||Organizing in Healthcare
|Taking Advantage of Exposed Pressure Points
For those who have read Confessions before, you already know that I spent many years serving as an Organizing Director with the Teamsters and Steelworkers and have written about how I was the conductor in an orchestra of chaos during campaigns. The campaigns that were the most fun (before I was on your side) were organizing workers in a hospital environment. There were so many sensitive pressure points that we would make jokes behind closed doors about how we would get hospital leadership to bow down to our demands.
I was sent to Pittsburgh back in 2000 to discuss an
organizing alliance between the United Steelworkers (USW) and the California
Nurses Association (CNA). After several
months and multiple trips to California, we struck a deal. To the USW, it seemed like a no-brainer
because the CNA had established an outstanding organizing record and the USW were
on a mission to establish their position in the Healthcare industry.
Rose Ann DeMoro, Director of the CNA, used to repeat
over and over that labor should be the driving force of “needed changes in
healthcare law”. She wanted to be the
Lee Iacocca of healthcare and had visions of sitting on the executive
committees of all of the major hospital corporations. She knew that the only way she could achieve
this goal was to capture heavy union density across the nation. My position was that we could only accomplish
this goal by utilizing unprecedented aggressive tactics. We were all in agreement.
Like all other industries, healthcare organizing
strategies rally around the ability to infiltrate the target organization and
work internally under the radar to build support without the leadership team’s
knowledge of union activity. But have
you ever wondered what an organizer does once they get a foothold inside their
target? Have you wondered how employees
are convinced and persuaded into believing that their management team is inherently
bad, or at least incompetent? The goal
of a union organizer is always to destroy the relationship that the targeted
employees have with their leadership and with the institution as it stands. It is
important for unions to simultaneously build unit support as well as attack
inherent weaknesses that exist in healthcare institutions.
But what do you do once you are there? How do you
convince employees that their management team is inherently bad, or at least
incompetent? Make no mistake: the fact is the goal is always to destroy the
relationship the targeted employees have with their managers and the
institution as it stands. Healthcare organizing campaigns are most
successful for the union when typical corporate campaign strategies are
introduced: it is important for unions to simultaneously build unit support
as well as attack weaknesses inherent in public healthcare institutions,
whether it be in hospitals, long term care facilities, Drug Abuse Treatment centers or any
type of the many health care facilities across the country, including home care
workers. While on the union side, healthcare facilities were viewed as soft
targets because they were so dependent on public opinion and a perception of
excellence in order to be successful. Patient care was the hospital’s priority above
all else and that was also their greatest weakness. We use to equate hardcore
healthcare organizing tactics to mugging a parent with a baby in their arms. Of
course they want to protect the baby so they are happy to give the mugger all
their money as long as they can get their child out of immediate harm. Our mission was to harm the unit and even
destroy it if we had to. We knew we were
building a reputation of “scorched earth” tactics at one location that would be
publicly discussed and would give future targets the incentive to surrender to the
union without a fight.
We used our “scorched earth” tactic in a California
hospital. We had been in this particular
facility with the CNA for about six months, strengthening our internal
organizing committees for all of the departments inside the hospital. We developed a detailed understanding of
every key issue that was unique to each department. We used these issues to
create a focused foundation of mistrust towards management based on the
perceptions of abuse or neglect from the hospital that we helped employees to
We decided to go for an election with the nurses
first. The RN’s were the most aggressive
in the earliest stages of the organizing efforts. We realized that their biggest issues were
basic equipment upgrades and a lack of flexibility that they needed to improve
patient care. During this organizing
drive, the hospital was in the process of becoming Magnet certified. The process for obtaining Magnet status is a
difficult one. Hospitals want this
status to demonstrate their levels of excellence in nursing care. It is an ongoing process and requires a high
level of dedication from the nursing staff that must prove their level of
excellence to receive the status.
We found that the RN’s were angry with the hospital
about their decision to go for Magnet status.
They felt that the hospital was pushing for the certification for
marketing purposes only and that the nurses and patients would not be better
off. It was very easy to instill a sense
of rage into them. We told them that
management were elitists and trying to pocket profits off of the backs of the
nurses and their patients. We walked in
with the fire burning, we simply added jet fuel to it and watched it burn.
As the campaign advanced, we targeted the most
tenured and respected nurses to be the internal organizing committee. They continued to recruit informal leaders from
within the nursing rank and file to support and advance our campaign. We also included nurse managers who could be
trusted by the internal organizing committee to give us an insider’s view into
the way hospital management thinks and operates.
