(continued)revolution has pushed some physicians so far over the edge that they've taken to reading the fine print in antitrust laws. The Federation of Physicians and Dentists is trying to organize doctors without incurring the wrath of antitrust enforcers in Washington and the state capitals. The professionals' taboo about organizing as a bargaining unit appears to be waning.
"People tend to come to the union and ask for assistance when they feel their jobs are threatened," said Howard Scott of the Pittsburgh-based United Steelworkers of America. "Downturns in the industry cause a lot of uncertainty among healthcare workers and frequently result in organizing campaigns."
Numbers difficult to find.
Surprisingly, hard figures on union participation in healthcare are elusive. For example, the American Hospital Association doesn't keep statistics on union membership.
The Bureau of National Affairs, a Washington-based newsletter publisher, estimates that there were 740,100 union members out of 5.4 million total hospital employees in 1993, or 13.7%. Nonhospital medical workers had 346,000 union members out of 4.8 million, or 7.2%.
Of the Steelworkers' 570,000 members, only 2% are in healthcare. Many of them work in community hospitals in Appalachian mining and metalworking towns. Other locals represent Kaiser Permanente workers in Southern California.
In the Steelworkers' view, hospital workers realize the pie is finite. "People's expectations are not enormous in financial terms," Scott said. "People are much quicker to come to us over issues of fairness, fair promotions, treatment by supervisors, favoritism. These are the real spark-plug issues."
The AHA also has noticed that "the interest is rising," confirms Rhonda Rhodes, assistant general counsel at the association. "It's not necessarily that the unionization efforts are increasing, but the interest is rising because people are looking to it as a way to protect their jobs." But, she cautions, "in some cases they find out that joining a union doesn't necessarily guarantee them a job."
G. Roger King, a management lawyer with Jones Day Reavis & Pogue in Columbus, Ohio, agrees. "CEOs, boards of trustees don't know what the answers are. The entire retransformation and changes that occur almost weekly in mergers, acquisitions, managed-care scenarios are really still to be absorbed at all levels."
Joining a union isn't going to bring job security, King said, because labor doesn't have any answers, either. "It doesn't appear organized labor is bringing anything to the table at all about the future of the health delivery system."
In King's view, the areas where labor is most likely to score gains are long-term care and affiliates of hospitals, such as clinics and outpatient facilities (See related story, p. 28). "The main hospital......continues to be very difficult for organized labor," he said.
Considering that the National Labor Relations Board divided the healthcare industry into smaller, more easily organized labor divisions in 1991, "the level of activity has not been what most people expected," King said.
That hasn't stopped nurses from trying.
Last year the Kansas State Nurses Association, for instance, engaged in its first collective bargaining election in 10 years, at Charter Wichita Behavioral Health System, a psychiatric hospital in Wichita. The nurses wanted greater participation in decisions affecting patient care, safeguards for practice standards, more staffing and better pay. They specifically requested the creation of a labor-management committee that would take up patient-care issues.
Bryan Babcock, Charter Wichita's administrator, said the nurses' major objection was a cut in their shift differentials. "The second issue was a greater role for nursing in the administrative process," he said.
Babcock said the hospital's own measurements show no problems with quality of care. But he thinks nurses are disturbed because they find less satisfaction in their jobs, which he attributes to changes dictated by managed care.
Five years ago, the average patient stayed in the hospital about a month, and caregivers followed them from sickness all the way to health. "In today's environment a nurse only sees them through a part of that system," Babcock said, often helping them become less sick but not entirely well.
Twenty-five Charter nurses-all who were eligible-voted Nov. 17, 1994. The result, however, remains unknown because the ballots have been impounded by the NLRB. Nurses around the country are in the same boat. They've voted but won't know whether they're union or not until the labor board counts the ballots.
NLRB bides its time.
After the U.S. Supreme Court ruled last May that nurses are supervisors, and thus ineligible for collective bargaining protection, the NLRB last October heard a case brought by a hospital in Alaska that's expected to clear up some of the murk. An NLRB spokeswoman said "nobody knows" when the board will rule.
"It definitely has put limitations on our organizing efforts everywhere," said Joni Ketter of the American Nurses Association.
High interest in unions isn't translating into higher membership, said Kenneth McDonald, president of Management Science Associates in Independence, Mo. Unions "don't have resources to tie up for months in these
(Continued on p. 30)