Special report. The new hospital labor picture: More unions? More strikes? More problems for security directors?

A recent U.S. Supreme Court decision upholding National Labor Relations Board (NLRB) rules for hospital bargaining units appears to be fueling union efforts to organize hospitals nationwide. As unions gain more footholds in hospitals, the prospects for strikes and labor unrest increase. This expected surge in organizing may place hospital security departments in critical situations, whether they're the specific target of unions or not. This report reviews the implications of the new bargaining unit rules as they affect hospital security operations.     

A profile of hospital union election activity, 1985--1994 NLRB rulemaking and results in right-to-work states

The authors present union election results in non-governmental, short-term hospitals for the 10-year period 1985--1994. The authors include profiles for the periods before (1985--1989) and after (1990--1994) the National Labor Relations Board (NLRB) rulemaking. When comparing the period data, they found that the impact of rulemaking was a reduction in mean bargaining unit size, an increase in the absolute number of elections in hospitals, and an increase in the percentage of union wins. Their examination of hospital union election results in right-to-work (RTW) versus non-RTW states revealed that unions did not aggressively try to organize workers in non-RTW states and, when they did, they were not very successful. When the authors examined only initial recognition elections during the periods before and after rulemaking, as well as the whole 10 years, regression analysis identified three variables significantly related to union wins: the 1989 NLRB rule change, bargaining unit size, and employee participation rates.     

Calendar of Meetings

The authors present union election results in non-governmental, short-term hospitals for the 10-year period 1985-1994. The authors include profiles for the periods before (1985-1989) and after (1990-1994) the National Labor Relations Board (NLRB) rulemaking. When comparing the period data, they found that the impact of rulemaking was a reduction in mean bargaining unit size, an increase in the absolute number of elections in hospitals, and an increase in the percentage of union wins. Their examination of hospital union election results in right-to-work (RTW) versus non-RTW states revealed that unions did not aggressively try to organize workers in non-RTW states and, when they did, they were not very successful. When the authors examined only initial recognition elections during the periods before and after rulemaking, as well as the whole 10 years, regression analysis identified three variables significantly related to union wins: the 1989 NLRB rule change, bargaining unit size, and employee participation rates.     

Union organizing activity in the hospital industry

In 1974, the National Labor Relations Act was amended to include not-for-profit healthcare institutions. This triggered an important expansion in union organizing activity in the industry. Based on an examination of National Labor Relations Board election data, this article examines the impact of that development on hospital bargaining units, the labor organizations involved, and the geographical locations of the organizing activity. It concludes with some general recommendations to management.     

Bargaining unit rules having little effect on hospital union activity

The number of hospital union elections rose only slightly between 1990 and 1991, suggesting that the National Labor Relations Board's new hospital bargaining unit rules haven't had much impact on hospital organizing efforts. NLRB data appear to contradict the dire predictions of many hospitals and labor attorneys who said expanded bargaining unit categories would lead to unbridled union organizing efforts.     

Physician unions: any doctor can join, but who can bargain collectively?

Employees in the health care industry, including physicians, have recently taken more interest in unions and collective bargaining. At the present time the health care industry is approximately 20 percent unionized. Labor leaders believe that existing conditions are fertile ground for significant union activity that has been on a recent upswing after a decline during the early 1980s. While current attention is being drawn to the shortage of and increased union organizational activities by nurses, physicians may not be far behind. It is conceivable that by the year 2000 the majority of physicians in the United States will work in full-time salaried positions. In addition, the antitrust laws that currently restrain independent physicians from collective bargaining are being challenged and are likely to change as more physicians become salaried and begin to resemble other professional employee groups. The ruling determining that interns and residents are students rather than hospital employees is also certain to be challenged and changed, especially as pressures on the National Labor Relations Board (NLRB) are brought by house staff union organizations. After a 1987 ruling that the NLRB had been improperly interpreting the 1974 amendments to the Taft-Hartley Act, the NLRB was ordered to exercise its rule-making power in defining bargaining units for health care workers in acute care hospitals. Physicians would then be one of eight occupations defined as a separate health care bargaining unit.     

