By Aneri Pattani, Kaiser Health News Correspondent, reports on a broad range of public health topics, with a focus on mental health and substance use. She came to KHN from Spotlight PA, a collaborative newsroom investigating state government and statewide policies in Pennsylvania. She has also worked as a health reporter for The Philadelphia Inquirer, WNYC (New York City’s NPR station) and The New York Times. She was a 2019 recipient of the Rosalynn Carter Fellowship for Mental Health Journalism. Originally published at Kaiser Health News.
The nurses at Mission Hospital in Asheville, North Carolina, declared on March 6 — by filing the official paperwork — that they were ready to vote on the prospect of joining a national union. At the time, they were motivated by the desire for more nurses and support staff, and to have a voice in hospital decisions.
A week later, as the covid-19 pandemic bore down on the state, the effort was put on hold, and everyone scrambled to respond to the coronavirus. But the nurses’ long-standing concerns only became heightened during the crisis, and new issues they’d never considered suddenly became urgent problems.
Staffers struggled to find masks and other protective equipment, said nurses interviewed for this story. The hospital discouraged them from wearing masks one day and required masks 10 days later. The staff wasn’t consistently tested for covid and often not even notified when exposed to covid-positive patients. According to the nurses and a review of safety complaints made to federal regulators, the concerns persisted for months. And some nurses said the situation fueled doubts about whether hospital executives were prioritizing staff and patients, or the bottom line.
By the time the nurses held their election in September — six months after they had filed paperwork to do so — 70% voted to unionize. In a historically anti-union state with right-to-work laws and the second-least unionized workforce in the country, that margin of victory is a significant feat, said academic experts who study labor movements.
That it occurred during the pandemic is no coincidence.
For months now, front-line health workers across the country have faced a perpetual lack of personal protective equipment, or PPE, and inconsistent safety measures. Studies show they’re more likely to be infected by the coronavirus than the general population, and hundreds have died, according to reporting by KHN and The Guardian.
Many workers say employers and government systems that are meant to protect them have failed.
Research shows that health facilities with unions have better patient outcomes and are more likely to have inspections that can find and correct workplace hazards. One study found New York nursing homes with unionized workers had lower covid mortality rates, as well as better access to PPE and stronger infection control measures, than nonunion facilities.
Recognizing that, some workers — like the nurses at Mission Hospital — are forming new unions or thinking about organizing for the first time. Others, who already belong to a union, are taking more active leadership roles, voting to strike, launching public information campaigns and filing lawsuits against employers.
“The urgency and desperation we’ve heard from workers is at a pitch I haven’t experienced before in 20 years of this work,” said Cass Gualvez, organizing director for Service Employees International Union-United Healthcare Workers West in California. “We’ve talked to workers who said, ‘I was dead set against a union five years ago, but covid has changed that.’”
In response to union actions, many hospitals across the country have said worker safety is already their top priority, and unions are taking advantage of a difficult situation to divide staff and management, rather than working together.
Labor experts say it’s too soon to know if the outrage over working conditions will translate into an increase in union membership, but early indications suggest a small uptick. Of the approximately 1,500 petitions for union representation posted on the National Labor Relations Board website in 2020, 16% appear related to the health care field, up from 14% the previous year.
In Colorado, SEIU Local 105 health care organizing director Stephanie Felix-Sowy said her team is fielding dozens of calls a month from nonunion workers interested in joining. Not only are nurses and respiratory therapists reaching out, but dietary workers and cleaning staff are as well, including several from rural parts of the state where union representation has traditionally been low.
“The pandemic didn’t create most of the root problems they’re concerned about,” she said. “But it amplified them and the need to address them.”
A nurse for 30 years, Amy Waters had always been aware of a mostly unspoken but widespread sentiment that talking about unions could endanger her job. But after HCA Healthcare took over Mission Health in 2019, she saw nurses and support staff members being cut and she worried about the effect on patient care. Joining National Nurses United could help, she thought. During the pandemic, her fears only worsened. At times, nurses cared for seven patients at once, despite research indicating four is a reasonable number.
In a statement, Mission Health said it has adequate staffing and is aggressively recruiting nurses. “We have the beds, staffing, PPE supplies and equipment we need at this time and we are well-equipped to handle any potential surge,” spokesperson Nancy Lindell wrote. The hospital has required universal masking since March and requires staff members who test positive to stay home, she added.
Although the nurses didn’t vote to unionize until September, Waters said, they began acting collectively from the early days of the pandemic. They drafted a petition and sent a letter to administrators together. When the hospital agreed to provide advanced training on how to use PPE to protect against covid transmission, it was a small but significant victory, Waters said.
“Seeing that change brought a fair number of nurses who had still been undecided about the union to feel like, ‘Yeah, if we work together, we can make change,’” she said.
Old Concerns Heightened, New Issues Arise
Even as union membership in most industries has declined in recent years, health workers unions have remained relatively stable. Experts say it’s partly because of the focus on patient care issues, like safe staffing ratios, which resonate widely and have only grown during the pandemic.
At St. Mary Medical Center outside Philadelphia, short staffing led nurses to strike in November. Donna Halpern, a nurse on the cardiovascular and critical care unit, said staffing had been a point of negotiation with the hospital since the nurses joined the Pennsylvania Association of Staff Nurses and Allied Professionals in 2019. But with another surge of covid cases approaching, the nurses decided not to wait any longer to take action, she said.
A month later, officials with Trinity Health Mid-Atlantic, which owns the hospital, announced a tentative labor agreement with the union. The contract “gives nurses a voice in discussions on staffing while preserving the hospital’s right and authority to make all staffing decisions,” the hospital said in a statement.
