Unions in the Healthcare Industry: Challenges to Stay Union-Free

How does an employer stay union-free in the healthcare industry? This type of environment is an ideal model for all employers across industries to understand how pent-up employee frustrations can quickly lead to unionization under the right circumstances.

Certainly, the impacts of the COVID-19 pandemic will be felt for decades, but it was almost immediately felt with the announcement a pandemic was in progress in the healthcare industry. Nurses, healthcare facility nursing aides, home health-aid workers, and nursing homes confronted serious illness and numerous deaths among their patients day-after-day. In hospitals, in particular, nurses, nurse aides, and housekeepers stepped up. They worked overtime in hazardous conditions expecting their employers to do everything possible to protect their health and safety.

As the pandemic unfolded, many employees quickly came to feel like their employers didn't care enough about their health and safety, that they didn't have a voice in the workplace; and that they were dangerously overworked, which put patients and their lives in jeopardy. It's easy to see how feeling overworked and like your voice isn't being heard could lead to an uptick of unions in healthcare.

Healthcare Staffing Issues Leads to Union Organizing

Unfortunately, after the start of the pandemic, it took a while for many healthcare employers to provide adequate PPE, approve hazard pay, amend policies addressing time off for sickness due to COVID and take other steps towards putting employee protections in place. It wasn't necessarily the fault of the employers. The pandemic hit suddenly with little warning. The CDC issued conflicting guidelines, and access to needed safety and medical equipment and supplies was limited due to the structure of the nation's supply chains. There was a shortage of PPE equipment and patient ventilators, staffing issues while struggling to handle a large and rapid influx of COVID-19 patients, and a shortage of virus testing supplies. Some facilities had to reduce the number of support staff because of the inability to do elective procedures, which led to huge financial losses quickly. 

The healthcare industry is a classic example of how an unexpected turn of events can lead to an uptick in union organizing campaigns. In this particular industry, the pandemic is a tipping point more than a trigger for unionization. Many of the employee issues during the pandemic were issues before the pandemic started. Staffing, in particular, has been an ongoing issue with healthcare workers saying the worker-to-patient ratio made it impossible to deliver adequate patient care, a claim made in other facilities, too, like nursing homes. National Nurses United says that what happened during the pandemic reflects a lack of response of employers and government officials to past demands made to improve workplace safety before the pandemic, which led to nurses being sent to the pandemic frontline with inadequate protection. 

Unions in Healthcare Same as Unions in All Industries

The Bureau of Labor Statistics says 8.0 percent of healthcare support occupations and 11.9 percent of healthcare practitioners (includes nurses and many other occupations) and technical occupations were union members in 2020. This is an increase of .6 percent and .1 percent year-over-year. The unions have been active during the pandemic because there are so many issues they can quickly run with to potentially grow membership, like workplace safety and pay. 

SEIU-represented HCA Healthcare workers went on strike at Riverside Community Hospital in June 2020 with staffing and safety the two named concerns. In 2021, HCA has to negotiate collective bargaining agreements that cover 10,000 nurses in five states. Dignity Health will renegotiate contracts covering 14,000 nurses at 29 hospitals. These are just two of the major collective bargaining contracts that will be up for renegotiation. Rebecca Givan, Associate Professor in the School of Management and Labor Relations at Rutgers University, believes one of the possible impacts of multiple contracts coming up for negotiation at the same time is the union gets a marketing advantage in terms of gaining community support, leveraging off the fact the pandemic pushed healthcare workers into the public's eye. Employers are put on the defensive, forced to respond to negative union claims instead of proactively promoting the advantages of the business. 

The more unions are in the spotlight; the more likely all industries will feel the pressure of unions. Many of the issues driving healthcare workers to unions could potentially apply to any workforce. For example, a nurse who belongs to the New York State Nurses Association says they are professionals but work in a factory-like atmosphere and have little autonomy to define their practice or to determine how skills and knowledge can be implemented.

In the words of Judy Sheridan-Gonzalez, RN, "Professional caregivers have the same needs as other workers: to improve salary, benefits, hours, working conditions, respect for what we do, safety, fair treatment if accused of violations, etc. Professionals have additional needs: to practice our profession as we see fit, based on our licensure, certification, education, and autonomous judgment capability. Thus, we have a GREATER need to be unified in an organized body to negotiate these terms."

The Importance of Giving Employees a Voice

Sheridan-Gonzalez also mentions that they seldom hear from management except for "a cute letter sent out on Nurses Week or Christmas." Final decisions on resources and their allocation are determined by management without input from the nursing professionals. UnionProof has frequently discussed the importance of employee voice, employee trust in management, and transparency. When these three workplace characteristics are missing, employees are much more likely to talk to unions. 

