Union Organizing in the Health Care Industry – New Unions and Alliances Among Rivals

Though our nation’s economy has recently lost millions of jobs, the health care industry has continued to add them. Not surprisingly, unions are eager to sign up health care workers. In the last 10 years, the rate of union wins in the health care industry has grown faster than the national average. Unions are uniting to lobby for labor-friendly legislation to promote increased union membership in the health care sector.

In addition to traditional organizing, health care union organizers are using more radical corporate campaigns that target hospital donors, shareholders, community groups, and even patients. The unions push these target groups to put pressure on hospital owners to allow unions to organize their employees. Many critics have argued that some of these agreements with employers have greatly limited workers’ power and emphasized the union’s cooperation with management.

The following article provides an overview of the major unions involved in the health care industry, as well as strategies to ensure your organization is prepared and remains successful.

Service Employees International Union
The Service Employees International Union (SEIU) began in 1921 primarily as a janitor’s union and branched out to include government, security, and health care workers. By 2000, it was the largest, fastest-growing union in the United States, with much of that growth stemming from a series of strategic mergers with smaller unions. In June 2005, the SEIU and six other unions left the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) to form the Change to Win coalition. Citing the need for a renewed effort to organize workers, Change to Win purports to be focused on achieving fair wages, health care benefits, and secure retirement for all employees. The coalition also encourages workers to unionize on an industry-wide basis, consolidating smaller unions within larger unions.

SEIU Healthcare
In 2007, the SEIU announced plans to launch a new health care union to serve approximately one million members, such as nurses and service workers at hospitals and nursing homes. SEIU Healthcare combined financial and personnel resources from the 38 local SEIU Healthcare unions. Of the SEIU’s 1.9 million members, 900,000 work in health care. In September 2008, the SEIU reported it would begin several high-profile projects to bring business leaders, health care providers, community organizations, and elected officials together to work on the nation’s health care system. SEIU leaders were part of a May meeting held by President Obama to discuss a health care overhaul. More recently, SEIU members attended town hall meetings to speak out in support of the proposed health care reform. In August, the SEIU was part of a group-largely funded by the pharmaceutical industry’s lobby-that launched $12 million in television advertisements to support Obama’s health care proposal. This group, the Americans for Stable Quality Care, could spend tens of millions more this fall.

SEIU and NUHW
The SEIU attempted to consolidate three local units representing home health care workers into one unit last December, taking authority away from the local units. The SEIU accused the local unit officials of financial misconduct, and in response, the leaders of the local units criticized the SEIU’s practice of centralizing power at its Washington headquarters and making corrupt deals with employers. In January, a 150,000-member SEIU local unit in Oakland was put under trusteeship by the SEIU, and the local officials of that unit were dismissed. The ousted officials formed a new union, the National Union of Healthcare Workers (NUHW).

The NUHW announced the first workers had cast votes in favor of representation by the new union in March. A majority of 350 union-represented workers at four nursing homes in northern California managed by North American Health Care wanted to end their labor relationship with SEIU and join the NUHW. The day after this announcement, the SEIU filed unfair labor practice charges against the four nursing homes, charging that administrators of the facilities had illegally withdrawn union recognition and colluded with a competing labor union. In that same month, a National Labor Relations Board regional director ruled against the NUHW, saying that the contract between the SEIU and the hospital chain prevented the effort by a new labor union to represent 14,000 Catholic Healthcare West workers. Despite the ruling, the founding convention to formally launch the NUHW took place in April 2009. According to the NUHW, approximately 91,000 California health care workers have signed petitions filed at the labor board, stating they would like be members of the new union.

The NUHW also claims that, in response to these decertification drives, the SEIU has resorted to harassment and intimidation and tactics similar to union prevention. The SEIU argues that the new group has unfairly restrained and coerced workers, as well as complained to the National Labor Relations Board. A decisive battle between the two unions will come in 2010, when the SEIU-UHW contract with Kaiser Permanente expires and the opportunity for decertification elections reopens. Kaiser, the largest health care provider in California, has 50,000 workers that could potentially become members of NUHW.