Preparing for increased union organizing. A commitment to deal justly with employees is the best response to the new bargaining unit rules

The U.S. Supreme Court recently upheld a National Labor Relations Board regulation giving unions of healthcare workers the right to organize as many as eight different kinds of hospital bargaining units. With the Court's decision, hospital administrators must prepare for increased union organizing by maintaining policies that evidence the institution's commitment to social justice in the workplace. Hospital administrators can reduce the potential for labor-management conflict by stressing the institution's commitment to social justice and establishing programs to educate managers and other employees about Catholic teaching on social justice. Facility administrators should also establish a written philosophy statement outlining the institution's position on unionization, institute labor relations training, survey employees' opinions of management and their work environment, conduct audits of managers' perceptions of the organization's effectiveness, and periodically review the state of labor relations in the organization.     

Power boost for labor. Landscape shift likely to trigger new wave of organizing in healthcare

Recent actions by the National Labor Relations Board could give unions representing healthcare workers some extra momentum. "This is the first time in many years, certainly since the Bush years, that the NLRB is doing what I consider is its job in looking out for people who work for a living," says Jean Ross, of National Nurses United.     

NLRB ignores congressional mandate, allows bargaining units to multiply

The NLRB has studiously ignored a congressional mandate that large numbers of bargaining units should not be allowed in hospitals. Health care institutions may force negotiations with eight or nine unions unless the courts take a hard look at bargaining unit determinations.     

NLRB's St. Francis decision signals broader-based bargaining units

The number of potentially appropriate bargaining units in a hospital has been sharply reduced by the National Labor Relations Board's recent St. Francis decision. Following a series of rejections by the U.S. Courts of Appeals, the NLRB has abandoned its previous position and adopted new standards that it believes are more in keeping with Congress' directive to prevent the proliferation of bargaining units in the health care industry. The new standards require that there be unusually sharp differences between the wages, hours, working conditions, etc., of employees requesting a separate bargaining unit and those in an overall professional or nonprofessional unit. As a result, hospital bargaining units will become much more broadly based. The St. Francis decision does not, however, invalidate previous NLRB certification or relieve a hospital of established bargaining obligations. To establish the appropriateness of broader based units, employers can ensure that employees in such a proposed unit are covered by a centrally administered wage and salary program with common wage scales, labor grades, pay increments, and job performance evaluation standards. Functional integration, continuing education and training, job transfers, shared facilities and activities, and centralized personnel policies and procedures are also areas in which employees' mutuality of interest can be established, thereby supporting the creation or maintenance of broad units.     

Nurses and the new NLRB rules. Implications for healthcare management

The inclusion of nurses as an allowable bargaining unit is one of the most significant aspects of the U.S. Supreme Court's decision to uphold the National Labor Relations Board's new collective bargaining unit rules. For a number of reasons, the decision makes it more likely that nurses at a given hospital will vote to form a union. Union nurses receive, on average, 6 percent higher salaries than do their nonunion counterparts. In addition, being able to organize into a smaller unit gives nurses a much stronger bargaining position. Finally, because of the new collective bargaining unit rules, labor leaders now find hospitals an attractive place to attempt to establish unions. In responding to the possibility that nurses might unionize, hospital managers should acknowledge that nurses often have legitimate grievances concerning pay and working conditions. They should also be aware that changes in the healthcare system during the 1980s often led managers and administrators to neglect focusing on nurses' satisfaction in favor of an emphasis on the bottom line. In the future, if managers can offer nurses the same rewards a union organizer offers and at the same time establish a cooperative, employee-oriented hospital atmosphere, nurses will benefit from the Supreme Court Ruling, whether or not they ultimately join a union.     

Nurses ready to right back. Ruling that full-time charge nurses can't belong to unions has labor leaders determined to work for ways around it

Nurse labor leaders are fighting mad over last week's ruling that full-time charge nurses aren't eligible for union membership. Labor and healthcare insiders say the decision leaves gray areas that will have to be settled at the negotiating table. Barbara Medvec, left, an executive at the system that brought the case before the NLRB, says she finds the "silence" on part-time charge nurses puzzling.     

Employee participation programs in the health care industry: are they unlawful under recent labor rulings?

