Unionization of Workers in the United States in Healthcare

by Jason Shaw


One of the main instruments of the job and workforce sector is unionisation. These unions are mainly intended to defend their interests as workers and to ensure that, under the basic legal mandates, they receive the necessary wages. Unionization is not a common trend or practise in the healthcare sector because of the perceived risk that unions and collective bargaining arrangements can bring to the delivery of health care services (Patterson, 2010).  Recently, however, measures have been seen to improve the unionisation of health care workers. This paper will analyse why this phenomenon is unfolding; the causes of this phenomenon will be explored and what can be done to prevent such unionisation.

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“although some hospitals have unions, the healthcare industry is not heavily unionised” according to the Bureau of Labor Statistics (2011). In 2008, about 17% of hospital staff belonged to unions or were under union contracts; and across all industries, all healthcare sectors were at rates below the 14% average (BLS, 2011). However, from 2008 to 2018, with health insurance projected to add 3.2 million new workers, numerous organised labour groups and unions have considered covering the industry. According to a report by IRI Consultants for the American Society for Healthcare Human Resources Management, health industry unions have been competitive in more than 70 percent of the elections carried out over the past five years (Aschenbrand, 2010). More evidence of union support is seen in hospitals, with unions winning 105 of the 143 healthcare industry elections in the first months of 2010. As a result, health care employers aim to ensure that workers are provided with the knowledge they need in order to make informed choices in response to messages from the union. Workers need to recognise that labour unions are not professional organisations and that these labour organisations organise employees, collectively negotiate and carry out strikes (Aschenbrand, 2010).  Last year, with about 12,000 Minnesota Nurses Association nurses picketing 14 separate hospitals in Minneapolis and St. Paul, one of the biggest nursing strikes in US history was actually seen (Gomstyn, 2010). As unions have begun to intimidate health care workers, it has become imperative for employers to educate their employees about the unions and to come up with consensus topics that can be addressed in order to address labour problems. Moreover, it has also been essential for employers to come up with ways to prevent labor unions from encroaching on hospital’s ability to manage its employees. 

Unionization of Workers in the United States in Healthcare

            The health care industry has managed to add many more jobs, even as the nation in general has struggled with many individuals losing their jobs (Orechwa, 2009). The health care industry’s need for laborers and employees has persisted over the years; for which reason, unions have been eager to sign them in. Consequently, the growth of labor unions in health care has grown exponentially. Unions are also lobbying before legislators in an attempt to seek for higher union memberships in the health care industry (Orechwa, 2009).  Healthcare union groups have done more than traditional organizing for these health organizations; they have also taken to using more aggressive corporate decisions and activities which target hospital donors, shareholders, and patients (Orechwa, 2009). These unions have pushed these health labor unions to also pressure the hospitals to give opportunities for unions in organizing their employees. For the most part however, some of these agreements have focused on curtailing the power of workers and have instead focused on union cooperation with the management (Orechwa, 2009). For which reason, issues in unionization have cropped up, and these issues are the focal point for most refusals for the widespread adoption of unionization in the healthcare industry. 

            Various attempts, some being successful, at unionization within the healthcare industry have been carried out in the past. One of these organizations is the Service Employees International Union which was started in 1921 as a janitor’s union (Gorechwa, 2009).  It later branched out to include government employees, security, and health workers.  By the year 2000, it became one of the largest unions in the US. Another union, known as the SEIU Healthcare is one of the healthcare unions in the US with about one million members, mostly nurses and service workers at hospitals (Gorechwa, 2009). The goal of this union has been on bringing business leaders, healthcare providers, organizations, and government officials together and working on the healthcare system. They have been very vocal about health care reform and other efforts to improve the health care system. In effect, this health care union has followed the pace of the current efforts to reform the health care system in an attempt to secure the rights of healthcare workers. 

            With expanded unionization, experts believe that these changes will not impact well on our healthcare system. Healthcare providers and analysts point out that unionization would likely mean higher health care costs and restrictive work environments which would add to the increasing cost of health care delivery (Gorechwa, 2009). Hospital facilities are now being pressured to be more aware of these issues and how they can assist their administrators and workers about the implications of unionization. In the process, the health workers would be able to consider the implications of joining labor unions – beyond their personal goals as employees. 

            Analysts are also claiming that the current trend in the apparent increase in health care unions has been partly due to a “backlash against some of the belt-tightening by hospitals in response to the recent economic downturn…” (Elliott, 2010).  In other words, major uncertainties in the health system reform are playing major roles in the unionization trend in the healthcare industry.    

