Running head: LEADERSHIP: NURSING UNIONS

Leadership: Nursing Unions

Elise Martinez
Azusa Pacific University

LEADERSHIP: NURSING UNIONS

Nursing is recognized as a caregiving profession, with a focus on the patients and their
families rather than the nurse. Unions on the other hand are focused on the worker, work
environment and wages. The patients give the nurses a job, however, how is one supposed to
take care of others before considering or caring for themselves. This paper will discuss several
articles regarding the history of nursing unions, the pros and cons and the thoughts of the author.
Background
Unions and professional nursing associations have history dating back to the post WWII
era and tensions rise in the struggle to fight to represent the best interests of the nursing
profession. Marquis and Huston (2006) noted that union rates are high during prosperity low
during recessions, with changes that vary with the excesses and shortages of the economy. The
struggles include collective bargaining efforts focused on better wages, staffing levels, floating,
mandatory over- time, and benefits for nurses, demanding and fighting for nation- wide
improvements in working conditions for RNs, patient protection standards, expanding the
engagement of RNs in public policy, and accessible, quality healthcare for every American
resident (Johnson & Billingsley, 2014).
According to Johnson and Billingsley, (2014), failure of professional groups to maintain
their living standards during the high inflationary, post-Depression era, fueled the rapid growth
of labor unions and the expansion of collective bargaining. It was the 1935 National Labor
Relations Act, which allowed workers to collectively bargain against long working hours and
unhealthy conditions. In 1942, being faced with long working hours and personnel shortages
during wartime, it was successfully negotiated with the War Labor Board, a 15% salary increase
for nurses. There was conflict within nursing and the other professional societies centered on two
central dichotomies: whether there was consistency between collective bargaining and

LEADERSHIP: NURSING UNIONS

professional ethics, and whether collective bargaining should be controlled by unions. Nurses
economic standing suffered tremendously until unionization and was further enhanced by the
womens liberation movement of the late 1960s, which challenged the notion that women did not
need to be economically dependent on their male counterparts. Low pay for women nurses could
be further justified by the cultural sexism that viewed women as innately nurturing (Gorman &
Westing, 2013). Now, collective bargaining is under siege in the US, and union membership in
health care is rising, the Affordable Care Act has been upheld by the Supreme Court, the national
nursing shortage continues, and the US continues to struggle economically (Johnson &
Billingsley, 2014).
In healthcare, the tensions between nursing unions and professional practice initiatives
such as Magnet represent real opposition in nursingwith different viewpoints and reasoned
arguments on both sides. Sustained by nurses belief that unions can give them a greater voice in
patient care, unions have focused their efforts on this central concern for all nurses. It has been
suggested that the commotion of today may be prime time for unions (Johnson & Billingsley,
2014). The central organizing ideas of nursingwhere nursing unions and Magnet converge
are the fundamental role of nurses in delivering quality patient care and the self-regulating nature
of the nursing profession.
Associated Controversial Elements
There are several arguments to support both sides of unionization in the nursing field.
The following section will identify several aspects for either side.
Nursing Pros
There are several positive aspects associated with unionization, Marquis and Huston
(2006) recognized that nurses typically join unions because there is a belief unions can increase

LEADERSHIP: NURSING UNIONS

the power of the individual and support the social need to be accepted. By doing so, also
increasing personal input into organizational decision making and eliminate risks of
discrimination and favoritism. Some nurses also believe unions can provide job security and may
improve patient outcomes and quality of care. Collective bargaining also fights for higher wages
and better working conditions. Management that is focused on profit take advantage of the fact
that nurses work because they care and are compassionate, and use it as an angle to keep costs
low at the expense of hard working nurses (Lampert, 2013). Nursing unions have been active in
the public sphere, from campaigning for politicians to aiding in hurricane relief, to advancing
single-payer health care, to fighting for and defending safe patient-nurse staffing ratios. Unions
offer a potent means of addressing issues of human rights on behalf of patients and nurses
(Gorman and Westing 2013). All of these issues can facilitate the joining of a union to a nurse in
order to pursue a solution.
Nursing Cons
There are also negative features that surround unionization, such as the belief that unions
promote the welfare state and oppose the American system of free enterprise. There is a general
feeling that professionals should not unionize because unions potentially reduce the need to
demonstrate individualism and promote social status, fear of employer reprimand, fear of lost
income associated with a strike or walkout (Marquis and Huston, 2006). Also, in the event of a
strike patients are left uncared for, an idea that may rouse feelings of guilt. Walking out on
patients and their families is against the nursing code of ethics and can put a nurse in an
uncomfortable situation. In some cases, having a union may create a healing environment that is
not as holistic, lazy nurses just working for the money. Lastly, the majority of unions are
ineffective and also require regular dues (Lampert, 2013).

