Labor unions didn't break any records for organizing activity in healthcare in 2013, but opponents and supporters of organized labor think conditions are ripe for a major surge in the coming year.
Factors driving that surge include the National Labor Relations Board likely approving new rules expediting union elections, and healthcare workers are feeling greater anxiety over wages and job security due to partly market and policy pressures to reduce healthcare costs.
“There is a heightened interest among workers whose wages haven't gone up in three or four or five years,” said Kirk Adams, executive vice president for healthcare at the Service Employees International Union, healthcare's largest labor
Although union membership in the U.S. overall has steadily dropped since the 1980s, organized labor has found more success organizing in healthcare. Currently, about 14% of the workers involved in the delivery of healthcare at public and private facilities are unionized, compared with less than 7% of employees in the private sector as a whole.
The latest data on union activity in healthcare show that for the first 11 months of 2013, there were 185 votes on whether to certify a union of hospital workers, and unions won 68% of those votes, according to NLRB data. That compares with 238 votes in 2012, 72% of which went for the union.
The number of elections and the win rate for unions were slightly below their respective averages for the past decade. But Jim Trivisonno, president of labor-management advisory firm IRI Consultants, said the dip suggests union activity will increase. “I think there's a lot of pent-up demand,” said Trivisonno, whose firm analyzes labor trends for the American Hospital Association. “The Affordable Care Act means people will have to look at costs, and that sometimes leads to change and less job security. And that leads to more organizing activity.”
IRI's most recent report on healthcare labor activity found that the SEIU
filed 42% of all the healthcare organizing petitions during the first six months of 2013, followed by the American Federation of State County and Municipal Employees, which filed 17% of the petitions. The rest were divided among a few unions, including the National Nurses United, which filed 2%.
NNU is among the unions that have pioneered the recent use of one-day strikes, which last year affected operations at hospitals in communities across the country. “While past commentators might have opined that nurses were generally unwilling to strike and disrupt patient care, that stereotype no longer holds true,” Amanda Sonneborn, a partner with Seyfarth Shaw in Chicago, wrote in a paper accompanying the IRI report.
Besides using new strike techniques during contract negotiations, unions have become increasingly sophisticated in their outreach efforts to form new bargaining units, management experts say. Social media tools such as Twitter and Facebook have made it easier to overcome one of the biggest traditional hurdles to union formation—the difficulty of talking to workers directly in controlled-access settings such as hospitals.
That has forced healthcare employers to become proactive in regularly reaching out to employees in respectful communications and preparing union opposition materials in advance. Employers can't afford to wait until they get a notice of a union election, said Mike Paruta, director of workforce development at Care New England Health System in Providence, R.I. “By the time the management figures it out, it's too late. The unions have already encircled you. In the old days it was handing out leaflets. Now, they do it by e-mail and social media.”
Adding to the challenge for healthcare employers, the NLRB is widely expected to issue rules speeding up election times, said G. Roger King, a labor-management attorney with Jones Day in Columbus, Ohio. In December 2011, the board passed rules that would have decreased the time between a union petition and actual voting, from an average of 31 days to as little as 10 days. It eventually abandoned the rules following a court challenge based on the fact that the board's vote lacked a three-member quorum because of Senate Republicans' filibustering of President Barack Obama's nominees.
Last August, however, the Senate confirmed four new NLRB members, giving the board its first full complement of five members since August 2003, with a majority being labor-friendly Obama nominees.
King said the NLRB also may approve new rules making it easier for union representatives to have direct access to employees and harder to challenge election petitions before voting takes place.
The SEIU's Adams said that while they want to unionize, hospital workers understand that their industry is in the midst of a “transformative moment,” given the changes in reimbursement, migration of services away from acute-care settings, rapid advances in technology and the rising tide of healthcare mergers.
“Front-line workers understand that changes have to be made,” he said. “I actually see the workforce in this industry being at the front of the parade, trying to move for reforms and new ideas and new models. The workers have ideas and want to put their ideas into action in terms of how to better deliver care.”Follow Joe Carlson on Twitter: @MHJCarlson