Unions: Choice and mandate

Unions: Choice and mandate Jacqulyn Gideon, RN

have seen the effects of collective bargaining on nurses and nursing from all levels, as a staff member of the Missouri Nurses' Association for five years, doing collective bargaining for nurses, and as a member and chair of the Economic and General Welfare Commission of the American Nurses' Association (ANA). I have also seen nurses using collective action instead of collective bargaining, and I have seen nurses doing nothing at all collectively. My own attitude has shifted from antiunion to prounion, and I have seen the good and bad about unionization. I have important information about the survival of what we call nursingour work and our profession. The mandate is to unionize. The only choice now is which union. Unionization is the last choice on the list, the only choice nursing has left. These are some reasons to organize, some reasons not to organize, and a prediction. Do organize i f you want your salaries and fringe benefits to improve. I start with the subject of money because it is

Jacqulyn Gideon, RN, MEd, is associate executive director of the Missouri Nurses' Association. She received an associate degree in

nursing from Lincoln University, Jefferson City, Mo; a BSN from the University of Missouri, Columbia; and a master's in adult education from Lincoln University. She is expecting a law degree in December. This article is adapted from her speech at the 1980 Atlanta Congress.

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ollective bargaining is a tool, but by itself it doesn’t solve anything.

the last taboo. We still can’t talk about money. You are making, as an average, $6.78 per hour.’ That is abominable, considering the education, experience, and responsibility you have. The clerks in your local grocery store make far more than you do. Do you know why? Because they have a good union. Because they think they’re worth it, and through their union they demand it. If you say, “I don’t care about money,” you’re either lying or married to a rich man (or woman). Either way, you’re doing yourself and your profession a disservice to let the public think you’re worth only $6.78 an hour. None of us works for the fun of it. If I didn’t get paid, I wouldn’t or couldn’t work at what I do. I have to eat, pay my utility bill, and send my kid to college. Society values your services according to how much they pay you. It’s not enough. But you will not be paid more until you insist on being paid more. If you want to be paid more, organize. Nurses who are organized under collective bargaining agreements earn from 10% to 17% more than their nonunion counterparts.2 Do organize i f you want to give better care to yourself and your patients. You can’t stay sane or even physically healthy if you are on call seven nights in a row and are called back twice a night. You also can’t give good care under those conditions, and you know it. Organizing will give you some protec1202

tion from those abuses. It will insure that you are paid for all time worked and get premium pay for hours worked on call or on weekends. There is no reason nurses should get straight time for call-back, while so-called “nonprofessionals” get time-and-a-half. Management will have to hire enough nurses to take care of the patient load instead of pressuring too-small staffs to fill in. Patients benefit by care from a nurse who is physically and mentally rested enough to give good care. Do organize i f you want some control over your practice. Nurses are “professionals,” and you have a higher duty than loyalty to your employer. (1’11 explain the quotation marks later.) Your first obligation is to your patients. Like physicians, your obligation is to serve; unlike physicians, you are also employees. Doctors do not attempt to serve two masters, as nurses must. Those of you who believe you are still physicians’ handmaidens are serving three masters. Do see for yourselves what a bind nurses are in, with two loyalties. The patient obligation is first, but your employer demands and deserves a measure of loyalty, too. This is a conflict. It cannot help but be. If it creates no conflict for you, then I submit that you either are not serving your hospital well, or you are not serving your patients at all. There has to be a conflict between the two roles, employee and “professional.” Organizing will give you a handle on

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conflicts between your duty to your patients and your duty to your employer. For example, you can write into a contract that you will not be disciplined or fired for challenging a n order t h a t might endanger a ~ a t i e n t If . ~you’ve never seen that happen to a colleague, you’re lucky. You can write into your contract that you will practice in accord with standards of practice, now specific for OR nurses; ANA’s code of ethics, and your own state nursing practice act.4 That will let you file grievances and correct problems in many practice areas that are hard to write into specific contract language. You can write into the contract a mechanism for meeting with management, particularly nursing management, to discuss and correct patient care problems before they become large. Another mechanism that helps in contracts is a joint nurse-physician committee that hears and solves problems in relationships between the two disciplines. This is better than giving that size 8 surgeon you’re mad at size 6 gloves. Do organize with a group that knows about representing nurses. ANA is presently t h e third largest health care union in the country and represents far more nurses than any other union. We represent about 110,000 of the 900,000 nurses working. All other labor unions combined represent around 20,000.5

