Nurses Unionize to Heal the System

Nurses Unionize to Heal the System

by Eleanor J. Bader

Deborah Burger, one of three presidents of National Nurses United, the largest union of registered nurses in the U.S., minces no words when expressing her dissatisfaction with the Affordable Care Act, also known as “Obamacare.”

“It is not anywhere near universal coverage,” she begins. “It puts the worst players in the healthcare field, the insurance companies, in charge of deciding what kind of care a particular patient is given. Talk about death panels…,” Burger’s voice begins to trail off but within seconds she regains her focus and her voice becomes louder and more impassioned.

“Okay, let’s talk about a hypothetical patient, Ms. Jones. She is sick with advanced liver disease and her doctor says that she needs a transplant. There’s a liver ready for her, but before the surgery can happen her insurance company has to review the request. Let’s say it’s denied. Only if pressure is brought to bear — only if Ms. Jones and her family and friends can quickly organize to pressure the insurer, will there be even the possibility of a reversal. By that time, it may be too late for Ms. Jones. The bottom line is this: Under the Affordable Care Act the insurance companies still get to decide what treatment you get. It’s not about what a doctor and his or her patient thinks is necessary.”

(Augusta, WI) oil on board 40 x 36 inches ©Zoe Hawk

“Sure,” she continues, “there are some good things about Obamacare. The insurance companies can no longer deny a person coverage due to pre-existing conditions; kids can be covered on their parents’ policies until they’re 26; there is no cap on how much they’ll pay for life-saving medications; and all preventative stuff is provided without a co-pay.”

Yes, this matters, Burger concedes, but National Nurses United (NNU) did not leap to give Obama and the Dems its endorsement this year, as it did in 2008.

Medicare for All

Instead, the union is working to promote what it sees as a solution to the health care mess — a single payer, Medicare for All system where everyone, regardless of income, age or gender has equal access to medical care. It’s a stance the group discusses wherever and whenever it can and National Nurses United spokespeople travel the country to describe how a universal system might work in the U.S.

Members of the California Nurses Association — one of the largest groups within National Nurses United — for example, spent several weeks this summer traversing the state to explain the concept and offer free health care screenings to more than 2,000 uninsured state residents in 19 locales.

“NNU held Town Hall meetings where community members spoke about the day-to-day impact of not having access to healthcare,” Burger reports. “This was contrasted with people speaking about what it means for them to have Medicare. Before the meetings some of the people who showed up knew almost nothing about Medicare and had no idea that Medicare is a government-run program, but once people understood the idea of single payer, they seemed to like it.”

Plans are presently underway to bring similar discussions to other states; in addition, alongside groups like Physicians for a National Health Program, National Nurses United plans to train an army of nurses to speak about single payer at community centers and public forums across the country.

But while improving access to medical care is the hub of National Nurses United activity, the three-year-old union does not look at either health or illness as isolated matters. That is, while the Maryland-based union represents the coming together of the California Nurses Association, United American Nurses and the Massachusetts Nurses Association — and organizes workers and administers collective bargaining agreements for more than 170,000 nurses across the country — it does not confine itself to bread-and-butter unionism.

Its broad agenda encompasses everything from adjudicating workplace grievances to decreasing unemployment, and its members work to support policies that will improve communities. In fact, as part of the union’s Campaign to Heal America, National Nurses United is pushing for what it calls the Main Street Contract, essentially a progressive wish list that not only demands Medicare for All, but also supports the creation of jobs at living wages; equal access to quality public schools and affordable housing; a safe, clean environment; and, a revised tax policy that requires corporations and the wealthy to pay their fair share.

Pulling Back the Curtain

The National Nurses United website explains the union’s rationale for supporting the Main Street Contract: “Over the past 30 years, while wages have fallen or stagnated and insurance premiums and other basic costs skyrocketed, wealth has been shifted from working families to Wall Street. It’s not shared sacrifice when only working people make concessions.” Corporate taxes, it adds, are at an historic low, while profits — $1.6 trillion during the last quarter of 2010 — are at record highs. What’s more, the Campaign highlights the fact that CEOs typically earn $275 for every dollar earned by workers.

