Thank you for our recent discussion regarding the American Professionals Union's attempt to organize our nursing staff. The nurses have made their many grievances known and I have listened intently to their rationale about unionizing. With the widespread shortage of nurses, many hospitals have given way to unionization. This is not a new trend. It is a popular way for nurses to resolve challenges and negotiate salaries. The American Nurses Association first endorsed collective bargaining in the later 19040s and at the time, viewed it as the road to improving both wages and working conditions (Carrell & Heavrin, 2007). Today, nurses' attention has shifted from wages, benefits, and work conditions, to also include patient issues. Recent strikes in California, Minnesota and Pennsylvania have focused on nurse to patient ratios in particular, after extensive research revealed a direct correlation between minimum nurse to patient ratios and improved patient outcomes (Gillen, 2012).
According to a 2012 article published in Nursing Standards, nurses commonly look to unions to deal with issues such as mandatory and voluntary overtime; the use of temporary nurses; protection from reassignment, work encroachment by non-nurses and mandated non-nursing duties; provisions for work orientation and continuing education; whistleblower protection; improved health and safety provisions; and "just cause" language for discipline and termination. Admittedly, the concerns are solid and warrant discussion.
As I understand it, wage and benefits issues are not always the chief concern of those who wish to unionize. Often "soft" issues are also major considerations. These include recognition (feeling overworked and underappreciated), hopelessness (feelings that promotions will never come), lack of control (no feeling of empowerment -- something collective bargaining could provide), job insecurity (most union employees work "at will), and broken promises by management (Carrell & Heavrin, 2007). The nurses believe that a union would give them a voice on the job about safety, pay, benefits, security, and the best way to get work done. They are adamant that things here need to change.
Unions do have their positives, such as establishing communication and protocols between employees and management. The nurses have addressed their desire to have a voice to systematically work through what they deem to be critical problems. I can appreciate their position and also the hard work they do -- their value cannot be overstated. However, all too often unions present additional challenges in organizations and fall short of their intended goals. For this reason, I do not support the unionization of our nurses.
Our nurses have cited low salaries and working conditions as their chief complaints. They also believe that human resources and senior management are too far removed from the realities of life on the hospital floor to truly understand (Gillen, 2012). It is true that in the nursing profession the shortage of personnel does contribute to challenging working conditions -- admittedly, it is a hard to make the nurse to patient ratio comfortable for all involved. We have sought to combat this by hiring additional staff when possible; however, our nurses continue to express dissatisfaction. Will forming a union mean better working conditions? I would have to argue no. If the poor working conditions can be attributed to a staff shortage, then how will forming a union increase the overall number of nurses on staff? It will not. In fact, unions frequently have the opposite effect, since many quality nurses will not even apply at unionized facilities (Sherwood, 2012). The budget constraints that limit our hiring capabilities will continue to exist and, in fact, increase as we spend dollars to engage in collective bargaining processes and procedures.
Where wages are concerned, basic economics suggest that when the supply of nurses decreases, the demand for nurses increases -- and the price for their services goes up significantly. That said, the average wage for nurses has been increased by over 10-15% a year for the last several years (Harrison, 2012). As a result, some nurses left for more lucrative job offers from other facilities or private practices with more aggressive annual salary increases. The perception has become that we no longer offer a competitive wage. Unfortunately, many hospitals are seeing dips in profits. We are not unique where this trend is concerned. A union would not improve the scenario of low hospital profits. To grapple with the tough economic times, we have been offering a 3-5% cost of living increase each year. Presently, it would be fiscally impossible for us to offer 10% pay raises to our nurses.
While unions may succeed in collective bargaining strategies that lead to moderate to substantial increase in pay, these same unions also tax employees with union dues. I am not sure our nurses realize just how this will affect their take home pay. I believe that over the long-term, unions can mean less money for members. Collective bargaining agreements can be so rigid that they can prohibit efforts by management to improve wages and offer annual performance increases. Let us say, hypothetically, that American Professionals Union helps our nurses negotiate annual pay increases over the next three years at 8% a year. If the overall market for nurses has pay increasing in the 11-13% range, then as time progresses our negotiated annual increase will slowly be perceived as less competitive. Without the rigidity of collective bargaining, if the budget could bear it, we could respond in kind to industry trends and keep our valued nurses happy with their salaries and on staff.
Unions can also discourage individual initiative. A supervisor should be free to reward exceptional nurses without the compensation constraints of a contractual agreement. Many union agreements inevitably reward mediocre nurses -- those who are satisfied to "just get by." Union members who are poor performers should not be rewarded or retained simply because of seniority or title. In my opinion, a nurses union would trample on managerial freedom to accept only the best nursing talent and demand only the best in conduct and performance. Managers should have the authority to advocate for the patient before the interests of nurses -- without fear of union repercussions.
All healing professionals are first and foremost public servants. We should consider whether a union will ultimately come between the nurse and the patient. In my opinion, it is the patient who is missing from the nurse's pitch for collective bargaining, including contract negotiations, grievance handling, and standards. We serve an institution that prides itself on providing a superior quality of healthcare and high standards. If mere economic considerations take priority over patient care, what becomes of our honorable tradition of service? On both an ethical and moral level, I feel the needs of the patient should outweigh the needs of the nurse. Collective bargaining could become a conflict of interest. Unionization does not necessarily promote quality care, which is our core business.
Times are lean for patients. We should consider the expense of negotiation and contract administration, which will ultimately be passed along to our patients. A new union will tip resources toward the benefit of the nurse and away from the patient. Further, in the event of a nursing strike, patient care would be devastated. Some in the nursing industry argue that they should have this right, citing that nurses in other countries have gone on strike without putting patients at risk (Harrison, 2012). I would argue that the personnel challenge this action creates has caused many healthcare institutions to turn to the use of alternative providers who may not provide the same standard of care. This is another area where nurses should be educated. If the nurses are union members and the union leaders decide to strike, the members typically receive strike wages while the leaders receive full pay. I think that if all our nursing staff, particularly those worried about wages, fully understood this principle they would give additional thought to their position on forming a union.
In addition, we are currently in a position to offer flexible shift options. However, union guidelines may become a hindrance when attempting to custom-fit work schedules to the ever evolving whims of nursing staff. This could impede our ability to cover all shifts in a way that allows for the adequate providing of patient care. Unions have historically forced employees to rotate weekend and holidays, regardless of previously agreed upon arrangements (Sherwood, 2012). Our nurses are used to "working it out" with co-workers. This would disappear under a union contract.
My ultimate position is that nursing is a profession with professionals. If we look at other professional groups -- lawyers, doctors, etc. -- they are not union. Unions were created to give the employees leverage to negotiate. However, there are enough unfilled nursing jobs that nurses can vote with their feet -- leaving for greener pastures as they choose. Our current nursing staff turnover rates make this point clear. Given the overall restrictions and constraints a union would create, my suggested alternative is that we create an internal coalition or task-force. It…