Nurses Unionizing: Benefits of Working in a Union Hospital

By: Kathleen Gaines BSN, BA, RN, CBC

Nursing unions, while prominent in some states, are not an option for all registered nurses. California currently has one of the largest and strongest nursing unions in the country. According to the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) website, it is one of the fastest-growing labor and professional organizations in the US. With a membership of over 100,000 nurses, the CNA has grown nearly 400 percent in the last 15 years.

Joining a healthcare system with a nursing union can be beneficial to nurses. The goal of a union is to improve:

• Working conditions
• Wages
• Benefits
• Working hours

Unions not only benefit nurses but also to the healthcare system. According to a recent study by Dave Belman, unions mean increased productivity for the employer with better training, less turnover, and longer tenure of the workforce.

What is a Nurse’s Union?

A labor union, also known as a trade union, is an organization of workers that forms to protect and advocate for its members’ interests — which, in this case, is nurses. Generally, unions do this through collective bargaining on behalf of its members. For nurses, this means safe staffing ratios, managing nursing shortages, and pay raises. Currently, there is no single labor union that represents nurses nationwide.  

Some of the most active unions representing nurses include: 

• SEIU United Healthcare East
• National Nurses United
• The American Federation of Labor and Congress of Industrial Organizations (AFL-CIO)
• Pennsylvania Association of Staff Nurses and Allied Professionals
• United Nurses Association of Pennsylvania
• New York State Nurses Association
• The United Food and Commercial Workers International Union

The New York State Nurses Association represents roughly 42,000 nurses while the Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP) represent 8,300 nurses and healthcare professionals. The latest group of nurses to join PASNAP was from St. Christopher’s Hospital for Children and the now-defunct Hahnemann University Hospital.

This group presents a wide variety of unions, some of which represent workers in other industries, or perform collective bargaining on behalf of RNs and LPNs. Hospitals are not required to use the same labor union based on the state they're in. The labor union that is used depends on the healthcare organization.

National Nurses United

The CNA/NNOC founded the single largest nursing union in the country in 2009, which unites the CNA/NNOC, the United American Nurses, and the Massachusetts Nurses Association.

At the initial convention in 2009 after its inception, National Nurses United (NNU) developed a call to arms for healthcare labor unions across the nation due to the increase in unsafe staffing and the decline in patient care. According to a press release following the conference, the NNU announced the following campaign:

• Advance the interests of direct care nurses and patients across the U.S.
• Organize all direct care RNs "into a single organization capable of exercising influence over the healthcare industry, governments, and employers."
• Promote effective collective bargaining representation to all NNU affiliates to promote the economic and professional interests of all direct care RNs.
• Expand the voice of direct care RNs and patients in public policy, including the enactment of safe nurse to patient ratios and patient advocacy rights in Congress and every state.
• Win "healthcare justice, accessible, quality healthcare for all, as a human right."

Since its inception a decade ago, the NNU has made great strides for nurses across the country. The NNU is known for negotiating some of the highest pay scales in the country, sponsoring legislation, and advocating for Medicare coverage for all Americans. Furthermore, in their first year, the NNU was able to achieve several remarkable things, including:

• Organized 6,500 RNs into NNU in Florida, Illinois, Iowa, Nevada, and Texas.
• Supported major collective bargaining campaigns in Minnesota and Washington DC
• Sponsored national legislation to promote comprehensive reform for patient safety and professional nursing practice, including RN-to-patient ratios modeled on the successful California law sponsored by NNU affiliate CNA.
• CNA/NNOC sponsored the nation’s foremost RN patient safety law, in California, requiring minimum RN-to-patient ratios.

Through the work of the NNU, nurses have enjoyed safer working conditions, higher pay, and guaranteed vacation and holiday time. But the work of the NNU is never over. Currently, there is an initiative to decrease violence towards healthcare workers in the hospital setting.

