When Nurses Unite, Health Care Wins A Battle for Healthcare
and Unionism in DC Nurses' Struggle
By Brian Tierney
November 1, 2010
In June, President Obama told a meeting of delegates of the
American Nurses Association that "Nurses are the beating
heart of our healthcare system."
Unfortunately, when it comes to working conditions and cuts,
nurses across the country have more and more become the
bleeding heart of our healthcare system. And the worsening
conditions faced by the single largest section of the
healthcare workforce have raised the stakes for unionization
and collective bargaining battles in that sector.
In early October, a snapshot of this reality could be seen at
the largest hospital in the nation's capital. Nearly 1,600
registered nurses at the Washington Hospital Center (WHC)
voted overwhelming to affiliate with National Nurses United
(NNU), the largest nurses' union in the country. Formerly
members of the independent organization Nurses United of the
National Capital Region, 1,121 nurses among a turnout of
1,190 voted in favor of joining NNU.
Tense relations between the nurses and hospital management
were the backdrop to the NNU election victory. Hospital
executives have taken an increasingly combative stance
against the nurses' union in their efforts to cut costs.
When asked about the overwhelming turnout by nurses to vote
to join NNU, Stephen Frum, an RN and lead negotiator for the
union explained the nurses' support for affiliation in light
of management's ongoing hostility against them.
"Nurses at WHC are impressed with NNU and want to seek
broader and stronger allies in their fight for patient care
at our hospital," Frum said. "Frankly, the attacks by
management have been so terrible, we felt we needed to bring
more power to the fight for justice at the hospital. Being a
part of NNU will give us that additional power."
Nurses hope that the new affiliation with a stronger national
union will not only give the nurses more power at the
bargaining table to negotiate a fair contract, but also the
extra muscle to reverse the hospital's latest attacks.
A week before the NNU affiliation vote, the hospital
unilaterally cut take-home pay for most of the nurses. The
imposed takeaway, which includes cuts in shift pay for
evenings, nights and weekends, resembles similarly harsh
takeaways in management's last contract proposal which 98
percent of the nurses voted against. The nurses have been
working without a contract since June.
"Management has shown tremendous disrespect for the
registered nurses and a callous disregard for the needs of
our patients, and the hospital's latest move only adds insult
to injury," Frum said in a press release following the
He also noted that understaffing and other issues have
contributed to worsening work conditions and in turn have led
to increased turnover, with over 220 nurses leaving WHC since
the beginning of the year.
"The overwhelming decision by the Washington Hospital Center
nurses to join NNU sends a strong signal to management that
we're prepared to fight back."
While WHC management has tried to push through severe wage
cuts, the nurses' union has pointed out that the hospital -
which is run by a $3.8 billion non-profit called MedStar
Health - has maintained healthy margins. MedStar Health's CEO
makes an average of $2.7 million a year.
The hospital has been on the warpath against the nurses,
particularly over the past year as it has sought to intimate
and break their union. The hostile atmosphere was set by
management ahead of contract negotiations earlier in the year
when WHC terminated 18 nurses in March for not reporting to
work during the biggest blizzard to hit Washington, DC in
more than 70 years.
When this egregious attack hit the press, the union mobilized
its members to challenge the firings and garnered the support
of the local labor community.
Since the firings, nine of the 18 nurses were reinstated
following an investigation. But nurses continued to stand in
solidarity with each other. The union filed an Unfair Labor
Practice (ULP) charge in July, citing the firings as a
violation of the hospital's snow emergency policy.
In August, 80 percent of voting nurses approved a one-day ULP
strike to demand that the other terminated nurses be rehired
and receive back pay. The union ultimately called off the 24-
hour strike because leaders assessed that there was not
But the remaining nurses who were unjustly fired last
February may stand a better chance of getting their jobs back
with NNU support. Last week, the hospital finally submitted
to the first arbitration on the matter and while the union is
confident it has a solid case, it is not ruling out other
means to pursue justice for the terminated nurses.
Prior to the NNU vote, contract negotiations had made little
or no progress as management continued to demand cuts in pay
and benefits. The union held several pickets throughout the
summer, including a nearly 2,000-strong picket of RNs and
supporters at the hospital in May.
With the added clout of NNU, registered nurses at WHC have
armed themselves with more leverage in their negotiations
with an obstinate employer. But the issues facing nurses and
their union at WHC are reflective of a nationwide crisis in
primary-care hospital services.
Understaffing is rampant in hospitals throughout the country.
Yet, as the new healthcare "reform" law takes effect, the
role of primary-care givers is expected to grow
A year ago nurses and their unions were at the heart of the
fight around healthcare reform, with many pushing for the
public option or single-payer at a time when the White House
had already removed those options from the table.
What ultimately passed as "reform" will bolster, rather than
eliminate, the private health insurance industry as the
central arbiter of who gets care and who doesn't. But with
millions forced into private health insurance plans, the
influx of new patients will heighten the need for nurses. The
growth of employment opportunities in nursing that is
expected over the next decade will expand the nursing sector
and could translate to more power for nurses - if they are
organized. Currently, 21 percent of registered nurses in the
country are union members, according to the Bureau of Labor
Statistics. From an organizing perspective, this reality
raises the stakes for unionization efforts among nurses.
With its most recent victory in DC, the National Nurses Union
is building on its membership of more than 155,000 RNs across
the country. NNU is a new national formation created last
December with the merger of the several smaller and largely
This unification signified a break from nurse unionism's more
fragmented history, offering the potential of a more powerful
voice for nurses nationwide. NNU also represents a more
militant alternative to the other large nurses' organization,
the National Federation of Nurses, which is aligned with the
American Nurses Association and its penchant for partnerships
And the timing of NNU's inception may be pivotal. On the one
hand, the recession has led to cost cutting and increased
workloads in hospitals that are cutting back on staff and
nurse training. The impact on the nursing profession in
hospitals, both public and private, is devastating in many
cases, leading to high turnover rates - to say nothing of the
dangerous effect these practices have on patient care.
On the other hand, hospitals in general expect financial
difficulties brought on by the economic crisis to ease as the
new healthcare law is implemented. Hospitals will
theoretically be less burdened by the costs of caring for
uninsured patients. But as long as the economy remains weak
and with private insurance companies still at the center of
the healthcare equation, those potential benefits for
hospitals may be negligible.
As Judy Shindul-Rothschild, a nursing researcher at Boston
College, observed earlier this year, "If we don't find a way
either at the state or federal level to once and for all put
the private insurance companies out of business, we will see
more of these cyclical efforts to squeeze the workers who
Understaffing and attacks on nurses' pay and benefits have
led to a number of other labor disputes at hospitals in
recent months, including 12,000 nurses at 14 Minnesota
hospitals who came close to striking in July, and the 28-day
strike by some 1,500 nurses at Temple University Hospital in
Philadelphia in April.
Back in Washington, DC, NNU's role in fighting for lower
nurse-to-patient ratios will be important for the nurses and
patients at WHC. One nurse told the Washington Post that she
has double the amount of patients that she has to care for at
any given time compared to when she started working at the
hospital 11 years ago.
"I feel like I'm not doing the job that I want to do," she
said. "I'm not doing a good job of taking care of them, of
meeting the emotional needs. It just breaks my heart."
But now WHC nurses have larger forces backing their efforts
to win a decent contract. Their victory will be a victory not
just for NNU, but for the labor movement as a whole and for
all those at the heart of healthcare: the nurses battling for
their patients on the frontlines of a profit-driven system.
[Brian Tierney is a freelance labor journalist in Washington,
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