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.     

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.     

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.     

An analysis of hospital union election activity: 1985-1987--by hospital ownership, size, and system, and employee organization and bargaining-unit size

During the three-year period 1985-1987, there were 238 elections in nongovernmental, short-term hospitals to determine whether or not unions would represent the employees. Unions had a success rate of 47.1 percent, similar to that of earlier years. This study reports these election results by hospital and election characteristics. For hospitals, the analysis includes elections by census region, ownership, bed size, and multi-institutional characteristics. For elections, the analysis includes the nature and type of election, employee organization, and employee bargaining-unit-size characteristics. This study concludes that the number of union elections decline as hospital bed size increases, and the union success rate is curvilinear and higher in both small and very large hospitals; union success declines as bargaining-unit size increases. Investor-owned and nonprofit, religious hospitals that are members of multi-institutional systems have lower union success rates than nonsystem hospitals do in their ownership category. However, unions are much more successful in multi-union and decertification elections compared with single-unit elections and initial recognition elections.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Collective bargaining practices in the health care industry: an empirical analysis

The study described in this article focuses on the effects of collective bargaining on the health care industry. Due to the wide range of bargaining groups authorized to become unionized in the health care industry, this study concentrates on how collective bargaining affects the nurses in hospitals. The authors also surveyed a number of administrators and nurses in several hospitals in the midwestern part of the United States to secure their opinions about the effect of the union on their profession. The results of the survey are presented. Finally, the authors summarize related themes and interesting points from the literature and the surveys and provide recommendations.     

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.     

Impact of the OSHA trench and excavation standard on fatal injury in the construction industry

In 1989 the US Occupational Safety & Health Administration revised the excavation and trenching standard. We examined fatal injuries from trench cave-in in the construction industry for five year periods before and after the revision in the 47 US states for which data were available for both periods. There was a 2-fold decline in the rate of fatal injury after revision of the standard, which substantially exceeded the decline in other causes of fatal injury in the construction industry during the same period. The decline was somewhat greater in large business firms but was evident in construction firms of all size classes. The fatality rate from trench cave-in in union construction workers was approximately half that of nonunion workers, but we were unable to determine whether this was best explained by union status, employment of union workers at larger construction firms, or both. This study provides evidence for the effectiveness of OSHA regulation in preventing fatal work injury.     

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.     

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.     

Costs of diarrhoeal diseases and the savings from a control programme in Cebu, Philippines.

A control of diarrhoeal diseases programme was set up in Cebu Province, Philippines, in 1986. In order to compare the reduction in treatment costs before and after implementation of the programme, and the potential savings to be made from its continuation, we collected data for 1985 and 1989 in 10 health facilities in Cebu. Since the programme''s introduction, household expenditures on drugs for diarrhoea cases have decreased by a total of 1.03 million Philippine pesos (P) (US$ 41,200). At the health centre level, the costs of treating diarrhoea cases were close to optimum, but in the district hospitals treatment of inpatients with diarrhoea changed little between 1985 and 1989. This arose because such hospitals were compensated by the central authorities for inpatients but not for outpatients. Potential savings of around US$ 60,000 could have been made, however, had the district hospitals adopted the practices used in the main referral hospital.     

Could socio-economic transformation and the resulting psychological stress influence cancer risk in Opole province, Poland?

The paper presents the results of a risk assessment analysis of cancer morbidity in Opole province before and after a political transformation in Poland, i.e. in the 1985-1989 quinquennium and the following two equivalent periods of: 1990-1994 and 1995-1999. Measures of morbidity are given and its growth in males and females are compared with the ageing effect as well as with unemployment. In the paper a general conclusion has been drawn suggesting that the socio-economic transformation begun after 1989 and the resulting stress could have been the one of the possible background effects influencing the health status in the region. It must be accentuated, however, that the relation has not been a subject of statistical proving due to a methodological impossibility; a divagated question is offered for scientific concern and open discussion.     

Association between all-cause mortality and insurance status transition among the elderly population in a rural area in Korea: Kangwha Cohort Study

The study purpose was to examine the association between health insurance transition and all-cause mortality. 3206 residents in Korea who participated in two surveys in 1985 and 1994, were followed-up during 1994–2008. Adjusted hazard ratios (aHR) were calculated using Cox hazard model. Participants were divided into four groups by insurance transition (the “National Health Insurance (NHI)–NHI”, “NHI–Medicaid”, “Medicaid–NHI”, and “Medicaid–Medicaid” groups), where NHI–Medicaid means participants covered by NHI in 1985 but by Medicaid in 1994. For men covered by NHI in 1985, the mortality risk in the NHI–Medicaid was higher (aHR = 1.47) than in the NHI–NHI. For men and women, covered by Medicaid in 1985, aHR was non-significantly lower in the Medicaid–NHI than in the Medicaid–Medicaid. When four groups were analyzed together, men in the Medicaid–Medicaid (aHR = 1.67) and NHI–Medicaid (aHR = 1.46) groups had higher mortality risk than males in the NHI–NHI, whereas no significant difference was observed for females. In conclusion, transition from NHI to Medicaid increases mortality risk, and transition from Medicaid to NHI may mitigate risk, while remaining on Medicaid pose the greatest risk, especially for men. Therefore, policy makers should strengthen coverage for Medicaid. The weak effects of transition from NHI to Medicaid on mortality for women require validation.