Pros to Nursing Unions

1. Job Security

Many non-union nurses are subject to “at-will employment,” meaning they can be fired for any reason or no reason at all and have their wages and benefits cut at management’s discretion. For most nurses, this is something that rarely happens, but in a non-union hospital, a nursing position is never 100% secure.

On the other hand, union contracts usually prohibit termination without cause and protect nurse wages and benefits. If an administrator wishes to fire a nurse, there must be documentation of the steps taken to remedy the situation and warnings given to the employee.

2. Better Working Conditions

This is one of the biggest incentives for being represented by a nursing union. The union fights with the healthcare system to ensure safe nurse-to-patient ratios which must be followed; otherwise, nurses can bring a grievance to their union representative.

Union officials also work for better safety policies as well as against mandatory overtime or mandatory cancellation. A few of the biggest known factors that are contributing to the current nursing shortage is unsafe staffing, stress, and overwork. Unions help to offset this.

Currently, due to the ongoing violence against healthcare professionals in the workplace, there are numerous ongoing initiatives throughout the country to help combat the issue. Unions are supporting current legislation that is being developed to protect nurses from harm.

3. Guaranteed Wages and Pay Increases

This is another large incentive for joining a nursing union. Union hospitals are known to have higher pay scales, regardless of the cost of living. The median weekly earnings of union employees are roughly 20% higher than the pay of non-union members.

4. Seniority Advantages

In union hospitals, seniority matters. Nurses that have been employed for a significant amount of time will see additional benefits, such as fewer required holidays and weekends. This will vary greatly amongst hospitals and some unions do not emphasize seniority advantages.

5. Education Reimbursement

While most hospitals will provide education reimbursement, it is not always guaranteed. Furthermore, it often can be at the discretion of a manager whether additional education is deemed appropriate or needed. Union members will have guaranteed access to education reimbursement.

6. Better Benefits

Labor unions negotiate for benefits including healthcare, dental, and vision coverage on behalf of its members. For union members, there might be additional options available free of charge or at a lower premium. Furthermore, unions will work to secure guaranteed vacation time and ensure there is a process for requesting time off.

7. Guaranteed Process for Grievances

Union members have the ability to file grievances against the employer if they feel that something in their contract is not being upheld. This can include unsafe working conditions or unsafe nurse-to-patient ratios. The union will fight for the employee to ensure this does not continue to happen. Unions outline a specific process for addressing complaints or grievances that actually has a chance at a satisfactory resolution for both parties.

8. Ability to Strike

This is often seen as a con to belonging to a union, but it can be beneficial as well. If union representatives feel that the contract is not being upheld by the healthcare system, there is a process in place that allows healthcare workers to strike.

During this time, union nurses are not allowed to work and therefore are not paid. Hospitals will bring in temporary workers to fill the needs; however, this route is often avoided at all costs because it costs the hospital money and does not provide the standard of care that is expected.

9. Legal Representation

In case a nurse is in breach of protocol and requires disciplinary action, a union representative will always be there to ensure that the employee is treated fairly. Unions often provide representation to address grievances when a nurse is mistreated — either physically or verbally — in the workplace so that their complaints reach the appropriate authorities.

A Case for Unions

Interestingly, a 2011 study published in the Journal of Nursing Administration found that hospitals with nursing unions had higher job dissatisfaction and higher nursing retention. Also, numerous studies found a positive correlation between nursing unions and patient outcomes. An older study done in 2002 found that hospitals in California with nursing unions had a 5.7% lower mortality rate for patients that suffered a heart attack.  

Working for a union hospital is a nurse’s preference and one that should be considered when applying for a position at a hospital that has a nursing union. It is important to note that nurses are not required to be part of the union; however, they may not receive the same protections and benefits as nurses in the union.

If you decide to conduct more research about nurse’s unions, be aware that because unions are a controversial topic in the U.S., it can be difficult to locate unbiased information on the topic.