Employees need to feel empowered. The nurses at Mission Health (taken over by HCA Healthcare) voted to unionize in September 2020. However, they acted collectively long before then, sending a petition and letter to administrators demanding stronger COVID-19 protocols and better training on using PPE. The hospital agreed, and the nurses believed it was a significant victory. It was also a two-edged sword. The victory proved to the employees a collective voice could bring management action. Still, it also demonstrated the importance of regularly communicating with employees – giving them opportunities to use their voice to express concerns, provide feedback and share knowledge. Perhaps Mission Hospital could have avoided unionizing if management had been listening to its employees all along and provided more feedback so that an employee petition wasn't necessary.

Nurses decided to strike at St. Mary Medical Center in November 2020 due to short staffing. Staffing had been a topic of discussion between nurses and management since 2019 when they joined the Pennsylvania Association of Staff Nurses and Allied Professionals (a labor union). Still, the pandemic led the nurses to take action. A tentative labor agreement was reached in December 2020, and the hospital statement said the contract "gives nurses a voice in discussions on staffing while preserving the hospital's right and authority to make all staffing decisions."

Once again, employee voice is a core issue.

Disadvantages of Unions in Healthcare and Other Industries

One of the major concerns going forward for companies that want to stay union-free is that unions are encouraged and supported by the current U.S. administration. The unions will have a strong influence in pushing legislators to pass industry-specific pro-union laws. Unions, for example, can lobby for laws that regulate healthcare facilities in a way that supports the union agenda and restrict employer decision-making about things like mandatory overtime, disciplinary actions, and various working conditions. 

Keeping employees informed about unions is key to staying union-free. A nurse pointed out the cons of unionizing, and they should sound familiar because they get to the heart of the same disadvantages of unions in non-healthcare businesses. 

  • Management must always consult with the union on issues like employee pay and benefits, and if it leads to a strike, patients suffer
  • Unions will always support the union nurse, meaning employers can't easily fire the nurse for poor performance (once again hurts patient care)
  • Unions charge dues, and some of the union dues go to political causes which union members may not support
  • Union and non-union nurses have said that unions entrench seniority so that nurses with low seniority are last on requests for holiday time off, are more easily assigned to other units, and are first to lose hours when patient numbers are low
  • Unions make it difficult to advance careers on merit or higher educational status when competing with unionized nurses with more seniority

Multiple Unions Reaching Out

There is no single union representing healthcare workers, though the AFL-CIO would like to see a number of the unions come together under their umbrella. The Service Employees International Union, National Nurses United, National Union of Healthcare Workers, and the AFL-CIO are four of the largest unions organizing healthcare workers. The National Union of Hospital and Health Care Employees is supported by two powerful labor groups – AFSCME, part of the AFL-CIO. AFSCME is known for its involvement in Democratic Party political campaigns, proving that labor unions and politics go hand-in-hand. There is a large number of member-led state and local labor unions too. 

According to RegisteredNursing.org, many of the state and local unions were prompted by labor lawyers and are not the result of nurses leading an organizing event. Some nurses pay as much as $90 each month for union dues, so it's not surprising unions want them to organize. The article also discusses the damage strikes cause, which includes lower-quality patient care, lost wages, high employer costs of training and replacing strikers, and in some cases, community hospital closures.

The interesting comment the author makes at the end is this: "One fact remains true: unions in healthcare is big business for union leaders. Under the guise of improving nurses' working conditions and patient outcomes, unions continue to advocate for their own survival first and foremost."

union-free in the healthcare industry

Tips for Staying Union-Free in Healthcare

The challenge of staying union-free is going to continue to get more complex. Every industry can learn from the increasing interest in unions by nurses and other healthcare workers. Following are some of the steps you can take immediately to stave off unions by developing positive employee relations.

1. Employee voice - As discussed, giving your employees a strong voice tops the list. A strong employee voice means your leaders actively listen, deliver feedback, address specific concerns and maintain an open-door policy that is put into action. 

2. Maintain a system of open and honest communication – The pandemic placed a lot of stress on healthcare workers. The stories emerging from events over the last year that are leading to unions getting involved have a common theme. Management made decisions about issues like staffing, leave time, and safety without consulting their employees or explaining why certain decisions were made.

Employees today expect their leaders to include them in decision-making by giving them plenty of opportunities for input and sharing the reasoning behind decisions. Even if management must make unpopular decisions, like staffing reductions, employees will understand why certain decisions had to be made. There is a good chance your employees may have ideas that management had not thought of too. Include employees and invite diverse perspectives on finding solutions to particular challenges.