Notice we’re not shy about the word union: Read ANA President Barbara Nichols’s open letter in the January American Journal of Nursing ( r e printed in the March AORN Journal).6 She writes, “Too much time has been squandered on discussions of whether we are a union or a professional association. The American Nurses’ Association is both.” The other two big unions in health care are the Service Employees International Union and District 1199, National Union of Hospital and Health Care Employees. Both have some experience in representing RNs. The American Federation of Teachers went into health care to bolster its sagging teacher membership. At their last convention, t h e i r president, Albert Shanker, said: When we go out there to fight vouchers and tuition tax credits and try to get support for public schools, people are going to ask: How many votes do you have? They are not going to ask: Are the people in your organization teachers or school secretaries or guidance counselors or college professors or para-professionals? They are going to ask: How many votes do you have?. . . I never knew a man who r a n for public office who cared whether it was a teacher who voted for him or a plumber or anybody else.7 Whatever union you talk to, ask them the right questions. (See related arti-

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cle.) Shop around, just as you would for any service. That’s what unions sellservice. If you shop around, I think you’ll select ANA to represent you. They have most of the right answers to most of the questions. In addition, organizing with ANA helps strengthen nursing a s a group, while organizing with any other union fragments us further. I recommend ANA to you, but my recommendation is qualified. As good as individual state nurses associations (SNAs) are-remember, it is the state level that negotiates for you-they need a strong national organization. If ANA continues to decrease its funding of the Economic and General Welfare program at the national level, it will not be able to help the SNAs to represent nurses effectively. It will lose the battle to keep nurses in one organization. That will be a shame, but that’s the way the system works. The organization that wants nurses the most and will put its money on the line for them will get them. The survey I quoted about 10% better salaries for organized nurses also suggests that the trade unions may be doing better a t getting high salaries than ANA affiliates6 Those are some dos for organizing. These are some don’ts. Don’t organize if you value your fairhaired-girl image. You will not be seen as doing management a favor. You will never again be entirely in their good graces. You will never again be patted on the head. You will never again be given anything by management-you’ll have to earn it. You will not be management’s child; you will be its peer, its equal. You will have to give up an individual approach to problem solving. You must learn to think about what is good for the group as a whole, not what is good for one nurse. You will not have the opportunity to negotiate a higher salary for

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yourself than is given to a nurse in the same position. You will not be given better money or benefits than your fellow nurses in return for keeping quiet. You will destroy forever management’s big, happy family where the door is always open. If you live in one of these fairy tale castles, don’t mess i t up. They will tell you, and it is true, that things will never be the same again. If you like things as they are, don’t even dream about organizing. It will make irrevocable changes in the place where you work. Don’t organize ifyou think it will solve all your problems. If you believe that anything will solve all your problems, you should be living in that fairy castle, or perhaps you should see your mental health nurse practitioner. Collective bargaining is a tool you can use to solve problems, but by itself it does not solve anything. By itself, it is a problem. Only if you use it will it work, and then it won’t fix everything. It will give you a handle to use. The conflicts in being an employeeprofessional a r e real, and they a r e not small. No system will solve all problems, because new ones arise every day. Collective bargaining sets up a mechanism to handle problems, but if you are apathetic and would rather complain t h a n do something, by all means complain. It’s far easier, less trouble, a n d j u s t as effective a s organizing-if you believe that just organizing will solve all your problems. Don’t organize if you think it will be easy. Organizing is a long, frustrating fight. I n the process, you will make enemies, be disappointed in friends, get tired, get mad, become apathetic, and possibly have a breakdown. It is about the hardest work known to woman. It is roughly equivalent to the trial of going to nursing school. To give you some idea: You have to gather into one cohesive group most of

