Should I Join A Nurses Union? Pros And Cons
By Pete Gerardo
Should you join a nurses union?
At first glance, the question may not seem especially relevant. After all, the percentage of American employees who belong to unions was only 10.8% in 2020, up 0.5% from 2019, according to the U.S. Bureau of Labor Statistics. The number of wage and salary workers belonging to unions, at 14.3 million in 2020, was down by 321,000, or 2.2 percent, from 2019.
According to the U.S. Bureau of Labor Statistics, only 20.4 percent of RNs and 10 percent of LPNs/LVNs currently identify as union members. Nursing unions are trying to increase membership.
Whether you have pro- or anti-union sentiments, or no opinion at all, there’s a fair chance that you’ll someday need to answer the question, “Should I join or not?”
What Is A Nurses Union?
A labor union (aka, a trade union) is an organization of workers that is formed to protect and advocate for its members’ interests. Most often, this advocacy takes the form of collective bargaining aimed at improving employees’ wages, hours, working conditions and benefits.
At the moment, there is no single labor union that represents nurses nationwide.
Instead, a variety of unions (some of which represent workers in other industries) perform collective bargaining on behalf of RNs, LPNs, LVNs and other healthcare employees with the management of individual healthcare facilities.
Some of the most active unions representing nurses include California Nurses Association, Pennsylvania Association of Staff Nurses & Allied Professionals (PASNAP), United American Nurses, National Nurses United (NNU), and New York State Nurses Association (NYSNA). NNU is the largest union and professional association of registered nurses representing over 175,000 nurses, NYSNA is New York’s largest union and represents more than 42,000 nurses, while PASNP represents over 9,000 registered nurses.
Historically, the most effective form of leverage that unions have with employers is the strike, though most union leaders only use this tool as a last resort because of the risk that management will hire new employees to replace striking workers.
Pros of Joining a Union
Better pay and wages
Better pay frequently tops the list of reasons to join a union. The median weekly earnings of union employees are 20% higher than the pay of non-union members, and some sources claim that unionized nurses earn $200-$400 more per week than non-unionized nurses.
Many non-union workers are subject to “at-will employment,” meaning they can be fired for any reason (or no reason), and have their wages and benefits cut at management’s discretion. By contrast, union contracts usually prohibit termination without cause and protect nurses’ wages and benefits. Contracts also stipulate guaranteed pay raises based on time spent on the job, so a union nurse never has to ask a manager for a raise.
Better working conditions
Nurses unions have long advocated for higher nurse-to-patient ratios, better safety rules and protocols, and against mandatory overtime. Several studies have shown that poor working conditions are driving nurses from the profession, with the biggest complaints being overwork, stress, and concern about disabling musculoskeletal injuries.
Many unions work to improve the laws that regulate hospitals and other healthcare facilities. These include laws that require employers to protect nurses from violence and harassment in the workplace, as well as efforts to create government-funded programs that support nursing education.
Representation for disciplinary actions
In the event you ever face disciplinary action, a union representative will act as your counsel to ensure that you’re treated fairly throughout the proceedings.
Process for addressing grievances
For many workers, their ability to address unfair treatment or poor management is such a convoluted political mess that many opt to take no action. Unions outline a specific process for addressing complaints or grievances that actually has a chance at a satisfactory resolution for both parties.
Cons Of Joining A Union
One of the biggest complaints, especially among people who were not interested in joining a union, is having to pay a percentage of your salary to the union in the form of dues. In ‘Right-to-Work’ states, employees aren’t required to pay dues to receive union benefits, but this may be a requirement in other locations.
You could lose your job
Although it’s illegal to dismiss an employee for joining – or trying to organize – a union, it can be difficult to prove that someone was fired for those reasons. And if the union calls a strike, you could be permanently replaced by someone willing to cross picket lines.
Mandatory strikes with no pay
If your union votes to strike, you must join the fight or risk being called a ‘scab’ or ‘traitor’. Though some unions maintain a strike fund, most workers strike with no pay.
Also, strikes don’t always work. Eventually, strikes do end but most healthcare companies bring in replacement nurses.
For example, when nurses walked off the job at Boston’s Quincy Medical Center in 2013, the strike failed. The hospital brought in replacement workers, which prompted the union nurses to return to work without the contract they sought.
In March 2021, 700 nurses walked off the job at Saint Vincent Hospital in Massachusetts starting the longest one in the state’s recorded history and the longest one the entire country has seen in over 15 years. On September 4, Saint Vincent hospital, owned by Tenet Healthcare Corporation, also released a statement on Facebook saying that they “reaffirm” their commitment to the permanent replacement nurses who they hired as the strike approached seven months. They defended their position and said that the MNA’s guidelines also detail that in the event of a strike, no nurse is guaranteed to have their job back.
Difficulty removing bad employees
It can be hard to fire “bad eggs.” Union efforts to promote greater job security sometimes serve as a double-edged sword. On the positive side, union contracts ensure that members can’t be terminated for arbitrary or capricious reasons. On the negative side, union procedures can make it difficult to fire nurses for bad behavior or incompetence.
Seniority-based promotion and benefits
While guaranteed pay raises and step increases sound great, they’re often based on how long you’ve been at your job or other metrics that may not always be a reflection of how well you do your job.
It can also hamper your ability to advance your career when another nurse with more seniority snags the promotion you’ve been working so hard for.
Union mediation for everything
While it’s nice to have a mediator to resolve disputes, it can seriously hamper a working relationship and may put you at odds with your manager. Both sides may feel the need to document and mediate even the simplest disputes for fear of union-imposed sanctions.
Unfortunately, this can make for an uncomfortable work environment and complicate working things out between you and your manager.
Are Unionized Nurses Better Off?
Over the years, various studies have tried to determine if there’s a correlation between nurses unions and higher job satisfaction, better patient outcomes, improved safety, and working conditions. To date, the results tend to be inconclusive or contradictory.
For example, one study found that unionized nurses actually had higher levels of job dissatisfaction, but that this was probably due to the fact that union nurses are more likely to feel secure in their jobs – secure enough to register complaints without fear of retaliation.
Another study, which examined nursing unions and patient outcomes, uncovered a mixed bag of results. Unionized hospitals had a 9.1% lower heart-attack mortality rate, but a 5.3% higher rate of failure-to-rescue and a 33% higher rate of pressure ulcers.
Ultimately, the decision to join (or to not join) a union is a personal and professional one – a choice that depends on factors that include your political views, financial situation, current working conditions and the opinions of your colleagues and managers.
If you decide to conduct more research about nurses unions, be aware that because unions are a controversial topic in the U.S., it can be difficult to locate unbiased information on the topic.
Peter Gerardo is a freelance writer whose work has appeared in The New York Times and numerous trade magazines.
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