Besides healing Main Street, National Nurses United also supports a “Robin Hood” tax, a proposal to minimally tax Wall Street transactions. The plan has garnered endorsements from the AFL-CIO, as well as individuals such as actors Bill Nighy and Mark Ruffalo; musicians Chris Martin and Tom Morello; business giants Warren Buffett, Bill Gates and George Soros; economists Paul Krugman and Joseph Stiglitz; Archbishop Desmond Tutu; and, community activists from, The Institute for Policy Studies, Jobs with Justice, Public Citizen and NOW.

light the fires

The proposal, say supporters, would generate money to rebuild America’s crumbling infrastructure, from its roads, bridges and waterways to its public buildings. National Nurses United estimates that a tax of 50 cents per $100 in trades would raise $350 billion a year, and while the Robin Hood bill introduced by Rep. Peter De Fazio [D-OR] is more modest, requiring only three-hundredths of a penny on such trades, supporters say it would still generate millions of needed dollars for the federal government.

And then there’s the smaller picture — the work that National Nurses United does to mobilize nurses to improve their working conditions and better the delivery of medical care to patients.

One major bone of contention centers on in-hospital patient-to-staff ratios. According to the National Nurses United, there should be one Registered Nurse (RN) to two intensive care patients; one RN to five rehab patients; one RN to two burn unit patients; and one RN to four psychiatric patients. Unfortunately, union activists charge that alleged budget shortfalls are commonly used as a pretext for pushing nurses to care for larger than optimal caseloads. Nonetheless, Burger notes that “The evidence is clear that fixed patient-to-nurse ratios are highly effective in saving lives. In the long run, better ratios save hospitals money, fewer things go wrong and patients have shorter hospital stays.”

In addition, Burger reels off a host of other workplace concerns. Topping the list: Nurses’ vulnerability to back injuries from standing for long periods and lifting and moving patients, and exposure to a multitude of infectious diseases and toxic chemicals.

Knowing the Pains

The silver lining, however, is that these conditions often light the fires that fuel unionization drives. Nurses in Massillon, Ohio, for one, are currently organizing and hope to join the National Nurses United within the next few months. The reason? “Nurses in Massillon don’t get meal breaks and often have to work well beyond their eight, 10, or 12 hour shifts,” Burger explains. “Each nurse is responsible for seven to 10 patients at a time. Some of these patients, if they were living in California, would not be in a regular unit, but would be in an ICU [intensive care unit]. In Massillon RNs work incredibly hard to make sure their patients get high quality care, but it’s at their own expense. They don’t take meals or go on breaks and typically stay late to do their charting. When nurses are completely exhausted they’re putting their licenses on the line because they can easily make mistakes. This campaign is not about salaries. There are 250 nurses in Massillon and they’re now collecting union cards because they’re so concerned about patient care issues.”

And understaffing is not unique to Massillon.

Nurses know that
when health care is
cut for anyone,
everyone is harmed

That said, expected demographic trends — a predicted increase in the demand for services over the next decade — is likely to offer both a challenge and an opportunity for the National Nursing Union and other health care unions. In fact, the confluence of aging baby boomers and an expanded patient pool, thanks to the Affordable Care Act, has led to predictions about the growth of the healthcare sector. Indeed, the Bureau of Labor Statistics anticipates a 26 percent spike — the hiring of 711,900 new registered nurses — by 2020, bringing the number from 2.74 to 3.45 million within the next eight years.

While National Nurses United sees organizing these workers as an obvious priority, Burger notes that how the union functions is as important as the contracts and concessions it wins. All three presidents continue to work as direct care RNs, and Burger is emphatic that it is nurses, and not professional managers or administrators, who should decide the policies of the organization and determine its direction.

The union’s dual focus — organizing nurses at their workplaces and keeping an eye on state and federal policies that impact healthcare receipt and delivery — makes for a huge workload. They’re up for it, Burger laughs, regardless of which way the electoral winds blow come November. As the organization’s website states: “From Wisconsin to Michigan to Maine, RNs are joining the fight to resist state laws and budget proposals to silence our collective voices, reduce our retirement security, our health coverage, and our living standards…Nurses know that when health care, pensions, safety net programs, or education are cut for anyone, everyone is harmed.”

Eleanor J. Bader is a freelance writer, teacher and activist. She writes for The Brooklyn Rail,, The Progressive,, and other progressive and feminist blogs and publications.

Also see: Living Up to “The New Deal”: Half the Nation Is Still Waiting by Susan F. Feiner in this edition of On The Issues Magazine

Also see: Getting Closer to the Levers of Power by Diane Vacca in this edition of On The Issues Magazine

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