Winning a Greater Voice for Healthcare Workers: What Role Can and Should Unions Play Paul F. Clark...

Winning a Greater Voice for Healthcare Workers:

What Role Can and Should Unions Play

Paul F. ClarkDepartment of Labor Studies and Employment Relations

Penn State University

Darlene A. Clark, RN School of Nursing

Penn State University

Our HC System will never

reach its potential unless HC

employees have a greater

voice in how care is delivered.

RNs, in particular,

need to have a greater voice,

and play a greater role, in

decisions about how care is

delivered.

HC unions are a critical, if not

the most critical, mechanism for

gaining a greater voice for RNs

and other HC workers.

Greater RN involvement will

benefit patients, nurses, nurses’

unions, and the healthcare

system.

Patients will benefit as RN voice increases:

California RN-to-patient staffing law reduces patient mortality,

assures nurses more time to spend with patients, and substantially

promotes retention of experienced RNs.

(Aiken, et al., 2010)

Nurses will benefit:

Our work indicates that RNs want a greater voice because they believe such voice will lead to improvements in the

quality of care. This is consistent with RNs desire to

be effective patient advocates.

(Clark, Paul F. and Darlene Clark. 2008. “Results

of a Statewide Nurse Union Membership Survey.”)

Nurses’ Unions will benefit:

U.S. RNs are much more likely to vote for a union if they

believe the union can give them a greater voice in patient care/nursing practice decisions.

(Clark, Darlene A., Clark, Paul F., David Day, and Dennis Shea.

2000. "The Relationship Between Health Care Reform and Nurses’ Interest in Union Representation: The Role of Workplace Climate," Journal of Professional Nursing, Vol. 16, No. 2, March/April, pp. 92-

97.)

29%

34%

37%

39%

45%Improve professional skills

Stronger voice on state/national policies

Helps us fight trends that hurt professional quality

Gives us voice on important issues

Better salaries andbenefits

67%

62%

53%

47%

59%

RNs Reasons for Supporting Organizing

Percent saying each is a very/fairly convincing reason to have an [union/association] at their workplace

Department of Professional Employees, AFL-CIO, 2005

1985 1990 1995 2000 2005 2007

22%

21%

20%

19%

18%

17%

16%

Source: Ash, Spence, & Seago, What is the Union Wage Premium for RNs” .

RN Union Density 1985-2007

Union Density 1998 to 2003: RNs Compared to All Workers

0

5

10

15

20

25

1998 1999 2000 2001 2002 2003% o

f W

ork

forc

e R

ep

res

en

ted

b

y U

nio

n

RNs All

2005 2007 2009

The HC System will benefit:

Considerable evidence that employee involvement/

HPWS/increased voice can result in:

increased productivity

increased quality

reduced costs

(Clark, Darlene A., Clark, Paul F., David Day, and Dennis Shea.

2000. "The Relationship Between Health Care Reform and Nurses’ Interest in Union Representation: The Role of Workplace Climate," Journal of Professional Nursing, Vol. 16, No. 2, March/April, pp. 92-

97.)

Significant support FOR RNs playing a greater role

in our HC System.

Would you like nurses to have more or less influence in planning, developing policy, and the management of the following health services?

More Influence About the Same Less Influence % % %

Increasing the quality of care 89 10 1

Reducing medical errors and improving 90 9 >1 patient safety

Improving healthcare efficiency and reducing costs 84 14 1

Reducing medical errors and improving 51 41 6 patient safety

Integrating new technologies, including 76 22 2 electronic health records

Source: Robert Woods Johnson, 2010, http://www.rwjf.org/pr/product.jsp?id=54492

Unfortunately, involving and consulting

employees is not a significant part of most

healthcare systems.

Lots of resistance.

U.S. nurses’ unions are working to give RN’s a greater voice in

patient care through:

1.Collective Bargaining

2. Legislative/Political Action

Collective Bargaining

Two Approaches

Traditional, adversarial, bargaining

Collaborative/cooperative programs

Traditional

Collective Bargaining:

Traditional

Collective Bargaining:Staffing language

Traditional

Collective Bargaining:Staffing language

--Some RN unions have established ratios on Med-Surg. floors of 5/1

--Minnesota Nurses Association have final say on appropriate staffing levels, authority to close units if staffing not sufficient

Traditional

Collective Bargaining:Bans/Limits on mandatory overtime

Traditional

Collective Bargaining:Bans/Limits on mandatory overtime--Many nurses unions have

negotiated bans or limits on Mandatory OT

--Including Minn. Nurses, CNA, SEIU, etc.