            Unions want to gain entry into the expanding areas of employment and these unions are very much aware of the fact that if they successfully organize as many nurses and health workers as they can, that they would have a long and stable future.  Since many health workers have lost control of their jobs due to cost-cutting moves, many health workers have been enticed to unionize (Elliott, 2010). In general, union membership has been declining for the past few years; it almost went up to 21 million members in 1979, but by 2009, it decreased to 15.3 million members or to 12.3% of all health workers (Elliott, 2010).  It is notable to consider however that union membership among healthcare practitioners and technical occupations has increased. This group includes: physicians, dentists, nurses, veterinarians, therapists, and other health technicians. And now, about 1 million health care workers joined unions in 2009. About 12.9% of 600,000 employees in the group were members of unions in 2000 (Elliott, 2010). Such numbers increased to 13.6% or 962,000 workers in 2009 and most of this increase has been seen in the hospital settings with almost no unions seen in physician’s offices.

            Unions specific to healthcare have also increased and in December of 2009, the California Nurses Association, the National Nurses Organizing Committee, the Massachusetts Nurses Association, and the United American Nurses merged in order to become the 150,000 member National Nurses United organization. This is now the largest registered union in the nation (Elliott, 2010). This organization strongly expressed that as an organization, they wanted to have a strong and united voice for their patients and for their profession; and so they formed the union which was made up of nurses in order to lead their strong and united advocacy. 

            Various experts point out that some healthcare workplaces often become unionized because the other union representatives approach employees; in some cases, it is the employees which approach the union representatives (Elliott, 2010).  One example is the registered nurses working with Mountainview Hospital in Las Vegas who voted to join the National Nurses United’s California Nurses Association. The different employees in the hospital approached the union because it also was the union of choice of the employees at hospitals which was owned by Mountainview’s company, HCA (Elliott, 2010). At present, the union is actually starting to work on its first CBA with the hospital.  Some union representatives point out that physicians must also be aware of the trends toward unionization and to not be afraid of these trends – to not take it personally because an effective nurses’ labor union would be able to increase professionalism (Elliott, 2010). In the process, these physicians would also learn about aspects of employment which need to be focused on in order to secure an effective workforce and to establish a comfortable work environment for all health care workers. 

            These labor unions point out that money is not the sole issue of health care labor unions. Even as money is often the subject of controversy and contention during union negotiations; it is not a major issue among health workers. In 2009, union workers earned 27.9% more per week than those who did not join unions (Elliott, 2010).  Health workers covered by CBAs often made only about 14.3% more than their non-CBA labor counterparts.  Money issues often do not come up in healthcare labor organizations. In the previous recession, the hospital CEOs made major efforts towards cutting costs. Other issues like patient safety were actually higher concerns among these health organizations. The maintenance of staffing ratios was also considered more than money issues.  Such staffing ratios became major concerns with the recent hiring freezes and layoffs (Elliott, 2010).

            Unions with memberships, including only a limited number of insurance employees, are able to request lower healthcare rates without considering the effect of reductions on health workers (Kimzey and Johlie, 2009). For unions which represent a significant number of healthcare workers, will likely find themselves on a quandary as they support reduced healthcare costs and seek to add members while representing the voice of the members in collective bargaining (Kimzey and Johlie, 2009).  In other words, there is a conflict which cannot be ignored. Considering that the only realistic way for a union to remain viable is to retain and expand membership, observers believe that healthcare trade unions will ultimately address the demands of workers and desire autonomy, not so much as pursue decreases in healthcare. In order to maintain employees which they seek to represent, unions must actually convince employees that they can seek better wages for them and improve their work conditions (Kimzey and Johlie, 2009).  In effect, unionization in the healthcare industry is not simply a matter of asking members for their membership fees, it is also about lobbying for better rights and working conditions for workers in the healthcare industry.

            There have been many occasions when union membership in the healthcare industry was expected to increase significantly. Although some increase was seen, there were still some hospitals which did not see much activity in this regard. Some of these hospitals have actually even anticipated the increase of union members and have successfully stemmed their increase by negotiating bargaining units and by carrying out training and education for its employees (Malvey, 2010). In reality, health executives receiving more training are now well trained to oversee health employees and to incorporate remedies for human resource management that have productive labour relationships.