Per our usual modus operandi, we
organized undercover and spread a blanket of half-truths. We created an environment where nurses truly
believed that the problems with patient care were caused by a lack of dedicated
resources in the Critical Care Unit, Cardiology Department, Accident &
Emergency (A&E) Department, General Surgery and the Neonatal Unit. We found that there had been some serious
issues that had happened in these units and that there was an ongoing internal
review in process. Since hospital management could not and would not talk about
the occurrences and the review, the union worked to fill the void with
accusations and rumors through the internal organizing committee. This caused hospital management to grow
weaker. They were worried that there
would be a backlash, a drop in RN engagement levels and their enthusiasm. They were concerned about losing the Magnet
At this point in the campaign, our organizing team
was in the hospital during both the daytime and nighttime. We had meetings with local union retirement
chapters whose members were recruited to deliver special messages in the
hospital whenever they had a reason to visit.
You may be surprised how many retired union supporters have family and
friends who are patients, nurses or employees in a hospital. Our retiree mouthpieces besieged employees
with specific messages outlining weaknesses in the hospital’s policies.
While our retirees were spreading our guided
messages, we also had the area labor council work to file official complaints
with hospital management. We also
encouraged, educated and helped coordinated the retiree groups with the
resources to complain to The Joint Commission on Accreditation of Healthcare
Organization, the California Medical Association and the California Department
of Health Services (DHS). Of course, we also ensured that these complaints made it to the news
When we filed the
representation election (RC) petition we had over 70% of the RN’s in the
hospital on the union’s side. We filed
with a demand for automatic recognition.
At this point, we set the internal
organizing committee on a mission. We
had them make demands to the hospital’s CEO at his annual town hall meetings
that were held in the auditorium. Over
200 nurses marched in and demanded that if the hospital was truly serious about
maintaining nursing excellence it would immediately:
- Create healthcare environments using
evidence-based designs to promote better patient outcomes and less stress on
- Improve hospital policies to protect and
support nurses like removing needleless IV systems and improving safe needle
policies, many of which are now standard procedures.
- Ensure that all care be delivered by
- Create a zero tolerance for abuse
practices and procedures.
- Have the hospital attorneys coordinate with the police
and the district attorney to investigate all of the cases of employees who have
been assaulted, physically or sexually, while at the hospital.
- Have at least one clinical nurse specialist on duty 24 hours per
day, seven days per week.
- Ensure that each nursing manager be a clinical nurse
specialist in a relevant field for his/her unit.
- Ensure that Chief Nursing Officer has at least a
master's degree in nursing.
- Ensure that nursing managers have significant management
- Ensure that nursing managers who do not receive positive
evaluations by more than 80% of nurses who work under
them should be replaced.
- Ensure that new nursing manager hires should be
interviewed by the staff nurses they will supervise.
- Allow charge nurses to set the staffing levels on their
floors determined by what nurses feel they can take and filled by appropriate
mix of nurses based on experience and expertise.
- Have nurse-to-patient ratios posted very visibly for
visitors to see on every unit and updated every shift.
- Ensure that nurses receive full tuition reimbursement
for education that will enable them to stay in nursing or public
- Ensure that all employees, including part-time employees,
receive benefits from the first day of employment.
that the basic minimum nurse-to-patient ratios were set no higher than those
set by California legislation, whether or not the institution is located in
With the hospital management starting to hit back against the
organizing attempt, we decided to further alienate key personal. We made sure background checks were done and
we discovered personal shortcomings like DUI convictions, petty shoplifting and
other embarrassing past discretions to further minimize their authority status
and further distract them from the organizing drive.
Our initial target was the RN’s, but we knew that there were
others in the hospital who wanted our attention. We used them to our advantage. Most of the non-medical professional
employees were Hispanic. They felt that
they were discriminated against by hospital policies. We organized a large protest on and around
the hospital grounds. We made sure that
it was large enough and created enough chaos to be picked up by the local
media. Of course, we made sure these
workers had support from workers in all hospital departments.
We knew that this campaign was not going
to do anything but destroy the quality of patient care. We had to create that type of environment to
achieve victory. So we continued to push and push. Every day we made it more difficult for
hospital management to effectively run daily operations. Organizing activity never got easier for
them. We continually added more and more
pressure to the point where we reached a fever pitch. We deliberately sabotaged
the Magnet status quest and won the campaign.
We sabotaged the Magnet status because we knew that we were going to
win. We used their goal of obtaining
that status as a “carrot on a stick” when going through contract negotiations
after winning the election. We could help restablish the
application process if given incentive in the form of a good contract.
During this campaign, we had to focus on the Nursing staff as a whole. Today, the NLRB has new rules allowing for
micro-unions in specialized healthcare facilities. It is fully expected that these micro-unions
will work their way into hospitals and other healthcare institutions. All of the above tactics will continue to be
successful if a hospital or other healthcare facility is not prepared. The difference is it will be much easier to organize
a smaller group to get a foothold in the organization and then spread like a