Unions Find Many Nurses Eager to Join

Frustrated by a decade of managed care, mergers and budget cuts, registered nurses nationwide are rethinking their ideas about organized labor and joining unions by the thousands. And they are using their new bargaining clout to raise questions about patient care in contract talks and state legislatures.

Evidence of the new activism was clear this fall in Sacramento, where Gov. Gray Davis signed four labor-backed nursing bills, including a landmark law that will set minimum nurse-to-patient ratios at all hospitals in the state. The law was the first of its kind in the nation, but similar bills are in the works in Pennsylvania and Nevada.

Unions also are winning tough contract language that sets staffing ratios at hospitals and prohibits cost-saving practices that nurses say leave patients at risk.

The surge of unionization is yet another indication of the rumbling discontent among health care professionals, including doctors and technicians, in an era of belt-tightening by hospitals and health plans.

Unions that specialize in health care say they cannot find enough organizers to respond to calls from nurses, and even such unlikely unions as the Laborers International Union and the United Auto Workers have entered the field.

“It’s like the state is on fire,” said Rose Ann DeMoro, director of the California Nurses Assn., which is among the most aggressive nursing organizations in the country. “I’ve been here for 14 years, and I’ve never seen such a dramatic shift in such a short time.”

About 20,000 registered nurses have joined unions nationwide through federally supervised elections in the last two years, and there are active campaigns to sign up at least 10,000 more. About 18% of the 321,404 U.S. registered nurses are represented by unions.

The groups are even making inroads in such traditionally nonunion cities as Los Angeles, where the California Nurses Assn. signed up three hospitals in the last 18 months and is running advanced campaigns at three more. In California, about 35% of eligible registered nurses are organized, DeMoro said.

Those victories did not come without a fight. Hospitals have routinely responded to organizing campaigns by hiring consultants who specialize in defeating unions. Others have countered organizing efforts by raising salaries and improving staffing conditions.

Until recently, many nurses--professional, highly educated and predominantly women--did not see labor as a natural fit.

“Nurses hate the word ‘union’ more than anyone,” said a critical care nurse at Long Beach Memorial Medical Center, where the California Nurses Assn. is wooing 1,200 registered nurses. Two union campaigns failed there in the 1980s, but the mood is different now, said the nurse, who asked that her name be withheld.

“There have been major changes in health care,” she said. “There’s a total lack of trust now. Nobody’s looking out for us, so we have to look out for ourselves.”

The driving issue is not money. In fact, with nurses in short supply, wages have risen considerably over the past five years, from an average hourly rate of $22 to $27.50 for an entry-level position, and many hospitals now offer signing bonuses for nurses with special skills.

Instead, working conditions and patient welfare top the list of concerns at negotiations. Nurses say that after years of cutbacks they are stretched too thin to properly care for patients, many of whom are entering hospitals sicker and leaving sooner than before.

“You go home and you think, ‘Did I do this? Did I forget to check that?’ ” said Debbie Cuaresma, a registered nurse at St. Vincent Medical Center in Los Angeles, where 325 nurses joined the California Nurses Assn. last year. “Some days I would just go home and cry. I couldn’t meet the needs of patients or their families. I couldn’t help them because I didn’t have enough time.”

Hospital executives acknowledge the discontent, but blame managed care and say union contracts can do little to change the system.

“The unions are taking advantage of the frustrations that the nurses are having and giving them the impression that they can solve the problem,” said Jim Lott, spokesman for the Healthcare Assn. of Southern California, which represents hospitals and large medical groups. “The economic forces on hospitals are not a problem that the unions can solve. It’s a public policy issue.”

Health plan administrators in turn blame larger economic forces, and say that, ultimately, consumers are forcing the painful changes that are making nurses unhappy.

“Virtually everyone in the system is stressed,” said Walter Zelman, director of the California Assn. of Health Plans. “The plans aren’t making money, physician groups are stressed, and nurses are feeling the pressure as well. I’m not saying there may not be a problem. We may have pushed nurses over the brink and asked too much of them.”

To a degree, the nurses’ gripes can be traced to years-long pressure from managed care plans to reduce the lengths of hospital stays. Because patients who are allowed to stay are the sickest, nurses find themselves caring for people who need very high levels of care.

At the same time, many hospitals have cut their nursing staffs.

Jamie Cohen, coordinator of the Nurse Alliance for the Service Employees International Union, which has added 9,000 nurses in the last two years, said morale has dropped sharply under managed care.

In 1991, the union surveyed thousands of member nurses and found “serious problems” related to staffing and stress. “A year ago,” she said, “we went back and re-interviewed many of the same nurses. What we saw was that the problems had gotten worse in every area.”

Although issues vary from hospital to hospital, three core concerns are almost always on the list:

* High patient loads.

* Mandatory overtime, necessitated in part by staffing cuts.

* “Floating”--the increasingly common practice of shifting nurses around the hospital regardless of experience or training.

Along with salaries and benefits, those three concerns increasingly are being raised in labor talks, with unions winning contracts that address them.

Whether those contracts have brought relief to nurses is a matter of debate, as is their impact on hospitals. Several hospitals chose not to comment on whether nurse unionization has changed operations. Others said the difference was negligible.

Deloras Jones, senior nurse for Kaiser Permanente, predicted that the new contracts will have little impact because they mostly reiterate provisions in existing law.

A better way to address staffing problems would be to find a way to train and recruit more nurses, Jones said, because the problems stem from the state’s severe nursing shortage. California, according to the Bureau of Registered Nursing, ranks 50th in the United States in nurses per capita, partly because hospitals downsized staff to cut costs.

Lott, of the hospital trade association, said he expected the new contracts to increase costs slightly over the next several years, by about 1.5%. But he said those costs have not yet begun to be felt.

Another factor in the situation is legislation. With Californians in a mood for managed care reform and labor exerting a greater pull on the new gubernatorial administration, several issues championed by nurses were included in the health care laws signed this month by Davis.

One, which former Gov. Pete Wilson had vetoed, calls for the state health department to set minimum nurse-to-patient ratios necessary to provide “quality care.”