Unions for health care workers are growing

The number of medical personnel covered by some form of collective bargaining agreement or registered as union members is edging up, according to numbers from the Bureau of Labor Statistics.

This is partly because the health care sector now employs many more people than do traditionally unionized industries such as manufacturing. But the trend also marks a backlash against some of the belt-tightening by hospitals in response to the recent economic downturn, experts said. Uncertainty around health system reform is also playing a role.

"Unions very much want to gain inroads in expanding sectors of the labor force, and they know that if they can organize nurses and other health care workers, they will have a future," said Gary Chaison, PhD, professor of industrial relations at Clark University in Worcester, Mass. "Second, nurses and other health care workers feel a loss of control in their jobs because of cost-cutting pressures, particularly with the uncertainties of the impact and unintended consequences of health care reform legislation."

Bucking a trend

Union membership in the country as a whole has been declining for years. It peaked at nearly 21 million members, or 24.1% of workers, in 1979. By 2009, these numbers had dipped to 15.3 million members, or 12.3% of all employees, according to the Bureau of Labor Statistics.

Union membership among those in the category called "Healthcare Practitioner and Technical Occupations (Major Group)," however, appears to be countering this trend, reports the bureau, a division of the U.S. Labor Dept. The category includes physicians, dentists, veterinarians and various categories of therapists and technicians. But experts said registered nurses and other nonphysician categories fueled the trend toward greater unionization.

About 12.9%, or 693,000, employees in the category were union members in 2000. These numbers increased to 13.6%, or 962,000 workers in 2009. Most of this activity is in the hospital setting, and there is almost no union presence in physician offices.

Interest in unions specific to the health care setting also is increasing. In December 2009, the California Nurses Assn., the National Nurses Organizing Committee, the Massachusetts Nurses Assn., and United American Nurses merged to become the 150,000-member National Nurses United and the largest registered nurse union in the country. The organization is affiliated with the AFL-CIO.

"We want to have a stronger voice on the behalf of patients and on the behalf of our practice," said Karen Higgins, RN, a critical care nurse at Boston Medical Center and co-president of National Nurses United. "And we need to have a union that is totally made up of nurses on the front line."

Experts said most health care workplaces end up unionized because existing union representatives approach employees. But sometimes the reverse occurs.

For example, registered nurses at MountainView Hospital in Las Vegas voted 240-152 Jan. 14 to join the National Nurses United's California Nurses Assn./National Nurses Organizing Committee. Employees at this institution reached out to the union because it represented workers at other hospitals owned by MountainView's parent company, HCA. The union is now beginning work on its first contract with the hospital.

Chaison said physicians should be aware of these trends toward unionization, but "don't be afraid. It's not the end of the world. Don't take it personally. A good nurses union could really increase professionalism."

Money not the only issue

Although money is always contentious in union negotiations, it is less so with health professionals, he said. In 2009, union employees took home 27.9% more money per week than those who were not in a union. Health care workers covered by collective bargaining agreements negotiated by unions tended to make only 14.3% more, according to the Bureau of Labor Statistics.

Money issues do come up. In the recent recession, hospital CEOs have looked for ways to cut costs, such as increasing the amount of money employees pay toward health insurance and other benefits. Other issues related to patient safety tend to be higher on the agenda and include maintaining certain staffing ratios that have been affected by hiring freezes or layoffs, experts said.

"We're watching hospitals continue to try to cut back, and it's always nursing," Higgins said. "And if you don't have enough nurses at the bedside, patients suffer."

Other issues include organizing nurses to provide relief to disasters such as the recent earthquake in Haiti, seeking legislation addressing violence against health care workers, and lobbying against mandatory overtime, when nurses are required to stay for another shift after completing one because of staffing shortfalls.

"If I am too tired and I cannot do any more, you really are putting patients at risk," Higgins said.

The American Medical Association has several policies seeking antitrust relief to allow physicians to negotiate collectively. There are no policies on involvement of other health professionals in unions.