California nurses are taking their show on the road, getting rave reviews from colleagues in other parts of the country, criticism from competitors and worried looks from hospital administrators and politicians.
Invigorated after winning its first union election outside California, the California Nurses Association has some lofty goals that don’t stop at the state line or with better pay and working conditions for rank and file members. The California union is on a quest, spearheading what it hopes will become a national movement to change the way health care is delivered in this country.
“When you look at the way the women’s suffrage movement evolved, you’ll see some similarities I think to what’s going on in health care right now,” Deborah Burger, president of CNA and one of the leaders of the union’s national campaign, said.
“It didn’t happen all at once. It happened state by state, region by region with people slowly seeing how things could be instead of how they’d always been,” Burger said.
CNA officials say their main focus is organizing the roughly two million registered nurses who have no representation in the United States.
“But if we’re asked to come in to an area where another union already is, we’ll come,” Burger said.
After winning a vote in May, CNA now represents 1,800 nurses in Cook County, Ill., which United American Nurses had represented for many years. About 1,600 nurses participated in the vote, which the National Nurses Organizing Committee — CNA’s new national arm — won by a 2-1 margin, leading to the creation of CNA’s first bargaining unit outside of California.
UAN spokesperson Suzanne Martin says California nurses should aim their efforts elsewhere.
“UAN strongly opposes the practice of raiding already-organized nurses, a tactic CNA has frequently employed,” Martin says. “With nearly two million unorganized RNs in this country, our organizing focus as unions should be on nurses seeking a union.”
However, some Cook County nurses cited CNA’s track record in explaining their vote for the change in union representation.
“California nurses are the only ones in the U.S. that have ratios and we need something like that here, badly,” Bernice Faulkner, a Cook County nurse and new NNOC member, said.
“It’s getting so bad around here, you’ll have three nurses trying to take care of 25 patients at once, and that’s just too much,” according to Faulkner, a public health nurse and a former school nurse.
“California nurses came in here and they’re the only ones who seem willing to stand up to hospital administrators. We liked that,” Faulkner said. “We also like that this group is looking to take the battle to the national level.”
NNOC is active in several states including Massachusetts, New York, Michigan and Florida. CNA’s next attempt to win a collective bargaining vote outside California will probably be in Ohio. In addition, CNA has signed up roughly 2,000 members in 37 states other than California and Illinois over the past several months.
Talking points with nurses CNA seeks to represent usually begin with the union’s landmark nurse-to-patient ratio law passed by the California Legislature in 1999. Under state rules to implement the law, acute care hospitals must have one nurse on duty for every four patients in emergency departments, intensive care units and pediatric departments. In medical-surgical units the ratio is 1-to-5.
Martin said UAN “fully supports mandated, federal nurse-patient ratios” and is working with other AFL-CIO unions to support HR 1222, a bill sponsored by Rep. Jan Schakowsky (D-Ill.) that would establish “federal, minimum nurse-patient ratios and real penalties for hospitals that fail to meet them.”
American Nurses Association spokesperson Carol Cooke said ANA’s approach to staffing ratios “takes into consideration the complexity of patient-care needs, including such variables as staff experience and mix, patient-acuity rates and technological factors.” ANA worked with Reps. Lois Capps (D-Calif.) and Robert Simmons (R-Conn.) in the writing of HR 1372, a bill introduced in the spring to establish a requirement for minimum staffing ratios. Rather than establishing a specific ratio, ANA’s bill would require hospitals to establish a staffing system that “ensures a number of registered nurses on each shift and in each unit of the hospital to ensure appropriate staffing levels for patient care.”
“ANA supports ratios, we just do not support a ‘one-size-fits-all’ approach to ratios,” Cooke says. “We also believe ratios should be set and adjusted by RNs, not by legislators,” Cooke adds.
“That would be fine, if registered nurses were allowed to do that,” Burger said. “But the fact is that hardly ever happens. It certainly didn’t happen in Chicago.”
Conventional labor wisdom has it that duplicate efforts to organize workers can work against labor and in fact strengthen management bargaining positions.
“That might be a concern if other unions were actually advocating for nurses,” Burger said. “But other unions have not been doing a good job. In fact, one could argue that often other union’s agendas, especially in places like Illinois, have been cooperating with employers, not advocating for patients and nurses. The vote in Chicago should tell you something. That was a pretty strong message,” Burger said.
In numbers alone, CNA is the smallest of three national unions competing to represent America’s 2.3 million registered nurses. UAN, affiliated with ANA, represents about 102,000 registered nurses in 27 states. Service Employees International Union has about 80,000 registered nurses among its 900,000 health care union members in 21 states. CNA has about 62,000 members, almost all of them in California.
But what CNA lacks in numbers, it makes up for in aggressive style and far-reaching goals.
“Our agenda has two main thrusts,” Burger said. “First, we are very strong on patient protection advocacy. Patients’ well-being is our primary concern and often the best way to protect patients in a hospital is to make sure there are enough nurses on duty. So working conditions for nurses is a big part of our agenda, too.”
“But there’s another reason we’re out there,” Burger said of the union’s new campaign. “We’re talking about health care reform on a large scale. We’re working on a constitutional amendment to assure that every American has health care.”
The union has no sponsor yet to take its universal health care proposals to Congress, but Burger said that “there’s a lot of interest out there.”
That such talk is coming from California is not surprising, labor experts say. “California was one of the first states to move into ‘mismanaged care,’ or whatever you want to call the current state of health care in this country,” Ruth Milkman, director of the University of California-Los Angeles Institute of Industrial Relations, said. “It makes sense that the first nurse ratio laws would be in California, and now having the CNA in the vanguard of a new national effort to organize and advocate for change also makes sense.”
CNA is positioning itself as the new, aggressive player on the national scene, willing to take on the status quo, even if that means established unions in addition to hospitals and politicians.
With signs saying “Protect Patients, Not Profits,” CNA has become a very public thorn in the side of the California Hospital Association, a trade group representing most of California’s 450 acute care hospitals. Jan Emerson — spokesperson for the hospital association, which lobbied against nurse-to-patient ratios and then joined with Gov. Arnold Schwarzenegger (R) in an unsuccessful attempt to relax the rules — has accused the CNA of using high-profile tactics to increase the union’s national image.
“That’s fine with us — getting a national image. If that’s what it’s going to take to change things,” Burger says.
“Arnold certainly took notice of us in California, and I hope George Bush is paying attention, too, because there are definitely some changes that need to be made.”