Traditional

Collective Bargaining:Restrictions on floating

Traditional

Collective Bargaining:Restrictions on floating--SEIU New York City contracts ban

floating to areas RNs are not qualified/trained to work

--SEIU Maryland language limiting floating to cross-trained RNs

--CNA prohibits “double-floating”

Collaborative/Cooperative

Initiatives:


Initiatives:

--Often bargained through traditional C.B.• Staffing Committees

• Nursing Practice Committees

• Labor-Mgmt. Committees


Initiatives:


Initiatives:• Staffing



• Floating



• Floating

• Infection Control



• Floating


• Equipment



• Floating


• Equipment

• Processes



• Floating


• Equipment

• Processes

• Safety & Health



• Floating


• Equipment

• Processes

• Safety & Health

• Cost Savings



• Floating


• Equipment

• Processes

• Safety & Health

• Cost Savings

• Architecture



• Floating


• Equipment

• Processes

• Safety & Health

• Cost Savings

• Architecture

• Purchasing



• Floating


• Equipment

• Processes

• Safety & Health

• Cost Savings

• Architecture

• Purchasing

• Scheduling


Initiatives:

--Many examples of where these initiatives have been effective

--Also, lots of examples where these have not been successful

Political Level

Political Level

Federal or State staffing ratios (California, 2002; efforts in numerous states, including Texas & AZ)

Political Level

Federal or State bans on mandatory overtime (NJ, PA, & other states)


Political Level

Federal or State bans on mandatory overtime (NJ, PA, & other states)

Safety and Health legislation, state and national levels


Political Level

Health Care Reform

--National Health Insurance

SUM:

HC unions are a critical, if not

the most critical, mechanism for

gaining a greater voice for RNs

and other HC workers.

Not a U.S. phenomenon; nurses’ unions in many other

countries have been even more effective in gaining a

greater voice for RNs.

AUSTRALIA NURSING FEDERATION

VICTORIA BRANCH

1999

--Won minimum nurse/patient staffing ratios

--Refused to open new beds

--Brought 7,600 new RNS into workforce

AUSTRALIA NURSING FEDERATION

VICTORIA BRANCH

2004

Government tried to repeal ratios

2007

Tried again to repeal, union uses rolling bed closures to fight

ALL POLAND UNION OF NURSES

2007

Organized mass demonstrations across country to increase

funding for healthcare.

NURSES’ UNIONS

DENMARK, FINLAND, SWEDEN

2008

Conducted nationwide strikes for better salaries to help address nursing

shortage.

SWEDISH NURSES’ UNION (VÅRDFÖRBUNDET)

2008

National campaign to change healthcare system from “hospital-centered” to

“patient-centered”.

ICELANDIC NURSES’ ASSOCIATION

(ELAG ISLENSKRA HJÚKRUNARKVENNA)

Actively lobbies for increased funding for healthcare. Has helped elected two

nurses to Icelandic Parliament.

Interviews conducted w/ national nurses’ union leaders in the U.S.

and 9 other countries.

Focus on strategies for gaining a greater voice for RNs in decisions

involving quality of care.

Ongoing.

Subsequent work indicates that U.S. RNs want a greater voice because they believe

such voice will lead to improvements in the quality

of care.

(Clark, Paul F. and Darlene Clark. 2008. “Results of a Statewide

Nurse Union Membership Survey.” Report delivered to a Nurses’ Union.)

Nurses’ Unions believe:


-- R.N.s play one of the most critical roles in the delivery of healthcare, and


--R.N.s play one of the most critical roles in the delivery of healthcare, and

--R.N.s have intensive education in broad range of areas and significant experience



--R.N.s have intensive education in broad range of areas and significant experience, and

--R.N.s are patient advocates; patient care is their top priority


-- R.N.s play one of the most critical roles in the delivery of healthcare, and


--R.N.s view themselves as patient advocates; patient care is their top priority

They can, therefore, have a significant impact on the quality of

patient care IF given a greater voice.

Most healthcare systems around the world

are seeking to:

increase productivity

increase quality

reduce costs


Initiatives:

Also used to address:

• Mandatory OT

• Workplace Safety & Health

• Introduction of technology

Voice

Any mechanism, process, or action that gives nurses greater influence in workplace decisions, including:

--consultation/ee involvement

--collective bargaining

--concerted activities

--political/legislation action

Union Density in U.S.:

All Employees v. RNs

2007 12.1% 21.6%

2003 12.9% 19.5%

2000 13.7% 18.9%

1998 15.1% 16.8%

Winning a Greater Voice for Healthcare Workers: What Role Can and Should Unions Play Paul F. Clark...

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