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Working In These Times

Wednesday, Sep 9, 2009, 8:00 am

Nurses’ Orders: New ‘Super-Union’ Pushes for Healthcare Reform

BY Michelle Chen

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A volunteer nurse checks patients at a free health clinic in Inglewood, Calif.   (Photo by John Moore/Getty Images)

The progressive talking points for universal healthcare are often framed around the interests of patients. But one sector of the medical workforce is driving a movement at the intersection of organized labor and healthcare policy: nurses.

While lawmakers bicker and the public wades through a muddle of misinformation, the major nurses unions, particularly the California Nurses Association (CNA), are staking out bold positions on reform. Their efforts have culminated in a new union merger that seeks to align progressive nurses with other service workers as well as healthcare consumers.

As a critical link between physicians and patients, nurses occupy a pivot point in the reform debate. Alongside bread-and-butter campaigns on pandemic-flu preparedness and nurse-to-patient staffing ratios, the CNA has taken on universal healthcare as a labor issue, arguing that single-payer would not only serve patients' best interest, but also make the entire system more economically viable.

Nonetheless, nurses have encountered old snags in their organizing efforts: gendered stereotypes that have traditionally kept their workforce marginalized and undervalued.

On Kaiser Health News, Sandy Summers of the Truth About Nursing advocacy campaign describes the challenges nurses face as frontline healthcare providers:

The standard formulation when discussing providers is "doctors and hospitals," but it is nurses who provide most of the skilled care hospital patients receive, and the only care that many in underserved communities receive.…

Although nurses are autonomous, college-educated health professionals who save lives, the profession's image among those who make key decisions remains trapped in a web of female stereotypes, from the unskilled angel to the physician helper....

This disrespect weakens our health system. Decision-makers rightly spend billions on alleviating diseases, but relatively little on the poor nursing infrastructure that allows diseases to spread in the first place. Disrespect leads hospital administrators to replace nurses with less-skilled workers who cannot spot subtle but deadly changes in patient conditions, and who cannot teach or advocate for patients. The overwhelmed nurses who remain may themselves be unable to fulfill these roles, which costs lives and money. And disrespect leads officials to allocate miserly funding for community health nurses, nursing education and research.

In other words, from a nurse's perspective, the profit-driven structure of medicine today not only makes the country sicker and poorer, but also degrades the entire nursing profession, leaving patients at even greater risk.

And the irony is doubled if nurses themselves, weakened by a lack of collective bargaining power, can't even access the quality care they are tasked with providing. Last month, for instance, a drawn-out arbitration process between Sutter Health’s California Pacific Medical Center and its nursing staff culminated in a judicial order to rescind cutbacks in their health benefits.

Nurses at other California hospitals have complained of anti-union harassment by administrators and sharp cuts to hours and services.

Meanwhile, California nurses are fighting negative publicity from media coverage of the state's dysfunctional disciplinary system for nurse misconduct. Though Governor Arnold Schwarzenegger has promised to reform the Board of Registered Nurses, an oversight body, the CNA argues the Governor's neglect and chronic underfunding of the system is largely to blame.

The CNA's workplace activism complements its growing political visibility in the healthcare debate. Several recent investigations by the union have sought to expose the underbelly of the medical industry from an insider's perspective.

In the report “California's Real Death Panels,” the CNA examined state managed-care records and found that from 2002 to 2009, “six of the largest insurers operating in California rejected 47.7 million claims for care”—about one in five claims.

So while corporate interests in the medical industry have historically stymied major reform, why are nurses pushing for an overhaul of the way their employers are funded and managed? Well, there's something in it for them, too.

Earlier this year, the CNA and National Nurses Organizing Committee published a study showing that a single-payer healthcare system would generate more jobs, better pay, and strengthen the tax base. According to the Institute for Health and Socio-Economic Policy, the union's research arm, a Medicare-based universal-coverage program would:

  • Create 2,613,495 million new permanent good-paying jobs (slightly exceeding the number of jobs lost in 2008)
  • Boost the economy with $317 billion in increased business and public revenues
  • Add $100 billion in employee compensation
  • Infuse public budgets with $44 billion in new tax revenues

As nurses step up their workplace organizing, their political agenda in Washington growing wider and sharper.

This week, 1,200 registered nurses convened in San Francisco to inaugurate an unprecedented super-union. According to the CNA's press release, the merger of the CNA/NNOC, the United American Nurses and Massachusetts Nurses Association will bring together 150,000 nurses nationwide under the banner of National Nurses United.

The conference will focus on policy issues including the Employee Free Choice Act and single-payer healthcare, as well as the development of a broader organizing vision that will shape debates on “national and state healthcare reform, the ability of nurses to advocate more effectively to protect patients, and standards for nurses that are vital for the retention and recruitment needed to expand the [registered nurse] workforce.”

Though single-payer remains a long shot on Capitol Hill, CNA is mobilizing on the state level, too, joining other labor groups in support of single-payer-based reform legislation in California.

While the prospects for meaningful national healthcare reform may be fizzling, the battle has energized a new movement among some of the most underappreciated workers in healthcare. Organized nurses have laid out a prescription for both labor struggles and healthcare woes: shifting the system away from corporate coffers enriches patients, as well as the people responsible for taking care of them.

Michelle Chen is a contributing editor at In These Times, a contributor to Working In These Times, and an editor at CultureStrike. She is also a co-producer of Asia Pacific Forum on Pacifica's WBAI. Her work has appeared on Alternet,, Ms., and The Nation, Newsday, and her old zine, cain. Follow her on Twitter at @meeshellchen or reach her at michellechen [at] inthesetimes [dot] com.

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