In Colorado, where state inspection reports show understaffing led to a patient deathat a suburban Denver hospital, SEIU Local 105 has launched a media campaign about unsafe practices by the hospital’s parent company, HealthOne. The union doesn’t represent HealthOne employees, but union leaders said they felt compelled to act after repeatedly hearing concerns.
In a statement, HealthOne said staffing levels are appropriate across its hospitals and it is continuing to recruit and hire staff members.
Covid is also raising entirely new issues for workers to organize around. At the forefront is the lack of PPE, which was noted in one-third of the health worker deathscatalogued by KHN and The Guardian.
Nurses at Albany Medical Center in New York picketed on Dec. 1 with signs demanding PPE and spoke about having to reuse N95 masks up to 20 times.
The hospital told KHN it follows federal guidelines for reprocessing masks, but intensive care nurse Jennifer Bejo said it feels unsafe.
At MultiCare Indigo Urgent Care clinics in Washington state, staff members were provided only surgical masks and face shields for months, even when performing covid tests and seeing covid patients, said Dr. Brian Fox, who works at the clinics and is a member of the Union of American Physicians and Dentists. The company agreed to provide N95 masks after staffers went on a two-day strike in November.
MultiCare said it found another vendor for N95s in early December and is in the process of distributing them.
PPE has also become a rallying point for nonunion workers. At a November event handing out PPE in El Paso, Texas, more than 60 workers showed up in the first hour, said SEIU Texas President Elsa Caballero. Many were not union members, she said, but by the end of the day, dozens had signed membership cards to join.
Small Successes, Gradual Movement
Organized labor is not a panacea, union officials admit. Their members have faced PPE shortages and high infection rates throughout the pandemic, too. But collective action can help workers push for and achieve change, they said.
National Nurses United and the National Union of Healthcare Workers said they’ve each seen an influx in calls from nonmembers, but whether that results in more union elections is yet to be seen.
David Zonderman, an expert in labor history at North Carolina State University, said safety concerns like factory fires and mine collapses have often galvanized collective action in the past, as workers felt their lives were endangered. But labor laws can make it difficult to organize, he said, and many efforts to unionize are unsuccessful.
Health care employers, in particular, are known to launch aggressive and well-funded anti-union campaigns, said Rebecca Givan, a labor studies expert at Rutgers university. Still, workers might be more motivated by what they witnessed during the pandemic, she said.
“An experience like treating patients in this pandemic will change a health care worker forever,” Givan said, “and will have an impact on their willingness to speak out, to go on strike and to unionize if needed.”
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Another example: health workers in Madrid, after the snow storm in a city unprepared to rare snowstorms, had to do double and even triple turns because it was simply impossible to move back home and backwards to hospitals. Unions would be needed to agree in such conditions how to operate and compensate, wouldn’t they?
Juxtaposed to articles like this, it would be nice to see the returns that hospitals and clinics are making and how much their stock has risen and the sheer profiteering going on in privatized emergency rooms; as well as articles about how pharma is gouging everyone on the price of jabs and sticks and crappy tests as well as preventing proper medicines from even reaching the market. This info dovetails nicely with the way healthcare underpays and overworks staff and doctors and the returns on that exploitation should be looked at too. Then, of course, surprise billing, insurance denial, and crushing premiums… so many things, so little time. But it is nice to read info like this post.
Little side note on the politics: National Nurses United includes only 150,000 of the 2.8million REGISTERED nurses in the US, and pointedly excludes the 700,000 licensed practical nurses and licensed vocational nurses here. My days as an LPN are a couple of years behind me now, but it always chapped me that this potentially potent unionizing effort is self-hamstrung by what I perceived as a very patronizing and elitist mindset, to the effect that only RNs are “real nurses,” and then only those with at least a BS in Nursing and preferably more advanced credentials.
LPNs and LVNs often do the scut work — hands-on patient care, like baths and bedpans, while the RNs “supervise.” That’s a bad generalization, but there’s a significant set of RNs who look down on LPNs as a caste, from my admittedly small sample of experience. A lot of LPNs do the high-end nursing functions by earning certifications that add to their permitted scope of practice, to where they can do a lot of things that most RNs do not normally undertake.
There’s a common saying among nurses to the effect that “nurses eat their young,” https://www.florence-health.com/career/nurse_practitioner/4-compelling-theories-as-to-why-nurses-eat-their-young/ most often meaning the hazing and pettiness and shifting of workload and condescension that upper-caste RNs often display toward nursing students and new nurses, and LPNs/LVNs. Just human nature, of course, and lots of RNs don’t fit that pattern, but it’s there and it is such a problem that the last continuing education courses I took as an LPN included large mandatory sections on bullying in the workplace.
I have no idea if this problem exists in other countries not saddled with the neoliberal disease. It does badly affect patient care, and also stands in the way of organizing efforts. Why would NNU think it a wise idea to constrain their membership by excluding, ab initio some 700,000 potential members doing the same kind of work in the same institutions*, who would seem to have the same class interests as the RNs? Not a good way to build a mass movement with some popular clout behind it, it would seem to me.
Of course, as pointed out elsewhere in today’s posts, Trumka and the rest of Big Labor have been crushing worker aspirations and selling out to management, while drawing large salaries… Hard to change the behaviors of the institutions, when even the institutions one would hope would be agents of change end up, following the Iron Law of Institutions and the disease of self-interest, being reactionary in their bones.
*A lot of hospitals and clinics have gone on a credentials kick for quite a while now, only hiring RNs while keeping downward pressure on pay and upward pressure on work loads — the neoliberal business model of more and more work from fewer and fewer workers for less and less money. Nursing homes, mostly PE now, have overworked LPNs under the purely fictional “supervision” of an RN who often is not even on site, who is supposed to be working under an MD or DO. who is also often never seen.