LEADERSHIP: NURSING UNIONS

Nursing and Leadership
The real challenge is how to address these troublesome matters with respect,
collaboration, and compassion. Marquis and Huston (2006) mentioned nursing leaders and
management can possibly avert unions by addressing the needs behind them. Seago, Spetz, Ash,
Herrera and Keane (2011) examined whether unionization was associated with job satisfaction
among registered nurses (RNs) in the US. Findings demonstrated nurses with graduate degrees
are less likely to be unionized, but unionized nurses reported higher average income from their
principal nursing position. Union representation had a negative association with job satisfaction,
although this relationship was not statistically significant. The most significant finding in the
analyses was union status predicted less nurse satisfaction. Having a unionized workforce, may
also lead to more aggressiveness, it can lead to a seemingly greater voice for nurses in an
organization. The study suggested that it is possible to create an environment with effective
communication between union representatives in order to provide a more satisfying work
environment for nurses and managers and better quality care for patients.
Preferred Management Qualities
Marquis and Huston (2006), advised that nurse managers must be able to see collective
bargaining and employment legislation from four perspectives; the organization, general
historical and societal and personal and suggested means by which management and employees
can work together despite unionization. Among the list was the idea that there needs to be a
mutual respect between the organization and the union. Nursing leaders must report or identify
unfairness and insensitive practices, they must know about the employees they work with,
establish fair and well-communicated personnel policies, use an effective system of
communication, ensure that all managers are well-trained and effective, establish a well-

LEADERSHIP: NURSING UNIONS

developed formal procedure for handling employee grievances, have a competitive compensation
programs for wages and benefits, shared decision making, have an effective performance
appraisal system in place, use a fair and well communicated system for promotions and transfers,
use the organizational actions to indicate that job security is based on job performance,
adherence to rules and regulations and availability of work and have an administrative policy on
unionization (Marquis & Houston, 2006; Porter, 2010; Johnson & Billingsley, 2014).
Partnerships
Porter (2010) discussed a nursing labor management partnership (NLMP) implemented in
a Magnet hospital recognizing nursing leaders at all levels of practice and engaging them in the
workplace and the practice environment facilitate staff empowerment. The core of the nursing
labor management partnership is the commitment of both partners to place the highest priority on
quality patient care delivered in a safe environment by nursing staff supported in their
professional practice. The overall goals of the hospital-wide labor management partnership
(LMP) are focused on positive patient, staff, and hospital outcomes and achievements that are
beneficial to both parties. The LMP committee, made up of hospital and local union leaders as
well as union representatives, met monthly to discuss working together for improved outcomes
in patient care, staff satisfaction and engagement, work environment, and organizational
performance. Nursing was very involved in this effort and represented the majority of unionized
staff. The NLMP was focused on nursing management, local nursing union leadership, and
clinical nurses working together on shared goals. In the NLMP, it is important for the members to
be comfortable working together through collegial relationships characterized by mutual respect.
Nursing leaders must also embrace appreciative methods which help diverse interest
groups keep their collective focus on the possibilities of a partnership and on keeping

LEADERSHIP: NURSING UNIONS

negotiations moving forward with complete transparency and fairness for all. To meet the core
professional requirement of self- regulation, nursing departments often utilize shared
governance, a model adapted within hospitals in the late 1970s from university faculty
governance models that reconciled different interests and developed policies through the
distribution of power (Johnson & Billingsley, 2014).
Reflections of the Author
After doing some research on nursing unions, weighing the pros and cons, I believe that it
is possible to provide a hospital environment that fosters personal and professional growth
without the need for a nursing union. A few of the hospitals that I plan on applying to are
unionized or contain the open-door union philosophy. I personally would not care to join a union,
I would cross the line in the event of a strike; I chose the nursing profession for the patients.
The hospital that I choose to work for must have mutual respect for the management and
floor staff with open lines of communication. Personal and professional growth is an important
factor that I will weigh heavily when choosing a place for employment. Graduating from nursing
school this year, I believe that I have such a bank of knowledge and so much to offer- I would
not like to say that I am dispensable. Being a new graduate has its vulnerabilities that vary
between individuals, but that should not be the only reason to join a union. Magnet hospitals are
a particular interest of mine because of their status on shared governance and aims for both the
nurses and the quality of patient care. Joining a union is a personal decision that should not be
made without deep contemplation and understanding of what is gained or lost.
References
Gorman, G., & Westing, C. (2013). Nursing, unions, and caste: The lessons of local
6456. Advances in Nursing Science, 36(3), 256-264.

LEADERSHIP: NURSING UNIONS

Johnson, J., & Billingsley, M. (2014). Convergence: How nursing unions and magnet are
advancing nursing. Nursing Forum, 49(4), 225-232.
Lampert, L. (2013). Nurse labor unions: Do they have a place in healthcare? Nurse Stories,
Retrieved from: http://www.mightynurse.com/nurse-labor-unions-stories/.
Marquis, B., & Huston, C. (2006). Collective bargaining, unionization, and employment laws.
In Leadership roles and management functions in nursing: Theory and application (5th
ed., pp. 514-536). Philadelphia: Lippincott Williams & Wilkins.
Porter, C. (2010). A nursing labor management partnership model. Journal of Nursing
Administration, 40(6), 272-276.
Seago, J., Spetz, J., Ash, M., Herrera, C., & Keane, D. (2011). Hospital RN job satisfaction and
nurse unions. Journal of Nursing Administration, 41(3), 109-114.