing. In primary and secondary education, the dilemma is also sharp. In education, the question of professionalism vs collective bargaining is no longer salient, however, although it is not totally resolved. More than 56% of public school teachers are now covered by collective bargaining. Also, the National Education Association (NEA), with its 1.7 million members, and the rival American Federation of Teachers (AFT), with more than 500,000 in its ranks, have unequivocally endorsed collective bargaining. In higher education, more than 500 colleges and universities have collective bargaining contracts covering 141,000 faculty and professional staff.2 Closer to home for registered nurses is the collective behavior of interns and residents. Represented by the Physicians National Housestaff Association (PNHA), some 14,000 physicians are working under labor agreements in such cities as New York, Chicago, and Los Angeles. House staff bargaining has often been militant and more than once has culminated in work stoppages. More senior physicians, particularly as they have acquired salaried employee status in hospitals and health maintenance organizations, have followed in the footsteps of house staff physicians. As a final point, 46% of all professionals are represented for bargaining in the public sector a10ne.~ Included in this group are engineers, attorneys, professors, and scientists, as well as health care professionals. From the numbers alone, it is apparent that many professionals engage in collective bargaining or become associated with organizations that do, whatever incompatibility they feel. The lit- 1196 AORN Journal, June 1980, Vol31, No 7

erature of such groups as NEA, AFT, and PNHA suggests that, for their respective groups, at least, they see bargaining as a way of enhancing their members professional status. Should RNs be involved with labor organizations? As the number of nurses already represented for collective bargaining attests, this question is no longer open. The more pertinent issue for registered nurses is not whether to organize but which organization to join. Among groups most ardently courting nurses are professional unions such as the AFT; unions of largely nonprofessional health care workers, including District 1199, National Union of Hospital and Health Care Employees and the Service Employees International Union; and nonprofessional unions not associated with health care, typified by the former retail clerks union (now the United Food and Commercial Workers Union) and the Teamsters, to name just a few. In fact, I am currently involved in a study that reveals that more than 30 different labor organizations have a foothold among health care workers. Recently independent bargaining groups have emerged, created largely as a result of breakaways from the state affiliates of ANA. Examples are the United Nurses Association of California, Connecticut Health Care Association, and United Professionals for Quality Health Care of Wisconsin. Finally, the ANA itself represents more than 100,000 nurses, 25% of whom are not members of the Association. As the ANA President, Barbara Nichols, RN, recently stated, ANA currently represent(s) more registered nurses for collective bargaining purposes than all other labor organizations combined. * It is likely that competition to unionize health care professionals will accelerate in the next few years. In turn, the proportion of registered nurses covered by collective bargaining is likely to go considerably beyond the current figure of over 130,000. Given the current debate over the role of collective bargaining within ANA, an unresolved issue is whether ANA will be able to withstand the challenge of the other groups and remain the front runner in the race to represent professional nurses. Do professionals-particularly nurses -face issues in collective bargaining that other workers do not? The answer is no and yes. On the one hand, registered nurses, as are all workers, are concerned with their economic security and welfare. Achieving higher salaries, protecting these salaries against inflation, acquiring safeguards against arbitrary treatment from employers, and insuring some protection from loss of income through illness, layoff, and retirement are goals held by all workers, both professional and nonprofessional. On the other hand, nurses face differ- AORN Journal, June 1980, Vol31, No 7 1197

What major unions are organizing nurses? About 30 unions bargain for health care workers. These are the major groups. Some others include the Teamsters, the steel workers, and the hotel and restaurant workers. The American Nurses Association (ANA), with 105,000 RNs in collective bargaining, represents more RNs than the other major unions combined. ANA s constituents, the state nurses associations, have been bargaining for RNs since 1946. The Federation of Nurses and Health Professionals/American Federation of Teachers, an AFL-CIO affiliate, began organizing RNs in 1978. There are now 25,000 health care members, the majority of whom are RNs. The AFT as a whole has 550,000 members, most of whom are teachers. District 11 99, National Union of Hospital and Health Care Employees has represented RNs in a separate division since 1977. About 7,000 of the union s 100,000 members are RNs, and about three-quarters of its members are in the New York City metropolitan area. A member of the AFL-CIO, it is an affiliate of the Retail, Wholesale and Department Store Union. Service Employees International Union (SEIU), also an AFL-CIO affiliate, has about 20,000 RN members out of about 210,000 members in the health care field. Total union membership is about 600,000. SEIU also represents public employees and service and maintenance workers. United Food & Commercial Workers, an AFL-CIO affiliate, with about 700 RN members, has been organizing nurses for five years. They also represent other health care workers, service and maintenance workers, and social workers. ent bargaining problems. First, can one association, such as ANA, accommodate the divergent outlooks and needs of members who are in management and those who are not-particularly if collective bargaining is a central function of the association? Unlike most nonprofessional labor organizations, nurses associations have traditionally granted full membership to RNs without regard to their supervisory status. This was also true of the teachers. This policy can become a focus of internal conflict between those who favor collective bargaining and those who do not. The policy can also lead to external attacks from unions that exclude supervisors. For example, the AFT, District 1199, and the independent nurses associations have alleged that the ANA is management dominated because it allows supervisors to join. Under the National Labor Relations Act, it is unlawful for an employer to dominate or interfere with the formation or administration of any labor organization or contribute financial or other support to it. The intent is to prevent employers from interfering with their employees collective bargaining rights. Participation by supervisors in nurses organizations has also been used by administrators of health care institutions as a reason for refusing to bargain with these organizations. Hospital administrators have argued that ANA does not qualify as a legitimate labor organization because it has management personnel as member^.^ They maintain that there is a possible conflict of interest for these managers between their roles as representatives of an employer and their duties as ANA members. For the professional association seeking bargaining rights, the quandry is how to provide a rightful place for all members of the profession. ANA maintains it is not management dominated because its Commission on Economic and General Welfare and the local staff units are autonomous. An at- 1198 AORN Journal, June 1980, Vol31, No 7

