IRI Intelligence Briefing

News and Developments Affecting the Workplace

Volume Number & Date: 
Vol. 1 No. 7 - February 2009

Labor Rebirth Underway

Fueled by bitter rivalry, election-year politics and a mix of ambition and opportunity, unions have significantly escalated their organizing efforts in the healthcare industry, with 2008 shaping up to be a watershed year for U.S. labor.

Although union membership in the industrial sector has been in a free-fall for many years, just the opposite is true in the healthcare industry where, as one organizer puts it, unions hope to put the movement back into the labor movement.

By year end, hospitals and health systems could be facing a starkly more hostile organizing environment as emboldened unions make organizing the central focus in the labor power struggle.

This new threat presents a real opportunity for healthcare leaders to take action, by taking the pulse of their organizations and identifying weaknesses and openings that a union could exploit.

Those hospitals committed to maintaining a union-free workplace must be prepared to begin or renew a dialogue with managers and employees about what unionization could mean and cost. Most important, leaders must be able to articulate to employees the advantages of having the freedom and professional autonomy possible only through a direct working relationship with their supervisors and managers.

By acting now to educate managers and make organizational improvements, health leaders could help ensure that employees are less receptive to union appeals. The goal: to make the workplace a less vulnerable target.

The campaign to organize healthcare workers is playing out most aggressively in California, Texas, Ohio, Illinois, Florida, Washington and Pennsylvania, although there is some activity in nearly every state.

Two key factors have led to this escalation of organizing:

1. The Battle of the Healthcare Titans: California Nurses Association/National Nurses Organizing Committee v. Service Employees International Union

Rarely have rival unions been so publicly antagonistic or aggressively hostile in competing for the votes and voice of healthcare workers.

While hospital nurses and other healthcare workers have been prime organizing targets for many years, labor's recent success in this arena has created new momentum.

One difference between organizing in healthcare workers and other employees is the success of these unions in moving beyond the traditional union focus on pay and benefits to make members part of a broader cause. That's achieved in part by labor's efforts to align with lawmakers and business leaders in support of national healthcare re-form, a politically popular cause.

But an even more potent appeal to healthcare workers is labor's self-appointed role as the guardians of healthcare workers and safe like that enacted in California, is behind ratio legislation in at least a dozen states - a campaign the union is also using to collect the names and contact information for nurses across the country.

The SEIU, meanwhile, has put its political advocacy behind legislation to increase funding for nurse training and retention - a campaign designed to strengthen the union's appeal to RNs as well as the patient care aides and service workers that make up the majority of SEIU members.

Both unions now boast success rates topping 80 percent in healthcare petition elections. But neither is content to share the spoils.

Consider the face-off between the CNA/ NNOC and SEIU in Ohio, where the CNA scuttled a scheduled March 11 representation election scheduled as part of a deal between the SEIU and Catholic Healthcare Partners to give employees an opportunity to vote yea or nay after the union spent years trying to organize the system. In spoiling the SEIU's hard fought deal, the California-base union not only challenged its rival in the CHP arena, but made clear that it would compete to organize nurses in hospitals across the country."We're in a war with SEIU," Rose Ann DeMoro, CNA's head, told participants at a conference April.

The CNA/NNOC has ramped up its organizing and political activity from coast to coast, using FOIA requests to obtain nurses' names and information from state nurse licensing boards and attempting to raid bargaining units represented by state hospital associations. Recently, the CNA/NNOC made a play for Texas nurses already represented by AFL-CIO sister union, AFSCME.

In the weeks since the Ohio skirmish, the unions have taken their battle public in an extension of the rift begun when the SEIU and several allied unions split off from the AFL-CIO, and the CNA joined the old-guard federation - forever ending the uneasy alliance the two unions had forged in those hospitals and health systems where the CNA represented RNs and the SEIU represented service workers.

The CNA has since launched at least two public websites highly critical of the SEIU, including and

And the SEIU responded with www., which includes an on-line petition for nurses to share their "bad CNA experiences."

The battle is certain to rage on for a long time to come, but the end result for hospitals is aggressive competition for members that will play out in the form of more aggressive organizing campaigns in the workplace.

2. Employee Free Choice Act

The dueling unions do, however, agree on one thing - as do labor unions in every industry: the Employee Free Choice Act. This legislation continues to gain support on Capitol Hill as a result of coordinated union efforts to keep the legislation in the public eye during a pivotal election year.

The EFCA has long been on the radar of executives, human resources and employee relations professionals as a serious threat to the time-honored tradition of secret-ballot elections governed by the National Labor Relations Board.

But few workers on the frontlines of healthcare recognize the full impact of the legislation which, if passed, would make organizing far easier by imposing what amounts to a national neutrality agreement on employers.

Using benign terms like "neutrality" and "free choice," sponsors talk about the proposed law without mentioning what it really means to workers - a radical change in labor law that would deny them the right to cast a vote for or against joining a union.

During an April 2 hearing of the Senate Appropriations committee, for example, subcommittee Chairman Tom Harkin (D-IA), promised to push the measure through "in order to rebuild the economic security for the middle class of America."

Absent from the debate is much discussion of the likely result for many hospitals - workers inadvertently "signing up" for union representation by doing nothing more than signing a card requesting information on a patient care issue. That could mean no informed choice, and little recourse.

The burden is on an organization's leadership to educate managers and employees about the EFCA, and take the debate from the political rhetoric on Capitol Hill to the real-world ramifications in the workforce.

Ready, Aim ...

A new era of healthcare union organizing is already here. And if Democrats succeed in capturing the White House and a filibuster-proof majority in the Senate, the then inevitable passage of the EFCA gives labor an enormous advantage.

On the theory that success is where preparation and opportunity meet, forward-looking hospital leaders should begin preparing for new era in union activity now - not when the first union card appears, but in anticipation that it might.

Employers should begin a conversation now with employees about the benefits of a direct relationship in the workplace, as well as the costs to patient care common in union workplaces that experience bruising contract battles, belligerent union stewards and the risk of frequent work stoppages. These conversations are more effective before an organizing effort begins and absent the high emotions that a labor campaign brings.

In this environment, hospitals must not only understand their weak points, but also work to address them.

One useful tool is a Corporate Campaign Vulnerability Assessment, a process that probes and highlights the issues and areas most vulnerable to attack. Completed well in advance of union activity, an objective assessment allows leaders to address issues where possible and to develop the communications and outreach materials that will help shore up support and defend the organization's reputation.

Another useful tool is a comprehensive employee opinion survey and assessment process that allows managers to identify the areas of greatest dissatisfaction, pride and engagement in the workplace.

Now is the time to educate managers about how to recognize early signs of union activity, how to respond to employee questions, and the critical rules governing employers under National Labor Relations Act.

Now is the time for hospitals to make sure that they have the right organizational and communications structures in place to preserve or improve employee satisfaction and provide employees a meaningful voice in the organization.

In modern organizing, unions do far more than court workers with promises of better pay and job security. They also try to vilify companies and damage their reputations as a way of attracting allies and undermining an employer's relationship with its workers and the community it serves.

Few healthcare organizations are impervious to union organizing efforts. But it is far better to build a strong wall ahead of time and prepare for a battle than to be late to the battlefield and go in unprepared.

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