3. Regularly recognize employee contributions to business success – Employees are the heart of every business. When they feel unappreciated and isolated from management, it's an open invitation to labor unions. Your leaders can show appreciation in a variety of ways, and they don't necessarily involve additional expenses or a lot of money.

For example, recognizing employees on the company website or embracing an employee's innovative solution and sharing it publicly lets employees know your managers appreciate their efforts. A series of studies were conducted to identify low-cost non-monetary interventions to promote happiness among social workers. The research has found that symbolic awards like congratulatory cards and public recognition can significantly increase performance, intrinsic motivation, and retention rates. In one study, social workers who received a letter praising their work and their impact on clients felt significantly more valued than those who didn't receive a letter.   As the nurse mentioned, though, a Christmas card once a year is not a genuine way of showing appreciation. Recognizing employees must be an ongoing process.


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4. Train your leaders on union organizing – There is a lot your leaders should know about labor unions and the law. They need to know TIPS and FOE rules, employee and employer rights conveyed in the National Labor Relations Act, how to identify signs of union organizing, and steps to take should union organizing efforts become apparent. Leadership training is also important to ensure your managers know specific reasons why unions are not good for the organization. 

5. Develop a system for identifying emerging workforce concerns - In many of the situations leading to nurses and healthcare workers choosing to join a union, a common theme emerged. Employees said the issues had been bubbling for a while, and they tried to talk to management about them. Ignoring your employee concerns is never a good option. 

There are numerous ways to pinpoint concerns, including assessing social media posts, doing pulse surveys, evaluating the types of grievances, reviewing Human Resources cases, measured productivity declines, increased sick leave hours, increased turnover, and increasing workforce conflicts between workers and between employees and management are some. Even employees demanding more money or benefits like increased family leave time are symptoms of employee unhappiness. 

TinyPulse named eight signs of unhappy employees. They include an increase in customer complaints, a toxic attitude, refusal to offer feedback which demonstrates a lack of employee engagement, refusal to socialize with coworkers on the job, and showing up late and leaving early. 

staying union-free in healthcare

6. Monitor your organization's culture – Declaring a company has a positive culture based on core values doesn't make it a reality. One of the signs employees are disengaged, and prime for unionization is a noticeable unwillingness to support a positive organizational culture. A disregard for core values means employees don't believe management is sincere about its stated values. 

You can assess and monitor your culture in a variety of ways. Certainly, employee surveys are one way but establish a benchmark to measure against. Other steps include analyzing the dynamics of employee interactions; bias claims lodged with management or the EEOC; the frequency with which employees share new ideas; negativity or positivity noted in employee answers to questions about the business; and measuring the level of cultural tensions in the workplace, to name a few. 

7. Invest in employee training that minimizes the need for unionsTraining your employees on the disadvantages of unions is essential to staying union-free. Maintaining your union-focused website is one step. 

Other steps include sending frequent communication touting things like the value of direct communication between employees and managers, open opportunities for employees to voice concerns with managers, and reasons for opposition to union organizing. Projections, Inc. recommends using a variety of resources to heighten employee engagement, like online videos, tweets, text messages, email updates on real-world union activity harming businesses and thus employees and anything else that fits your workforce best. Companies can use eLearning courses that regularly engage employees in common union issues like health and safety, benefits, core values, communication with management, grievance procedures, and so on.

8. Don't wait for unions to show up - Always staying prepared to respond to unions is critical. By the time you learn employees are talking to unions, they have been communicating for a while. You may not need a rapid response team, but you do need a well-developed response plan that is always ready to be put into action. You should have easy access to a labor professional or have in-house certified labor relations professional and be ready to communicate rapidly with your workforce about unions. If you have to train your managers' supervisors, locate a labor law professional, develop information materials, get a website up and running and design an employee communication plan, the union will be way ahead of you. 

Help Employees Make Good Decisions

This industry may be seeing an uptick in union organizing attempts, but there are plenty of nurses and healthcare workers who also recognize the importance of staying union-free in the healthcare industry. In the articles mentioned, the employees who are against unionizing make it clear they have given a thoughtful analysis of the truth about unions. Employees who are engaged and informed are much less likely to get drawn into union organizing efforts. 

There's good news. We're here to help you avoid the mistakes some healthcare organizations have made while at the same time helping you develop an ongoing program and laborwise leadership that keeps your organization union-free. Don't leave anything to chance. 

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About the Author Jennifer Orechwa

With over 25 years in the industry, and now as IRI's Director of Business Development, Jennifer has gained a unique perspective on what it takes to build a culture of engagement. By blending a deep understanding of labor and employee relations with powerful digital marketing knowledge, Jennifer has helped thousands of companies achieve behavioral change at a cultural level.

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