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Questions to ask a union 1 . What experience have you had

representing registered nurses? What are the results? 2. How long have you been in the health care field? How long have you represented RNs? 3. How many RNs do you represent now? Where? 4. What benefits have you negotiated, including salaries, fringe benefits, and “professional” items such as time released for continuing education and tuition reimbursement? 5. What sort of participation will RNs have in your union? Do nurses have a separate division in the union? Do they have a seat on the board of directors? Do local groups of nurses elect their own officers, or is this done on a district basis? Do nurses

the nurses in your facility, many of whom have never seen nor heard of one another and most of whom have never iished to see nor hear of one another. You have to convince them to sign authorization cards (roughly equivalent to getting them to sign a marriage license), come to meetings, elect officers, conduct a campaign, put out newsletters, squelch rumors, win a n election, write a proposal, negotiate a contract, and process what seems like several million grievances. All this must be done against the biggest, best, and most sophisticated union-busting specialists money can buy-your patients’ money. All this must be done while you are told how disloyal, unprofessional, and unladylike you are. All this, so some nurse who sat back, and griped, and never joined can say to you, “Thanks for the big raise we got. What are you going to do for me now?” For your sake and for the sake of the state nurses association staff person who will be helping you, don’t organize unless you are ready to work hard.

compete for elected office with other levels of health care workers in the union? 6. Who makes the decisionsat the bargaining table? Can the local group call a strike without the national union’s permission? Can the national union call a strike without the local’s vote? 7 . What are the dues? How are they established? How are they spent? Do you provide for continuing education of your members? Do you hire lobbyists to press for nursing legislation at the national and state levels? 8 . Do you deal with nursing practice issues on a state or national level? What benefits of insurance, communication, and so on, do you provide?How much help and what kind of help can your union give a local group?

Don’t organize i f you think it’s not “professional.” If you have any doubts about whether you’re a professional, or whether collective bargaining will take away from your professional status, don’t worry about it. You are not a professional if you’re worried about it. Professionalism exists only because we say it exists. Law and medicine are considered professions only because they say they are, and sociologists have obliged by making up lists of criteria and definitions of professions. If collective bargaining destroyed professionalism, lawyers, physicians, and teachers would not be professionals. Lawyers and physicians have not had to organize in large numbers because they usually have not been employees. Where they have been employees, they have o r g a n i ~ e d . ~ If collective bargaining did destroy “professionalism,” it would be a blessing. This concept is a false god, a silver cross held up to ward off the evil spirits of fair pay, decent conditions, and your rights under the law. Even your nursing

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ake up your own mind if there is any other choice.

leaders have been convinced that some magic level of education would make you professional. The unspoken promise is that then you will get the money, the respect, and the power you are due-then, when you are professional. It is not so. If you remember nothing else in this message, remember this: You will not be professional, you will not get money, power, respect, nor even survive as a n occupation unless you believe in yourselves. It is time to strike down this false god of professionalism, to stop examining your navels and your scopes of practice, and get on with your business. Your business is taking care of people. You call it nursing, you do it well, and that should be enough for anybody. Finally, don’t organize ifyou can find a better alternative. As said before, it’s hard work, and it’s not a total solution. The only reason anybody does it is that they haven’t found a more effective alternative. Some possible alternatives are: 1. Local collective action groups. Collective bargaining is a form of collective action. Collective action is possible without t h e s t r u c t u r e of collective bargaining. We use collective action in the legislative process. Collective action is what AORN does when it organizes local chapters to write the US Department of Health, Education, and Welfare (HEW) about proposed regulations allowing non-RNs to circulate.

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Some groups of nurses have engaged in collective action with their employer on a local hospital level, stopping short of writing a formal agreement. It is informal and thus more palatable to some. Immediate problems can be solved, but the group must stay organized or reorganize to deal with later problems. The agreements reached a r e not legally binding, and the success of the group depends on the goodwill of the administration or the clout of the group members. 2. Staff nurse organizations. These would function like t h e physicians’ staff. The nurses would be colleagues, and by logical extension, they would vote on whether to admit a new nurse to the s t f l . They would elect a chief of staff (director of nursing) from t h e group. The problems in translating the physicians’ structure, in which staff members are not employees, to a nurse structure, in which staff members are employees, are major.l0 3 . Corporations of nurses. These groups could organize and sell nurse services to hospitals, much the way radiologists sell their services and temporary staffing services provide nursing care. The corporation could be owned by nurses. Nurses would be employed by and own stock in their corporation. This is complicated but would go far to solve the professional-employee conflict. 4. Nurses assert themselves. If this were done, we’d have no problems. As it

