John Commins, for HealthLeaders Media, September 8, 2009
Healthcare reform has elbowed out a lot of other major healthcare industry news of late, and that’s understandable. The next few weeks in Washington could determine—or not—how healthcare is delivered in this nation for decades to come. Trillions of dollars and the welfare of hundreds of millions of people are at stake.
In case you missed it, however, healthcare news was made outside of the Beltway recently with the auspicious announcement that three of the nation’s largest nurses unions—California Nurses Association/National Nurses organizing Committee, United American Nurses, and Massachusetts Nurses Association—would merge and form the nation’s largest registered nurses union.
The newly named National Nurses United will have 150,000 members and a national organization, after each union holds a separate ratifying convention, and then a founding convention in Scottsdale, AZ, on Dec. 7-8.
The merger had long been in the works, but that did nothing to quell the bald-faced glee of labor advocates salivating over the organizing potential for the new, well-funded, well-organized union. "As staff nurses, our time has finally come," Sandra Falwell, RN, with the District of Columbia Nurses Association, and a UAN director, said when the merger was announced. "Just think about all the management heads that turned grey when they heard what we are doing."
James G. Trivisonno, president of Detroit-based IRI Consultants, says the merger means the unions will end years of acrimonious and self-defeating infighting. "It’s a big deal because these organizations were literally stealing members from one another, and now they are working together. Clearly there is plenty to split up. There are millions of organizable workers in healthcare," he says.
Most healthcare systems and hospitals already have enough on their plate structuring employee compensation packages that compete with those of nearby rivals. Trivisonno says a large, well-organized union with a national reach could change that dynamic.
"If they get a favorable contract in one part of the country, staffing ratios or favorable benefits or pay practices, they can hold that up as a model contract," Trivisonno says. And unions are very, very good at recruiting. Trivisonno says the new, larger union will parachute in experienced, smart, professional "nurse flight teams" during local organizing drives to make "nurse-to-nurse connections" with potential new members. They will know the issues at a particular hospital, they will listen to the employees’ concerns, and they will explain how a union can resolve those concerns.
"To have someone come in from another part of the country to say how great it is, that is hard to dispel and it allows them to bring in experienced folks that have dealt with whatever they are dealing with in that particular organizing drive," Trivisonno says.
So, what can you do?
Trivisonno says hospitals must understand the concerns of their staffs with respect to patient care, staffing, compensation, and other critical areas that unions are sure to exploit in an organizing campaign. If hospital leaders don’t listen to their staff, be assured that union leaders will. "Unions are excellent listeners and they can make promises that they don’t have to deliver," he says.
In addition to understanding the concerns of staff, Trivisonno says hospitals must also clearly state why they oppose unionization, and how they believe it would negatively impact hospital operations. Hospitals must ensure that they have open lines of communication for staff, so they feel like their concerns are being heard and addressed. Again, if you don’t do it, unions will.
Hospital leaders should also review union literature to find out what promises they’re making. "They are a competitor for the hearts and minds of your employees, so look at what they are offering and make sure you are touting the things that your organization is already doing to meet those needs," he says.
Also, be prepared. Trivisonno recommends that hospitals create a readiness manual for organized labor and put it in a three-ring binder next to the manuals for disaster preparedness and Joint Commission surprise visits. "Labor unions will have their positions well thought out. You can’t wait for the 6 o’clock news to respond anymore. You might have 20 minutes to control the message before it is all over the place," he says. "Look at your vulnerabilities, where you may be attacked, and have some kind of reasonable explanation for why you are in that position. Have a statement that’s been fully vetted for the issues that have been raised."
A disclaimer: Regardless of how you feel about unions—and if you’re management you probably don’t like them—they can provide frustrated staff with the voice not just to get a more favorable contract, but to improve patient care and hospital operations. Would a union be needed if you were already addressing those legitimate concerns?
Bottom line: I’ve said it before, and you need to hear it again: If your staff votes to organize, don’t blame the unions. Blame yourself. Hospital leaders get the unions they deserve.
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John Commins is an editor with HealthLeaders Media. He can be reached at firstname.lastname@example.org.