Two recent National Labor Relations Board decisions, Electromation and DuPont, may very well be used to declare many health care organizations' employee empowerment and participation programs (including TQM and CQI groups) in violation of U.S. labor laws. This article provides a detailed explanation of the NLRB's two-part inquiry that will now be used to determine whether a health care institution's employee participation programs are under the NLRB's jurisdiction as a labor organization, and if so, whether the institution is engaged in unlawful employer domination. This article will also provide guidance from the NLRB as to what form of employee participation may be permitted under the National Labor Relations Act.     

NLRB rule making. The impact of regulatory reform on hospital unionization

Many hospital executives feared that the National Labor Relations Board's 1991 decision to recognize eight hospital employee bargaining units would lead to increased union activity. However, this study shows that union activity actually decreased after that decision.     

Decertification elections in health care: some recent evidence

This article examines union decertification elections conducted by the National Labor Relations Board between January 1999 and February 2002 in hospitals and nursing and residential care facilities. Employees petitioned 92% of all decertification elections. Service Employees International Union was involved in nearly 43% of all decertification elections and won 57%. Forty-three percent of all decertification elections involved bargaining units with 50 employees or less. Unions lost 66% of decertification elections in departments, but won 75% in bargaining units consisting of both professional and clerical employees. The union win rate in non-right-to-work states was 52% compared with 37% in right-to-work states.     

Union seniority supersedes ADA on issue of job accommodation

The 7th U.S. Circuit Court of Appeals ruled that the Americans with Disabilities Act (ADA) does not require an employer to violate a union's seniority system in an attempt to provide a reasonable accommodation to a worker with a disability. Terry Eckles, diagnosed with epilepsy, could only return to work based on certain restrictions that made it impossible for him to continue his current job. The Conrail yardmaster sought to invoke a rule that enables employees to bump more senior employees as a job accommodation. Attorneys for Eckles argued that the court's per se rule, enabling seniority to trump the ADA, debilitates the reasonable accommodation provision. This ruling represents the first time that a circuit court has resolved disparities between the ADA and the National Labor Relations Act. The decision is binding in Federal courts in Indiana, Wisconsin and Illinois.     

Labor relations: an update

Preventive labor relations training for managers and supervisors is vital today. Management must take the necessary steps to prepare its leadership to face the reality of hospitals being a prime organization target in the 1990s. The U.S. Supreme Court ruling will undoubtedly result in increased union activity as was experienced following the enactment of the 1974 healthcare amendments. Because of the rapid changes taking place within the healthcare industry and these new bargaining unit rules, hospitals will be targeted by unions. Management must be prepared in order to remain union free. Employee opinion surveys and preventive labor relations training for managers and supervisors are positive steps to be considered for a union-free workplace.     

Union certification elections in nursing care facilities

This empirical study examines 387 union certification elections conducted by the National Labor Relations Board in nursing care facilities (North American Industry Classification System 623) from January 1999 to December 2001. Unions won 60% of the elections. Service Employees International Union was involved in 42% of the elections. Bargaining unit size significantly impacted union victory. Unions had a better probability of winning elections in the northeast and midwest than in the south. Unlike other industries, American Federation of Labor-Congress of Industrial Organizations affiliated unions did not suffer a big labor image in nursing care facilities. Implications for union organizers and administrators of nursing care facilities are discussed.     

Labor relations strategies and tactics in hospital elections

This article explores various labor relations strategies and tactics used by hospitals in union elections. Union avoidance and union substitution were the two most widely used, with union avoidance being the best way to fight unions. Regardless of the strategy used, unions won a majority of the elections, most often using a neutral or accommodative strategy. Some widely used management tactics during an election included: hiring a labor lawyer, using a consultant known for breaking unions,and prohibiting distribution of union literature in non-working areas of hospitals.     

Hospital union election activity, 1974-85.

This study, using National Labor Relations Board data and American Hospital Association data, reports on the status of union election activity in the hospital industry for a 65-month period, January 1980-May 1985, and contrasts it with earlier data for a similar 65-month time period (1974-79). Together these data provide a comprehensive overview of union election activity in non-Federal, nongovernment hospitals since the passage of the 1974 Nonprofit Hospital Amendments to the Taft-Hartley Act. The study analyzes union, election, hospital, and environmental characteristics. Comparisons over the two time periods show that, while union victory rates in hospital elections have remained constant, the total number of elections has declined dramatically in the hospital industry.