Jean Ross, the UAN designate to the three-member Council of Presidents for the NNU, acknowledged that the UAN appeared to be splintering in the weeks leading up to the NNU formation and that some state organizations may eventually secede. The Michigan and Minnesota nurses' associations were the staunchest NNU supporters and also brought the biggest number of members, with a combined membership of 32,000. But the future is unclear for the UAN's 13,000 members in other states that were more skeptical of the NNU, such as Alaska, Florida and Illinois.
“We have members who are supportive, but unfortunately their leadership has been difficult,” Ross said. “I still hope that the nurses in those other states will take some control … and say, ‘As much as we don't like some of this stuff, we have to stick together.' ”
Once upon a time, the various state nurses associations were virtually all members of the American Nurses Association, but the decision by California's nurses to blaze their own path inspired others to break away as well, observers say. In the 15 years since the nurse-union landscape has grown, it has become highly Balkanized as groups jostle for membership and power.
The Service Employees International Union has been aggressive in courting nurses to its 85,000-member Nurse Alliance, which previously was a contender for the largest nurse-only unit in the country. However the SEIU includes more than 1 million healthcare workers drawn from every department in the hospital organization chart, causing critics to say nurses' unique needs—and comparatively higher salary dues—got lost within the giant international union.
This year also saw the formation of another state-nurse organization, the National Federation of Nurses, representing about 70,000 nurses from the state nurses associations in Montana, New Jersey, New York, Ohio, Oregon and Washington (Nov. 16, p. 24). However, observers say that given its stated emphasis on self-governance and sovereignty and its aversion to battling other unions directly, it remains to be seen if the NFN will be aggressive enough in the long term to stay together in the face of a challenger like the NNU.
Employers were highly reluctant to talk directly about developments in the union world. Numerous hospital executives declined to comment or return calls for this story. A spokeswoman for 469-bed Provena St. Joseph Medical Center in Joliet, Ill., said in an e-mail, “in our view, the issue is internal to the unions involved. Provena remains committed to working with the union which represents our nurses at Provena St. Joseph Medical Center.”
Association executives say a new large union isn't likely to change relations between hospitals and nurses. Carla Luggiero, who is a senior associate director with the American Hospital Association and an RN, said hospitals and nurses will continue their mutual focus on patient care, whatever disagreements they may have. “We've always had nurses unions, even back when I graduated from nursing school way back in the last century. It's not new, it's just a reconfiguration,” she said. “Hospitals and unions have coexisted for a long time.”
From John Rivers' vantage up on the ninth floor of an office building in Phoenix, the NNU's inaugural rally didn't do much to change his views of healthcare labor unions. Rivers is president and CEO of the Arizona Hospital and Healthcare Association, the ostensible target of the NNU gathering where DeMoro delivered her remark comparing oppressed Native Americans with modern hospital nurses.
Rivers said the formation of the NNU should not change the strategies that nonunion hospitals continue to use to keep their nurses happy and union-free: competitive compensation, financial transparency and the collaborative decisionmaking process. He quoted an old friend and AHA lawyer who once said, “If you get a union, you probably did something to deserve it.”
He said that more than anything, the steadily declining number of union numbers in hospitals and all industries was driving the apparent trend of union consolidation. “I'm not anti-union because I understand what they've contributed to society over the years, but I would be rethinking what business I'm in if I were in their shoes,” Rivers said. “In purely business terms, they're losing market share, and that's a red flag for anyone.”