he question now is, T which organization should I join? torney who has represented the Illinois Nurses Association has argued that the law does not prevent supervisors from being members in the association; rather, the law does not permit supervisors to take part in the association s collective bargaining activities. Supervisors may participate in all other ANA activities, he maintains.6 Second, nursing has unique bargaining issues. Most notable are patient care questions such as staffing, the right to refuse assignments, and establishment of joint committees to provide a mechanism for participation in patient care decisions. For some, the nurse s ability to acquire an influential voice in patient care policies lies at the heart of professionalism. Third, collective bargaining concerns power and the actual or threatened use of force. For the professional nurse, refusing to work or attempting to prevent other employees from working often seems inconsistent with being a dedicated professional who places patient care above all else. Until 1968, the ANA held to an official policy of no strikes. In some state associations, the policy continued for some years thereafter. With regard to picketing, national and state nurses associations have traditionally followed a position of neutrality in non-rn disputes, choosing not to honor picket lines of other employee organizations. In recent years, nurses have appeared less reluctant to engage in militant collective action, perhaps emulating other professionals such as teachers and physicians. A few examples are RN work stoppages in San Francisco, New York City, and Seattle. Misgivings about strikes are still strong, however, as demonstrated by the willingness of nurse bargainers to look to substitutes for the strike, including binding arbitration. The bargaining future for nurses is difficult to foresee clearly. Yet, several points seem pertinent. First, the belief that collective bargaining is incompatible with professionalism seems weaker now than at any time in the past. Perhaps this is because of role models from other professions where bargaining is prevalent and because many registered nurses have found they can reconcile professional and labor activities. This is in keeping with the findings of recent studies examining the attitudes toward collective bargaining of employees in other walks of life. Next, the related question of whether to join any labor organization has now been recast. The question now is, Which organization should I join, or which will represent me? Many groups-traditional unions and nurses associations-are pushing strongly to get nurses covered by labor agreements. More than once, organizing drives have involved rival groups. Third, the state of the American AORN Journal, June 1980. Vol31, No 7 1199

economy bodes ill for workers during the 1980s. Price increases exceeded 13% in 1979, and the consensus among economists is that rates of inflation will worsen in 1980-1981. Increasing unemployment is likely as one consequence of government efforts to restrain prices. To make matters worse for the nursing profession, the health care industry has been widely depicted as a major contributor to the inflationary spiral. Congressional bills to control costs and enforce productivity programs will worsen the impact on the economic and general welfare of individual nurses. Fourth, harsh economic conditions reinforce opposition to collective bargaining from employers. As many registered nurse bargaining organizations have already discovered, hospital administrators, often aided by outside consultants, are counterattacking during union organizing drives. If unionization is successful, administrators may be recalcitrant bargainers at the negotiating table. What is more, management may find the once unthinkable strike is actually a benefit to the employer. For example, one author concluded that a strike forced the hospitals involved to make more efficient use of registered nurses and all hospital personnel. In addition, the press coverage enabled the hospital to inform the public more adequately of their services and characteristics. Perhaps most important, the author said, the firmness with which the hospital resisted the nurses demands will be noted by other bargaining units. * In summary, the question of whether collective bargaining is acceptable for nurses is becoming a token issue in the 1980s because a higher proportion of registered nurses are becoming unionized. This will be a decade of conflict in hospital labor relations, as nurses and their representatives seek power over patient care and their economic status. More than any other issue, this conflict will continue to create misgivings for the average nurse about collective bargaining. By the end of the decade, one hopes that much of the conflict will be over and that collective bargaining will have become the foundation for more productive and harmonious relations between professional and nonprofessional health care employees and their employers. 0 Notes 1 I US Department of Labor, Earnings and Other Characteristics of Organized Workers, May 7 977, Report 566 (Washington, DC: US Bureau of Labor Statistics, April 1979). 2. Joseph W Garbarino. John Lawler, Faculty union activity in higher education: 1978, lndustrial Relations 18 (Spring 1979) 244-246. 3. US Department of Labor, Earnings and Other Characteristics of Organized Workers. 4. Barbara Nichols, An open letter to the nurses of America, American Journal of Nursing 80 (January 1980) 61; reprinted in AORN Journal 31 (March 1980) 718-720. 5. See NLRB v Annapolis Emergency Hospital Association d/b/a Anne Arundel General Hospital, CA 4, no 76-1166, AUg 31, 1977. 6. Leon M Despres, A lawyer explains what the national labor relations act really says, American Journal of Nursing 76 (May 1976) 790-794. 7. Thomas A Kochan, How American workers view labor unions, Monthly Labor Review (April 1979) 23-31. 8. David L Roach, Hospitals stand firm, ensure care in lengthy areawide nurses strike, Hospitals, JAHA 51 (Aug 1, 1977) 49-51. 1200 AORN Journal, June 1980, Vol31, No 7