MNA: A lifeline for Massachusetts nurses

When Beth Wilson began research for a master's thesis her primary objective was to discern if "in the wake of health care and hospital restructuring, the MNA was a lifeline for Massachusetts nurses."

Through surveys, interviews and focus groups Wilson, currently a Program Coordinator/Economic Analyst in the Nutrition Division of the Massachusetts Department of Public Health ultimately came to the conclusion in her thesis titled "A Lifeline? Is the Massachusetts Nurses Association Able to Shield Massachusetts RNs from Healthcare Industry Restructuring?" that indeed membership in the MNA serves as strong support, but more non-union nurses and in particular, nursing students, must be educated about the advantages of organizing.

Wilson, who presented her thesis at UMass-Lowell in April of 2004, points to a hospital and health care system "in flux" resulting from the past 30-year period when efforts were made to control costs through deregulatory measures. Cost-cutting changes translated into restructuring methods borrowed from industry—shakeups that effected hospital mergers, consolidations, integrations and downsizing and generated increasingly unsafe and overworked conditions for nurses. And so the domino effect began. Nurses left the hospital setting, creating a shortage and further straining remaining RNs.

As a result, more nurses were mobilized to unionize, primarily through MNA. In 1994, at the behest of its members, MNA initiated its Safe Care Campaign, a drive that propelled its status to one of national leader on the issue of nurses staffing and patient care and brought the issue of nurses unionizing into the forefront. Now, years and many bargaining units later, MNA has continued to strengthen its membership. But even as more nurses have become aware of the advantages of belonging to a union, the bottom line question to Wilson's thesis generated a contradiction in response.

Through analysis of working conditions, facility reorganization, patient care and job satisfaction of unionized and non-unionized RNs, Wilson attempted to determine whether unionized RNs maintained more positive conditions. As it turned out, her survey said one thing and one-on-one interviews with nurses said another.

The survey (65 delivered over a four-week period with 49 returned, 30 completed by union nurses and 19 by non-union nurses) indicated that non-union nurses had "more positive working conditions, patient care, and job satisfaction, with less facility reorganization than union nurses." But, according to Wilson, the broad format of the survey allowed nurses to answer "without much reflection on past experiences."

Those nurses interviewed, however, had a better opportunity to reflect on their experiences, both good and bad. Interviews allowed Wilson to "go beneath the surface and discover that the seemingly better conditions of non-union nurses were a misconception."

What Wilson discovered was that without a basic understanding of the political, economic, historical and ideological structure framing the hospital and healthcare systems, non-union nurses did not have a clear understanding as to why they were facing higher patient loads and increased work assignments. They chalked the decline of their working conditions up to patient-related factors, such as poor diet, lack of exercise, an aging population and low access to insurance. What these non-union nurses were not familiar with was the growth of managed care, changes in insurer reimbursements and the ramifications of years worth of cost containment measures.

The union nurses interviewed, however, were well educated on the political economy of health care. They were aware of the big business hospitals had become and were not fearful of telling the public and the Legislature the affects that undermining conditions had on them and ultimately their patients.

So, according to Wilson, therein lay the contradiction between her survey and personal interviews. While the survey indicated non-union nurses saw diminished conditions as their fault, union nurses were aware of what was really going on. While four out of five non-union nurses interviewed did not see the benefit of joining the MNA, these same nurses were also not aware of pro-nurse legislation MNA has passed or is in the process of making law. A false consciousness prevailed, according to Wilson's thesis, bringing her to the conclusion that "new ways" are needed to disseminate information about joining the union and the positive actions such a measure will engender.

But, according to Wilson, the MNA "can not do it all."

She concludes that nursing education must be expanded. Currently students are taught how to care for patients, but when it comes to providing critical information about the political economy of health care, instruction stops short.

In addition to "giving non-union nurses the tools to be self-aware," Wilson points to the need for national health care reform and calls for the adoption of universal health care.

"Hospitals should focus on patient care standards, not reimbursements and market share," she writes. "The insurer oligarchy must be dissembled, and the free-market mentality so pervasive in today's society must be removed from health care."