Last week’s merger of the National Federation of Nurses with the American Federation of Teachers made AFT the nation’s third largest nurses union, after the National Nurses Union (NNU) and the Service Employees International Union (SEIU).
But it is unclear whether the move will lead to more cooperation among the sometimes rancorous nursing unions — or to more progress in organizing a field that is growing faster than its union membership.
Nurses belong to many different unions. Some are general membership unions, like SEIU and AFSCME, that have expanded to organize health care workers; others are unions mainly made up of nurses and evolved from professional associations. Over the past two decades, these labor unions have battled both employers and sometimes each other to organize the expanding ranks of healthcare workers, including nurses.
The field seems ripe for unionization: Hospital professionals are frustrated that their control over their work has been undermined by new for-profit hospital chains and corporatized non-profit chains. But beyond their problems with opposition from management, nurse union organizers have split over strategy. For example, for many years, former SEIU president Andy Stern pushed to get unions to agree that a single union would organize healthcare workers, a frustrated ambition that contributed to his leading a break-up of the AFL-CIO in 2005.
But while unions have scored significant healthcare organizing successes — not just in hospitals but also nursing homes and home care — their victories among registered nurses have not kept pace with the field’s rapid growth. Just over 18 percent of the nation’s 2.8 million registered nurses belonged to unions in 2012, down from almost 20 percent in 2008. Not only did the proportion of unionized nurses drop in those four years, but so did the actual number, according to census data analyzed by the Unionstats Database—despite the total number of nurses increasing by about 70,000.
Yet nurses are still roughly twice as likely to be in a union as are other workers. The current configuration grew out of a long history of mergers, splits and in-fighting. Many nurses unions, including the just-absorbed NFN, split off from the American Nurses Association since the California Nurses Association left in 1995 over dissatisfaction with the control by nurses who held managerial positions in hospitals. In 1999, the ANA responded by establishing, then spinning off, the United American Nurses as a parallel association of state collective bargaining organizations. NFN consisted of some of the UAN groups that did not want to join with NNU, but then the New York State Nurses Association left NFN. NYSNA first vice-president Judy Sheridan-Gonzalez tells Working In These Times that NFN was a “weak federation that exists largely on paper, has done no organizing and would have disappeared completely if left to its own devices.”
Perhaps the most dramatic conflict over nurse membership has been the rollercoaster ride of alliance and antagonism between the California Nurses Association (now a part of NNU) and SEIU, with CNA switching from loyal ally to critic of both SEIU and the largest SEIU health care local in California, both before and after the national union’s highly controversial takeover of the local. Recently, after its organizing agreement with the SEIU national union expired, for example, CNA merged with the new union formed by the trusteed California SEIU leaders (known as the National Union of Healthcare Workers). NUHW is now contesting SEIU representation of tens of thousands of health care workers.
In a press conference announcing the merger with NFN, Randi Weingarten, president of the 1.5 million-member AFT, addressed the argument that NNU often makes that there should be only one union for nurses and that it should represent only nurses.
Weingarten enthusiastically welcomed the NFN nurses, describing AFT as a “union of professionals” who face similar problems, such as adequate staffing, budget cuts, de-professionalization, and “top-down dictates” in hospitals and schools. The merger, she said, would “solidify the unity of those who nurture the body and those who nurture the mind,” giving nurses more clout, as well as access to the teachers’ union experience in fighting political attacks. In addition, there was both need and room for several unions to organize the 80 percent of nurses who are not unionized. “There is no one national union” for nurses, she said.
Weingarten also noted that SEIU, AFSCME, AFT, OPEIU and other unions were talking more with each other and moving to cooperate in dealing with challenges, including staff cuts, that may be posed by implementation of Obamacare, adding that she “hope[s] that NNU sees the need” for such cooperation.
In what could also be seen as a veiled criticism of NNU — the largest nurses union — NFN president Barbara Crane praised AFT as a union that “gets things done, [does] not just complain.” NNU has a reputation as staking out militant positions in favor of policies like single-payer national health insurance or a financial transaction tax. Also, some nurse unions criticize NNU for not being a reliable partner or for “raiding” other nurse unions, challenging their right to represent workers at a particular workplace. (NNU leaders say in such cases nurses come to them seeking better representation).
NNU co-president Jean Ross was clearly unenthused about the merger. “For a movement of nurses and a social movement of the country, I think it’s a step backwards,” she told Working In These Times. “We would much rather they’d joined with us. We think nurses would be much better represented in a union of nurses” that has a primary focus on their special issues. “I’ve never ruled out working with other unions, but you only get the decisions you need if you’re got an organization of all nurses.”
She argues that nurses can be disillusioned and harder to organize if they’ve previously been in unions not devoted to nurses only. AFT notes that NUHW, now merged with CNA, includes many non-nursing health care workers, making NNU no longer an exclusive nursing union, but Ross says that is a unique California relationship.
The NFN merger clearly strengthens the AFT and its nurse division. Weingarten also suggests that there are new signs of cooperation among many of the health care unions. And nurses do continue to join unions, as nurses in El Paso, Texas, did last week in voting for NNU representation. But in the fast-changing, fast-growing industry, the big questions remain unsettled. How can the labor movement organize much more rapidly the expanding ranks of health care workers, and how can those unions most effectively protect both health workers’ work lives and the health of the broader community?
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David Moberg, a former senior editor of In These Times, was on staff with the magazine from when it began publishing in 1976 until his passing in July 2022. Before joining In These Times, he completed his work for a Ph.D. in anthropology at the University of Chicago and worked for Newsweek. He received fellowships from the John D. and Catherine T. MacArthur Foundation and the Nation Institute for research on the new global economy.