Nursing Unions: What Are They and Should You Join One?

Kathy Quan RN BSN PHN - 05/07/19

Labor Unions have been around for decades in many different professions. The purpose of a union is to provide an intermediary to advocate for and establish collective bargaining rules for employees when dealing with employers. Unions have historically been politicized and tend to be a polarizing and controversial subject. It can be hard to even find neutral literature about the pros and cons of unions.

Definition of a Labor Union

According to the Miriam Webster Dictionary a labor union isan organization of workers formed for the purpose of advancing its members' interests in respect to wages, benefits, and working conditions.

Nurses were granted the right to form collective bargaining units (labor unions) over 40 years ago. Labor unions for nurses and other healthcare workers have evolved and fought for nurse’s rights to salaries, hours, benefits, working conditions and job security. In addition, these unions have worked to improve patient care and rights. No single union represents all nurses or health care workers in the US. There are in fact several unions including SEIU (Service Employees International Union), United Food and Commercial Workers International, National Nurses United, and the AFL-CIO (American Federation of Labor and Congress of Industrial Organizations). Some of these unions also represent employees in other professions.

Membership is Shrinking

The strength of unions lie in their numbers and membership has been slowing and even shrinking in recent years in most industries except health care which continues to grow. More than 20% of nurses belong to labor unions while the national average of union members is 13.4%. The strongest leverage unions have is to strike or even just to threaten a strike and this becomes a very controversial issue with nurses and other health care workers. Many nurses are reticent to join unions because of the mandatory strike issue. Hospitals and other healthcare employers have grown stronger in hiring outsiders to cover and many times replace striking nurses, and this weakens the union stronghold. Lost wages are a huge issue for any striking members.

Some of the beneficial outcomes of unionizing nurses has been bringing focus to and reducing the nurse-to-patient ratios in hospitals, demanding higher education for nurses, and improved workplace conditions. Unions have strongly lobbied legislators to pass and enforce laws regulating the number of patients a nurse can be responsible for. Establishing paths for discussing grievances and protecting rights of nurses who have been disciplined is another venture that unions have helped to establish. A union nurse is also allowed to have a union representative advocate for him or her at any employment hearing regarding discipline or termination. Taking an objective view of the good and bad of unions is always the most beneficial way of making informed decisions.

Workplace Violence

Workplace violence is on the rise either with out of control co-workers or patients who feel entitled to abuse and even maim or kill nurses. In more instance than not, employers are not stepping up to the plate to protect nurses. Unions have been stepping in to work to improve working conditions and strengthen laws to protect nurses and other healthcare workers. For this reason, we may expect to see a growth in labor unions for nurses. Continuing education courses for nurses have focused on safe, healthy workplaces and teaching nurses how to maintain them.

Domestic violence is another area where continuing education units can help nurses cope with violence that spills over into the workplace.

Mandatory overtime is another issue facing nurses in light of budget cuts to constrain the skyrocketing costs of healthcare and an ongoing overall shortage of nurses. Studies have proven that the stress caused by mandatory overtime leads quickly to nurse burnout and caregiver fatigue which only serves to enhance the problem. On the other hand, hiring and keeping warm bodies who are not interested in providing quality care or incapable of doing so due to lack of skills and competencies is a criticism of nursing unions who protect all employees to a fault. Unionized hospitals and facilities are usually not allowed to hold random layoffs or pose hiring freezes.

Seniority vs. Merit

Another point of contention raised by those who oppose labor unions is that many unions will bargain for raises and even sometimes promotions based on seniority rather than on merit. While seniority might be less controversial and merit could be considered a popularity contest by the jaded, it doesn’t always sit well with all nurses who strive to set the bar high and provide the best quality care possible. All the while as another nurse who has been there forever because the union protects her, gets a better raise.

Wages, hours and benefits have always been a focus for hospitals and facilities that are unionized or offer a union option and are well-known for better pay, benefits, staff education and education reimbursement as well has working conditions and hours. It does come at a cost including union dues and very real possibility of mandatory striking. 

Becoming a Union Member

Joining a union is a very personal and professional choice involving many factors including finances, education goals, political views and the support of co-workers and management. In order to form a collective bargaining unit, there first has to be an interest among employees, an investigation of possible labor unions and a vote of the employees whether to join or not.