            There are various motivating factors which have been suggested in the increased trends towards unionization. Money, as was mentioned previously, does not appear to be one of these factors. For nurses, they seem to see the unions as a voice – as something which would speak in their behalf (Malvey, 2010). Nurses are strong and stalwart advocates for their patients’ rights and safety, and also for the safe practice of their profession. In instances when they know that their patients are in danger or at risk due to decreased staff /patient ratios, they want the management to hear about these issues. In instances when the management is not inclined to listen, nurses are compelled to use these unions (Malvey, 2010). Unionized workforces can pressure management to heed the call of the nursing profession – and to act on their issues for the benefit of the patients, the nurses, and the healthcare profession in general.

            Through the internet, unions have various avenues with which they can cover prospective members while not alerting employers. Unions were historically not permitted to interact with employers, especially in terms of visiting workplaces and soliciting workers during union campaigns (Malvey, 2010). The healthcare officials actually knew when the unions would be present at the office and what they were actually doing. Today, the internet has given unions free and unencumbered access to member employees anytime and anywhere (Malvey, 2010). Unions are able to expand their online access to employees and support the expansion of activists in their facilities, even under the administrator’s nose.  This is a major development from the days when the labor unions had to recruit in person.  But now, healthcare administrators do not exactly know how many of their employees are seeking membership in labor unions and using their services (Malvey, 2010). Moreover, union websites have a bigger picture of unionizing by ensuring that employees have the information in relation to union activities and facilities in their areas.             

            Union organizers have different strategies in order to draw in members. They first try to find out what the employees are trying to organize and then they try to convince these employees that union representation would ensure that they can get what they want (Kimzey and Johlie, 2009).  In the process, employees who have gripes and issues against the hospitals and their employees would be easily drawn in to join the labor unions. The failure of employers and health care supervisors to respond to the health care issues would likely drive the employees to consider membership in labor unions. In effect, “implementation of needed changes will in all likelihood increase union organizing in the industry, and absent a major and unlikely shift in the attitude of healthcare unions, implementation of these changes through the collective bargaining process is likely to be slow, painful, and disruptive” (Kimzey and Johlie, 2009). This is the trend which is pervading the healthcare system, and unless reforms and changes are set forth in the system, labor unions will continue to threaten the stability of the healthcare industry. 

            In order to prevent the pervasive infiltration of labor unions in the healthcare industry, non-union healthcare workers must start to coordinate and educate their workers about the different changes which reform may bring in the midst of uncertainty (Kimzey and Johlie, 2009).  Without such anticipation, the workforce would be vulnerable to unionization.  “Unionized employers in the industry must begin now to develop their strategies for dealing with the many labor and employment issues they will face under existing collective bargaining agreements and in future negotiations” (Kimzey and Johlie, 2009, p. 13).  These issues raise unrest and discontent among employees and they become prey to the opportunistic hands of union organizations which often seek their own purposes in recruiting unions.

            Orechwa (2009) also emphasizes on communication with employees. He claims that it is the critical first step which can be taken in order to control and manage unionization.  Issues which often lead up to unionization include economic concerns, work conditions, quality of patient care, and general employee satisfaction (Orechwa, 2009). In order to prepare for unionization activities, issues relevant to the healthcare facility must be addressed, and these needs must be addressed publicly.  Leadership trainings must also be carried out and must include data on union-free policy in employee hiring and orientation procedures (Orechwa, 2009). It is also important for supervisors to evaluate their wage and benefit structures.  Supervisors can use brochures; they can conduct meetings and seminars; and use eLearning and web tools in order to reach as many of their employees as possible (Orechwa, 2009).  Through such available means of communication, the employee feedback system can be implemented in the workplace and prevent the need for unionization. 


            The unionization of healthcare professionals in the United States saw trends in recent years of increasing numbers. As other professions also sought labor representation, the health industry slowly sought to catch up with this trend. In recent years, health workers have seen the need to join labor unions. Various health issues have cropped up and these issues have prompted health workers to consider unionization. Issues on patient safety, work conditions, and similar concerns which have not been given attention by health administrators have triggered the need for unionization among health workers.  In order to prevent unionization, health administrators must consider health reforms and must try to open the lines of communication with their employees. These open lines of communication must include opportunities for employees to air grievances and to discuss options in the workplace. Unionization can potentially endanger the foundations of healthcare; however, with communication and coordination, issues which give rise to these dangers can be resolved peacefully. 

Works Cited:
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