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i s now, a f e w o f y o u d o it. T h e r e s t s i t b a c k and w a v e goodbye w h e n t h e assert i v e one i s fired. I f all w o u l d stand up, t h e m a n a g e m e n t w o u l d n ' t f i r e all. If you're b r a v e , try it. I f you've b e e n d o i n g it and a r e n o t f i r e d yet, encourage y o u r colleagues t o d o l i k e w i s e . These a r e some reasons y o u s h o u l d organize, and some reasons y o u s h o u l d n o t . Y o u ' l l h a v e t o m a k e up y o u r o w n mind if y o u think it i s w o r t h it, o r if y o u think t h e r e i s any o t h e r choice. Ib e l i e v e t h e r e i s n o t . Ib e l i e v e that in t h e f u t u r e m o s t n u r s e s w i l l b e organized, o r else t h e r e w i l l b e n o occupation o r profession c a l l e d nursing, a s w e k n o w it. I f y o u organize t h r o u g h ANA, y o u c a n k e e p t h e profession i n t a c t . I f y o u o r ganize with a n o t h e r u n i o n , y o u ' l l become o n e l e v e l o f h e a l t h care workers, a l i t t l e above p r a c t i c a l n u r s e s and a l i t t l e b e l o w physician's assistants. I f y o u don't organize, e v e n fewer y o u n g people w i l l go i n t o an o c c u p a t i o n that p a y s so l i t t l e . E v e n m o r e o f y o u w i l l d r o p o u t o f a profession so f r u s t r a t i n g and p o w e r l e s s . T h e f e w l e f t w i l l b e t r a n s f o r m e d i n t o t o k e n n u r s e managers, s u p e r v i s i n g u n s k i l l e d people d o i n g what y o u do best. 0 Notes 1. Andrea L Lucas, "6.78 per hour," RN 43 (January 1980) 37. 2. /bid, 39; "Health care reports," Nursing 77 7 (June 1977). 3. Contract clause, Missouri Nurses' Association and Missouri Department of Mental Health; "Nurses group signs pact with department,"St LOUIS Globe Democrat, Nov 29, 1977, 12A. 4. Association of Operating Room Nurses, American Nurses' Association Division on Medical-Surgical Nursing Practice, Standards of Nursing Practice: Operating Room (Kansas City, Mo: American Nurses' Association, 1975). 5. Jacqulyn Gideon, "The American Nurses' Association: A professional model for collective bargaining," Journal of Health and Human Resources Administration 2 (August 1979) 14. 6. Barbara Nichols,"An open letter to the nurses of America," American Journal of Nursing 80 (January 1980) 61, reprinted in AORN Journal 31 (March 1980) 718-720

7. /bid. 8. Lucas, "6.78 per hour." 83. 9. M Gordon, "Physicians and collective bargaining," Journal of Health and Human Resources Administration 2 (August 1979) 59; J Jenkins, "Lawyers on the picket line," Student Lawyer 7 (January 1979) 20. 10. This concept has been explored and written about by Luther Christman, RN, PhD. Rush Untversity, Rush-Presbyterian-StLuke's Medical Center. Chicago.

Film review: OR View-Radiography OR View-Radiography, by Geraldene M Areghini, RN, premiered at the 27th AORN Congress in Atlanta. The film begins with a historic overview of radiographic techniques and includes a description of the biological effects of radiation. The film emphasizes practices that protect personnel from radiation exposure. The presentation describes radiographic procedures commonly performed in the OR. RR, and special procedure room. It provides specific details on scheduling and coordination of procedures with the radiology department, the care and storage of several types of equipment, and the duties of the scrub and circulating nurse. Guidelines for positioning the patient, the use of contrast media. draping. and explanations to the awake patient are also included. OR View-Radiography provides viewers with information essential for the safe care of patients and the protection of OR personnel during radiographic procedures. The film IS intended for viewing by OR and RR personnel. nursing students, and medical and radiology personnel. OR View-Radiography (DG 1358) can be rented in 16mmfilm and 34-inch videocassette formats for $15 or be purchased as a videocassette for $1 00. It may be ordered from the Surgical Film Library. Davis Geck. One Casper St, Danbury. Conn 06810. Nancy W Schneckloth, RN Audiovisual Committee

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