News & Events

Staffing Ratios the Mantra for Newly Formed NNU

John Commins, for HealthLeaders Media, December 14, 2009

It didn’t take the newly formed National Nurses Union long to announce itself.

On Tuesday, representatives from the California Nurses Association/National Nurses Organizing Committee, United American Nurses, and the Massachusetts Nurses Association voted unanimously to merge and create what they say is the largest RN union in the nation’s history.

A few hours after the expected outcome, RNs from the newly empowered 150,000-member NNU formed a picket at the nearby headquarters of the Arizona Hospital and Healthcare Association, which has opposed organizing efforts in that state.

"We’re here to send a signal to the Arizona hospital association and the American hospital industry. We will not be silenced, we will not be stopped," keynoter Jean Ross, one of three new NNU co-presidents, and the secretary-treasurer of United American Nurses, told the rally. "Hospital associations around the country oppose safe staffing legislation that guarantees patients the care they need, and with their allies intimidate RNs when we try to organize a union. That intimidation must stop."

The NNU’s drive for staffing ratios should surprise no one. The issue is simple, direct, and the cause of "patient safety" resonates with the media, the public, and with nurses.

Of course, skeptics note that staffing mandates are also a great way to increase membership—and dues—for nursing unions. "Their push for mandatory nurse staffing ratios is simply a marketing strategy designed to increase dues income," John Rivers, president of the AHHA told the Phoenix Business Journal.

"Union efforts on this issue have nothing to do with whether patients are better served by mandatory ratios which, by the way, have been an abysmal failure in California."

The NNU effort in Arizona is also getting some pushback from local nurses unions. "Ratios undercut the skills, knowledge, and experience of nursing professionals," Jennifer Mensik, RN, president of the Arizona Nurses Association, said in a media release that was issued with the AHHA. "Ratios are inflexible numbers that do not take into account individual patients’ needs and different levels of acuity and complexity among patients."

Jim Trivisonno, president of Detroit-based IRI Consultants to Management Inc., says the recession put a temporary kibosh on staffing ratios, as nurses became the primary breadwinners in their homes, came out of retirement to support their families, and hunkered down at their jobs to weather a foul economy. However, that grace period for hospitals may soon be at an end. "Once the economy picks up we are going to go back to where we were in terms of shortages and staffing will become a much bigger issue," says Trivisonno. "As a result the NNU is well position to be the chief spokesperson for nurses nationally."

With consolidation, NNU will be better able to coordinate its organizing efforts from coast to coast, and tout its successes with recruits. "They will showcase a particular collective bargaining agreements or wage increases in the contracts they’ve gotten in their labor organizations," Trivisonno says. "Now that they’ve consolidated they can expand the number of success stories that they can point to. If they were to get wage increases in Minnesota, in the past that was a Minnesota story. Now it’s part of the NNU and they can use that."

Trivisonno says unions are also parachuting "flight teams" of experienced nurses into contested organizing efforts to help sway their colleagues to vote union. "That is very powerful. They’ve been there," he says. "In any industry, that is the case when you have somebody who is a colleague. There is tremendous credibility when you’ve done the job."

The pendulum has definitely swung toward the side of organized labor these days, and nursing unions are well aware of the high demand for skilled clinicians. However, that doesn’t mean that hospitals are powerless to stop union encroachment on key issues like staffing ratios, Trivisonno says.

"Every hospital has staffing ratios and they should be talking about that with their nurses," he says. "The unions have stolen the staffing ratios message from hospitals. Now they own it. And hospitals need to take it back and say ‘we do have staffing ratios. Here is what they are. Here is how we determine them. Here is how we adjust them. Here is how acuity fits in.’"

The drive to unionize the healthcare sector will get even stronger in the coming months. As the great healthcare reform debate is finalized in Congress—regardless of what comes out—unions and their close friends in the White House will relight the fire for the Employee Free Choice Act, the most sweeping pro-union legislation in decades that will greatly facilitate organization. Are you ready?

Hospitals in right-to-work states can no longer rely on that firewall, as hospital executives in Texas and Florida will tell you. The unions are coming. They’re bigger and better organized than ever before, and the wind is at their back. Are you ready?