Frustrated by a decade of managed care, mergers and budget cuts, registered nurses across the nation are rethinking their opinions of organized labor and joining unions by the thousands. And they are using their new bargaining power to raise questions about patient care in contract talks and state legislatures.
Evidence of the new activism was clear this fall in Sacramento, Calif., where Gov. Gray Davis signed four labor-backed nursing bills, including a landmark law that will set minimum nurse-to-patient ratios at all hospitals in the state. The law is the first of its kind in the nation, but similar bills are in the works in Pennsylvania and Nevada.
Unions also are winning tough contract language that sets staffing ratios at hospitals and prohibits cost-saving practices that nurses say imperil patients.
The surge of unionization is another indication of the discontent among health-care professionals, including doctors and technicians, in an era of belt-tightening by hospitals and health plans.
Unions that specialize in health care say they can't find enough organizers to respond to calls from nurses, and even such unlikely unions as the Laborers International Union and the United Auto Workers have entered the field.
"It's like the state is on fire," said Rose Ann DeMoro, director of the California Nurses Association, which is among the most aggressive nursing organizations in the country. "I've been here for 14 years, and I've never seen such a dramatic shift in such a short time."
About 20,000 registered nurses have joined unions nationwide through federally supervised elections in the past two years, and there are campaigns to sign up at least 10,000 more. About 18 percent of the 321,404 U.S.-registered nurses are represented by unions.
The groups are making inroads in such traditionally nonunion cities as Los Angeles, where the California Nurses Association has signed up three hospitals in the past 18 months and is well along with campaigns at three more. In California, about 35 percent of eligible registered nurses are organized, DeMoro said.
Those victories did not come without a fight. Hospitals routinely have responded to organizing campaigns by hiring consultants who specialize in defeating unions. Others have countered organizing efforts by raising salaries and improving conditions.
The driving issue is not money. With nurses in short supply, wages have risen considerably over the past five years, from an average of $22 an hour to $27.50 for an entry-level position, and many hospitals offer signing bonuses for nurses with special skills.
Working conditions and patient welfare top the list of concerns at negotiations. Nurses say that after years of cutbacks, they are stretched too thin to properly care for patients, many of whom are entering hospitals sicker and leaving sooner than ever.
Hospital executives acknowledge the discontent but blame managed care and say union contracts can do little to change the system.
Health plan administrators blame larger economic forces and say that, ultimately, consumers are forcing the painful changes that are making nurses unhappy.
"Virtually everyone in the system is stressed," said Walter Zelman, director of the California Association of Health Plans. "The plans aren't making money, physician groups are stressed, and nurses are feeling the pressure as well. I'm not saying there may not be a problem. We may have pushed nurses over the brink and asked too much of them."