California Nurses Association/National Nurses Organizing Committee
The California Nurses Association (CNA) began as a state chapter of the American Nurses Association (ANA) in 1903. The ANA has a federated structure: Nurses do not typically join the organization directly, but instead join their respective state organization, which has membership in the ANA. After several years of believing the ANA was not providing them adequate financial support to increase collective bargaining activity in California, the CNA broke ties with the ANA in 1995 and formed its own union, becoming the first state organization to secede from the ANA. Since its break from the ANA, the CNA has acquired a reputation as one of the most aggressive labor unions in the country. In 2004, the CNA began establishing itself in other states under the name National Nurses Organizing Committee (NNOC). The CNA voted to seek affiliation in the AFL-CIO in 2007. CNA membership has doubled over the last seven years and represents 80,000 members from all 50 states.

UAN-NNOC
In February, CNA/NNOC, United American Nurses (UAN), and the Massachusetts Nurses Association (MNA) announced the formation of another new union: the United American Nurses-National Nurses Organizing Committee (UAN-NNOC). With a combined membership of more than 150,000 affiliates in 19 states, it is the largest nursing union in the history of the United States.

National Federation of Nurses
The National Federation of Nurses (NFN) was officially launched in April at an event in Portland, Oregon. The NFN represents more than 70,000 nurses in six state nurses’ associations, including New York, New Jersey, Ohio, Montana, Oregon, and Washington. Based on a federated model (much like the ANA), the NFN recognizes the independence of each member organization. Membership is open to state nurses’ associations and other labor organizations that represent RNs. The NFN is tied to the ANA, which outlines standards for nursing practices, but has historically opposed nurse unionism and includes managers in its leadership. Since nurse union leaders expect many of the 15 unions with nurse memberships to flood hospitals with authorization cards if the Employee Free Choice Act (EFCA) passes, they want to establish their own national union to ensure nurses are organized by nurses.

SEIU and CNA: From Violent Disputes to Cooperative Agreements
The SEIU signed a neutrality agreement in March 2008 with an Ohio Catholic hospital to organize 8,000 workers. The day before voting was scheduled to begin, members of the CNA distributed leaflets to discourage workers from joining the SEIU. After the workers received the leaflets attacking SEIU and its arrangement with management for an election, SEIU called off the vote. Then at an April 2008 conference in Detroit, SEIU staff and members protested at a banquet of CNA members, resulting in violence. The two unions have also launched raids and counter-raids across the country, and both have sent mailings to thousands of nurses (including nurses in other unions, as well as nurses whose unions are currently trying to organize) attacking each other.

After more than a year of fighting, the SEIU and CNA signed a cooperation agreement in March. They will work together to bring union representation to all non-union RNs and other health care employees, as well as improve patient care standards. The unions have also agreed to refrain from raiding each other’s members and will work together toward common goals, including lobbying for congressional passage of the EFCA. SEIU and CNA will coordinate campaigns at the largest health care systems and launch an intensive national organizing campaign. Catholic hospital chains will likely be among the first targets.

In June, the U.S. Conference of Catholic Bishops and the nation’s largest unions (including the SEIU and the AFL-CIO) signed an agreement describing how union organizing will be conducted at Catholic health care facilities. (The document is similar to the one Catholic Healthcare Partners and Community Mercy Health Partners created last year with the SEIU before the CNA protest canceled the vote.) This agreement is significant because Catholic health care providers represent the largest employers and providers of services in many communities. The agreement provides seven guidelines for management at Catholic health care facilities and unions, making it easier organize health care workers at these facilities.

What This Means for Your Organization
Many experts agree that expanded unionization, along with the passage of the EFCA, will negatively impact our health care system. Both health care providers and industry analysts fear that unionization could mean higher costs and more restrictive work rules, adding to the soaring cost of delivering health care. Hospital and health care facilities need to be aware of these issues and how they can educate their supervisors and workers about the threat of unionization.

Communication with your employees is a critical first step. Many issues are involved in the possible unionization of a health care facility (economic factors, working conditions, quality of patient care, employee satisfaction, etc.). To prepare for possible union activity, identify issues that are relevant to your facility and address those needs publicly. Train leadership and include information about your union-free policy in the employee hiring and orientation procedures. Assess your wage and benefit structure, and be sure to promote what you offer.

You can use brochures, meetings, video, webinars, e-mail, Web sites, or eLearning tools to reach your employees. The most effective efforts include an employee feedback system that encourages two-way communication.

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