IRI Intelligence Briefing

News and Developments Affecting the Workplace

Volume Number & Date: 
Vol. 1 No. 1 - April 2008

Texas Organizing Report

Nursing Union Victory Opens New Organizing Frontier

Last week, the California Nurses Association/National Nurses Or-ganizing Committee made sig-nificant ground on a new labor frontier: Texas.

In its successful election to organize the nearly 300 nurses of Houston's Cypress Fair-banks hospital, part of the Tenet health sys-tem, the CNA/NNOC claimed title as the first union to organize nurses in a state long resis-tant to labor's entreaties.

More so than any other single event, this election and the legislative initiatives spon-sored by union, will have significant impact on Texas hospitals and health systems in the coming months.

Because of Texas' long history as a right-to-work state, facilities in the state may be ill-prepared to respond to aggressive organiz-ing and corporate campaign activity that has become a fact of life for so many hospitals elsewhere in the country.

The Cypress Fairbanks Story

By a close 119 to 111 vote, RNs at Cypress Fairbanks voted to join the CNA/NNOC af-ter a low-key organizing campaign that lasted less than three months.

The union's victory was influenced largely by the so-called "peace accords" Tenet signed last year with both the CNA and Service Em-ployees International Union (SEIU). Under that agreement, Tenet hospitals are limited to the extent they can campaign against the union.

These agreements have the effect of stifling open discussion and dialogue in the work-place about unionization. At Cypress Fair-banks, for example, a group of nurses that opposed unionization was not permitted to meet, discuss the election or distribute mate-rials anywhere in the workplace.

Cypress is the smallest of Tenet's four hospitals in the Houston region, with fewer than 200 beds. In media reports following the vote, boastful NNOC organizers were quick to turn their sights on larger Tenet facilities, including the three hospitals in Dallas and a health system in El Paso.

Getting to know the CNA/NNOC

Few state-based unions have engineered a more successful debut on the national stage than the CNA, which has enjoyed explosive growth. Since its 2003 decision to expand beyond California through the NNOC, the CNA has organized nurses in hospitals in Maine, Illinois, Nevada and Pennsylvania and now claims as many as 80,000 members in all 50 states.

The union also has formed powerful al-liances, joining first with the United Steel-workers, then in 2007 taking charter among the powerful unions that make up the AFL-CIO. The partnership is mutually beneficial - infusing CNA with resources and placing President Rose Ann DeMoro on the executive committee of the country's best-known union while helping the AFL-CIO fill a void created when in 2005 the SEIU and six other unions disaffiliated to form Change to Win after a caustic political and ideological fight with AFL-CIO leadership. DeMoro described the CNA's move as necessary to build a "militant, united force" that would resuscitate the labor movement.

In recent months, the CNA/NNOC has been sparring in brutal competition with the Service Employees International Union, challenging its rival for both dues-paying members and prominence in the national la-bor movement.

The CNA has built its member base through campaigns advocating single-payer health care, staffing ratios and whistleblower protection, as well as traditional organiz-ing. And few unions - with the exception of the SEIU - have made more effective use of modern day organizing tools, including web-based communications and corporate campaigns that target employers with fierce negative publicity campaigns as a means of softening resistance.

NNOC Texas

In Texas, the CNA/NNOC is taking a two-pronged approach to establishing a beach-head, with organizing campaigns on one front and legislative campaigns on the other. The union has brought to Texas its crusade to mandate nurse-patient ratios- a law that union got passed in California against stiff odds and to much fanfare. Working in con-cert with the SEIU on this tack, the unions are targeting the 2009 legislative session.

Both publicity-savvy and organizationally astute, the CNA/NNOC first made its pres-ence known in Texas following Hurricanes Katrina and Rita in 2005, when the union dispatched several hundred volunteer nurses from California to Houston to assist relief ef-forts. It was no coincidence that Texas rather than Louisiana was the focus of the camera-ready campaign ... the state just happened to be the union's next organizing target. And the cadre of CNA nurses came to town with more than hurricane victims in mind.

Soon thereafter, the union began send-ing delegations of nurses the other direction - flying Texas RNs to California for a special screening of "Sicko," the Michael Moore doc-umentary highly critical of the U.S. healthcare industry. For the price of a two-day trip, the union enlisted dozens of Texas organizers.

And after only a few short years, NNOC Texas had established active committees across the state, from Houston to El Paso, Dallas, Austin, Brownsville and San Anto-nio.

As is the case with its work in other states, the CNA/NNOC makes a direct appeal to RNs based on the pillars of patient safety, workload and respect for the profession. Rarely in its literature does the union use the old-style union lure of better pay and bene-fits, instead courting this white-collar, educat-ed workforce with a strategically principled, altruistic appeal.

But the union is typically less benevolent toward the hospitals and executive leadership they target. In its rapid rise to prominence, the CNA/NNOC has been an aggressive critic of "corporate" medicine and hospital man-agement, which it readily accuses of putting profits before patient care.

As the union demonstrated in its home state, the most successful campaigns have a villain, and in California that villain was Gov. Arnold Schwarzenegger, who took a political beating at the hands of the nurses union when he tried to delay implementation of the hospi-tal staffing ratios.

With an aggressive, take-no-prisoners ap-proach to achieving its goals, the union has shown no more mercy toward hospital execu-tives and administrators in its tirades against the healthcare industry - a campaign that al-ready has gained traction in Texas.

In our extensive experience working in hos-pitals targeted or organized by the CNA, we have identified the key issues and tactics at play in CNA campaigns and how leaders can prepare and position their hospitals.

Are Texas Hospitals Prepared?

As the NNOC advances in Texas, health systems and hospitals should be prepared for a significant uptick in organizing and corporate campaign activity.

These efforts typically generate intense scrutiny on a number of potentially delicate issues, including executive compensation and profitability, staffing ratios, charitable care and community benefit, billing and collec-tions, bonds and financing, workplace fines and violations and facilities.

Preparation for a corporate campaign re-quires significantly more lead time than nec-essary to prepare for a traditional organizing campaign - in part because of the broad range of issues at play and the extensive coalitions unions build in opposition to the employer. Unions are often at work preparing the foun-dation for a corporate campaign months be-fore the first salvo is fired.

Even in its very early stages, union organiz-ing activity has implications for a hospital's entire operations - in terms of security, staffing, management training, communica-tions and community relations. And too of-ten, it's too late to correct any issues by the time the first union card shows up on cam-pus.

To prepare effectively, hospitals must re-view not only the traditional policies and procedures that govern distribution, visiting hours, solicitation and security, but also take a careful pulse of the workforce to identify areas of the greatest vulnerability.

Managers in particular must be trained and equipped to address the myriad issues they will face in organizing campaigns, and the leadership team be aware of the issues that alienate employees and have plans in place to address them.

Texas healthcare facilities should take no solace in the state's right-to-work legacy. With the SEIU already active in the state to organize service workers and nurses under the banner of the Nurse Alliance, the rivalry between the two unions promises to generate a tremendous amount of activity in Texas as neither union will cede the state to the other. And now that CNA/NNOC has forced the first crack in the wall, the next wedge prom-ises to be only larger.

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