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.     

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.     

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.     

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.     

Trends in hospital unionization and a predictive model for unionizing success

Between 1976 and 1980, the average annual increase in hospital expenses was 12.7%. Wages for employees accounted for approximately one-half of this increase. Because employee wages have such a great effect on hospital costs, it is important to study those factors that could curtail management's control over these expenses. One such factor is the establishment of labor unions. This study outlines the structural factors that encourage union activity, as well as the factors that contribute to its success. Variables studied include: the types of employees in the bargaining unit; the total number of employees in the bargaining unit; the number of hospitals in the same city; the control of the hospital and the presence of a profit motive; the number of beds in the hospital; the occupancy level of the hospital; and the region of the country in which the hospital is located.     

Physician unionization in the United States: fad or phenomenon?

This article explores the current trends and issues surrounding physician unionization in the United States, using data from secondary sources and nine interviews with leaders of organizations at the forefront of physician unionizing efforts. Several key points are supported by these data and prior unionization research. First, unions should become a viable organizing alternative for the almost 50% of doctors who are salaried employees because of fewer legal barriers to collective representation, the involvement of national labor unions with resources to spend on organizing, more physicians belonging to demographic groups less hostile to organized labor. and work-related pressures faced by physician-employee under managed care. A second key point is that unions will find it difficult to represent self-employed physicians because of the influence of organized medicine and legal barriers to gaining collective bargaining rights for this group. This discussion is intended to raise awareness of the physician union issue among health care policy-makers and researchers.     

Unionization in hospitals: causes, effects, and prevention strategies

Unionization pressure on hospitals has increased steadily since passage of the 1974 amendment to the National Labor Relations Act extending protection of organizing and collective bargaining to nonproprietary hospital facilities. This article analyzes the current state of knowledge on unionization in hospitals in regard to: future organizing pressures, the impact of collective bargaining on operations, the psychology of organizing, and the fundamental elements of a strategy for improving employee relations and avoiding organization.     

The new union strategy. Turning the community against you

They're called corporate campaigns, and unlike traditional union organizing efforts, their aim is to tarnish a hospital's relationship with its community by questioning its mission, tax-exempt status and quality of care. The campaigns can be brutal and relentless, and as hospital executives from Connecticut to California will attest, they can even get personal.     

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.     

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.     

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 elections and the NLRB. The healthcare industry continues to challenge bargaining unit determinations

In the healthcare industry today, unions and management must cope with a confused, contradictory, and often changeable body of law and National Labor Relations Board (NLRB) policy when unions attempt to establish themselves at a particular institution. More than 15 years ago, Congress amended the National Labor Relations Act to grant labor unions the right to organize employees of not-for-profit hospitals and other healthcare organizations. An election to form a union cannot be held, however, until the NLRB determines which employee classifications constitute an "appropriate" collective bargaining unit. Since 1974, labor and management have fought over this basic question before Congress, the NLRB, and the federal courts. One paragraph of congressional instruction to the NLRB, which stipulates that the board prevent "proliferation of bargaining units in the health care industry," has over the years been construed in widely varying ways by the board and the courts. Management has argued that two units should be the maximum number allowed as appropriate whereas unions have argued for more. Last April the NLRB established a rule allowing for as many as eight bargaining units at a particular institution, but three months later a federal district court issued a permanent injunction against the rule. The board has appealed the injunction, and as both sides await a ruling, dozens of pending hospital union election cases have mounted up. Nor does a decision by a court of appeals promise to resolve the issue.     

A professional imperative

Nurses at the University of Michigan Hospitals (UMH) have been organized since 1974 into a bargaining unit of the Michigan Nurses' Association (MNA), known as the Professional Nurse Council. There have been several bargaining periods and contracts. The most recent contract prior to the strike terminated in September, 1980. Following this contract expiration, negotiations occurred, month after month, between the union and the hospital's bargaining team. At times, it appeared as though settlement was imminent, but negotiations continued on through the fall of 1980 and into the winter of 1981. A state-appointed mediator failed to solve the problem. The authors contend that the principal issues were not those being negotiated at the bargaining table.     

Physician collective bargaining in a U.S. public hospital.

In a study to investigate the factors that would drive attending physicians employed in a public hospital to seek collective bargaining with their employer, the authors developed an instrument to determine which variables and which hypotheses were predictive of union proneness. The findings reveal that a desire for voice was the number one reason for physicians' wanting to join a union. Union-prone physicians had a lower salary on average, were more dissatisfied with their income, were more likely to feel the effects of work "speed up" (too many patients and too little time), were less likely to have administrative functions (thus a larger patient care role), had a strong sense of entitlement to collective bargaining, believed that unions improve participation in decisions affecting their jobs (reinforcing their desire for voice), and had a sense that a union would improve their treatment by supervisors (reinforcing their desire for due process and equity).     

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.     

Union organizing will be divisive and costly

It is time for hospital executives to face up to the practical implications of increased union organizing, says attorney K. Bruce Stickler. Get ready for special-interest negotiations, increased job protection demands, escalating wage and benefits costs, and more.     

Union pact need not preclude reasonable accommodation

A three-judge panel of the U.S. Circuit Court of Appeals for the District of Columbia ruled that an employer can accommodate a disabled worker without violating a collective bargaining agreement's seniority system. The case brought by Etim U. Aka illustrates the predicament faced by employers who are trying to comply with union contracts and the Americans with Disabilities Act (ADA). Aka, a former orderly at the Washington Hospital Center, could no longer lift patients following his coronary bypass surgery. He was rejected for six positions at the hospital on the grounds that other applicants' qualifications outweighed Aka's 20-year seniority. Aka earned a bachelor's degree and a master's degree in health service management during his 20 years at the hospital. He successfully argued that regardless of the union contract, by failing to accommodate his disability, the hospital was violating the ADA.     

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.     

Hospitals and union elections

This study examines union certification elections in hospitals from October 1994 to September 1997. Results indicate that union win rates were significantly higher in single-union elections and larger bargaining units. On the other hand, union win rates were significantly lower in church-related hospitals and hospitals that belonged to a health care system or had higher payroll costs. Unions also appeared to win elections at a higher rate in this period than in the past.