The image of the “thin blue line” has become common shorthand for the heroism and public trust associated with police officers. But seldom do we glorify the thin white line of nurse professionals who maintain our public health system, despite conditions that may put at risk their own health or capacity to practice.
Like police officers, nurses depend on solidarity to do their jobs. And they need the right to enact that value by forming unions and bargaining contracts that set humane wages, hours, and patient-to-nurse ratios. The significance of unions to nurses hit home for me when a caregiver in my native Midwest described how she and colleagues were literally made sick by forced overtime and increased loads of patients at their facility. If she protested, her manager told her, the hospital would file a claim of abandonment of patient against her and step up efforts to decertify, or dismantle, her union.
Such management resistance and the difficulty of curbing it during workplace elections are major factors in limiting union rates among nurses to just under 20 percent. Now, instead of setting its sights on the huge share of non-union nurses interested in forming bargaining units, the California Nurses Association (CNA) has targeted groups of nurses already represented by a larger rival, the Service Employees International Union (SEIU). In a key battle in Nevada and elsewhere, CNA has even taken up the management threat of decertifying the existing union as one of its weapons.
Proud of having beaten Gov. Schwarzenegger’s slew of ballot measures in 2005, CNA covets footholds in other states. But more than just expansion and the clout that comes with it are at stake. CNA has targeted SEIU over its strategy of finding common ground with some health care chains, such as on expanding public funding to cover patient care, and neutralizing employer opposition to unions.
SEIU’s novel approach in removing barriers to union growth has made inroads at facilities operated by Kaiser Permanente and Catholic Healthcare West, where SEIU now represents many health professionals. It has also given SEIU fluency in a fresh approach to union advocacy that links patient care to workers’ rights, speaking not to self-interest, but rather to shared priorities with the public, such as safe conditions and high-quality, affordable care. Beyond the esoteric world of union politics, SEIU has gained rare traction with elected officials and mainstream voters.
CNA’s criticism of organizing strategy may be fair game, but union demolition is not. So heated has CNA’s scorched-earth battle against SEIU become that fisticuffs erupted between the two sides at a recent union conference in Michigan. At the least, the fracas serves to further dispel the sexist notion that nurses are pushovers, agents of altruism who may suffer quietly and back away from a fight.
Neither progressives nor Americans in general should back away from this dispute simply because they find it petty or distasteful. All consumers lose when one of the strongest voices for patient care gets drawn into a shouting match. The confrontational approach by CNA against SEIU undercuts one of the few forces in society willing to push the actuaries, CEOs, and policy-makers who oversee our broken health care system to listen to health professionals and work with them to fix it.
That nurses, the incarnation of care in the eyes of Americans, should now be a bone of contention among unions is a clue to their paramount value as our nation’s conscience. Unlike priests, they do not bear the stigma of exploiting vulnerability. And unlike faith-based institutions, which in general have been complicit in the 50-year decline in union membership by turning away from issues of morality and justice involving workers and workplaces, nurses are tackling them head-on.
Caring for patients can be a harrowing job. I remember a nurse telling me about the common experience of wanting to sleep but instead lying awake, running down in her head the list of patients from her previous shift to confirm if she had handled every instruction, handed off every assignment, or more subtly still, heard every clue in what a patient or family member might have said that could bear on a diagnosis or treatment. This she did for more than twenty patients every day, sometimes after having worked an extra shift without notice. She told me this in the company of other nurses. They did not one-up each other with laments, but rather nodded together as if to say, “It comes with the territory.”
Such soul-searching is at the core of the profession and a vivid reminder that all Americans have a stake in union nurses’ fight to set patient care ratios at humane levels. The strands of our nation’s safety net are woven from the fiber of individual conscience. In the fight they have picked with another union to represent nurses, is it too much to ask that CNA leaders stop to reflect on what broader harm their campaign might be causing?
[Editor’s note, 4−29−08: Prior to founding the political consulting firm Progressive Victory, Hans Johnson helped lead list-development and communications efforts at SEIU. Since then he has not worked for the union.]