The American Medical Association got the headlines, but the American Nurses Association did it first.
Four days before the AMA decided to form a national union for physicians, the ANA approved a plan to form a new national support structure for unionizing nurses.
While only a small fraction of physicians is eligible to join the AMA's union, the ANA's initiative opens the door to a surge of organizing by the nation's nurses. That revived activism could affect the hospital industry much more than doctors' organizing efforts.
On June 17, the ANA's House of Delegates, meeting in Washington, voted overwhelmingly to establish the United American Nurses. The new organization is quasi-independent and embedded in the nation's largest nurses organization. It will handle all the ANA's collective bargaining activities.
The vote was 497-85, with two abstentions.
Of the 2.6 million registered nurses in the U.S., 980,000 are employed in hospitals, according to the American Hospital Association. The number of nurses who engage in collective bargaining through unions is not known but has been estimated at less than 25%.
The new organization aims to strengthen the ANA's voice at a time when many healthcare workers are turning to collective bargaining to help them maintain their incomes and retain some control over their work environments.
Under labor law, ANA members who are managers may not participate or exercise decisionmaking authority in the UAN. Therefore, the UAN will have its own governance structure, with an executive council and a governing body, called the National Labor Assembly. The UAN also will report to the ANA's executive director, not to its board. Its new labor assembly will convene for the first time in June 2000.
Beverly Malone, ANA president, said the structure is "a little complex, but because of labor law it has to be insulated. I call it having a house with firewalls."
UAN membership is voluntary for each state nurses association.
With the new organization, the ANA hopes to resolve internal conflicts between constituents who have collective bargaining and those who don't.
The ANA has a federated structure in which its 53 state nurses associations enjoy a large degree of autonomy. Twenty-four of those state associations function as collective bargaining groups. The rest prefer to concentrate on professional development.
The tension between the two factions has weakened the ANA's national position.
For example, in 1995 the ANA affiliate in California-fed up with what it regarded as the ANA's weak-kneed response to nurse layoffs and staffing shortages-broke off to form the California Nurses Association. It has been calling strikes and aggressively organizing new units ever since.
In 1997, the Pennsylvania Nurses Association split into three parts after losing 2,000 members to the Service Employees International Union (Nov. 3, 1997, p. 24).
"A strong national entity would more effectively support (state nurses associations) at risk of losing members from raids by other unions," an ANA position paper states.
The ANA has 180,000 members. About 125,000 nurses at 715 sites are covered by collective bargaining agreements negotiated by the ANA. However, only 100,000 of the nurses covered by the agreements are dues-paying ANA nurses.
Anne Schott, spokeswoman for the New York State Nurses Association, said her group was a leader in forming the UAN. "We think it is very important that nurses be represented by nurses in the workplace." At the same time, she said, practice issues are what really appeal to nurses. Other unions that try to enroll nurses can't provide the education and advocacy programs that state nurses associations can.
Malone said the ANA has discussed the union-support organization for so long that the association had ironed out most of the opposition. Even delegates from nonunion states supported the program, she said.
Lyndall Eddy, executive director at the Arizona Nurses Association, said her association voted for the deal even though members "are not interested in collective bargaining. We had been in collective bargaining in years gone by and found that it did not fit our culture."
The Arizona nurses wanted-and got-a structure to help them influence their work environment and improve their professional standing, without constraining other states from pursuing collective bargaining.