Traditional and Non-Traditional Collective Bargaining: Strategies to Improve the Patient Care Environment

Karen W. Budd, PhD, RN, CNS; Linda S. Warino, BSN, RN, CPAN; Mary Ellen Patton, RN


Online J Issues Nurs. 2004;9(1) 

In This Article

History of the American Nurses Association Collective Bargaining Efforts

Although nurse CBAs have been negotiated under the aegis of several national unions, the largest nurse union is the United American Nurses, which, as an affiliate of the ANA, is comprised of members of ANA's constituent states' local bargaining units. The ANA has more than a half-century of unionizing and traditional CB experience, which was acquired particularly during periods of nursing shortages. Calling upon such experience can be extremely useful to help nurses find their voice and change the health care environment during the current shortage. A summary of that experience follows.

The Post-World War II Shortage

Although the ANA had promoted the economic security and general welfare of nurses throughout the first half of the 20th century, it had not engaged in CB (Forman & Davis, 2002). This lack of CB involvement likely reflected the predominate view that nursing was a calling and not an occupation. In the post World War II years, however, poor working conditions, inadequate pay, and an increased demand for nurses resulted in an acute national shortage of nurses (Flanagan, 1986). Concern about the future of nursing was fueled by a report that had been prepared by Raymond Rich Associates, a consulting firm hired by ANA. The report stated, '....nursing could not hope to maintain high standards of practice, attract qualified recruits, or retain the best nurses unless the profession did everything in its power to gain for nurses a decent measure of social and economic security' (Ketter, 1996, p. 4).

In response to the report, a resolution was adopted at the 1946 ANA Convention to establish an economic and general welfare program. The program provided guidelines and assistance to State Nurses Associations (SNAs), now called Constituent Nurses Associations (CNAs), for promoting the economic security of nurses and engaging in CB. Subsequent certification of ANA as a labor organization in 1949 paved the way for SNAs to represent registered nurses as their bargaining agents.

Subsequent Shortages

According to Flanagan (1986), 'by the early 1960s, nurses in SNA local units were successfully negotiating provisions for shortened hours of work, salary increases, shift differentials, shift rotation, overtime, length-of-service increments, sick leave, health benefits, retirement plans, grievance procedures, Social Security coverage, and more' (p. 16). Nevertheless, by the mid-1960s a critical shortage of nurses attributed to economic exploitations was occurring once again, which prompted the ANA in 1966 to adopt the Resolution on National Salary Goal. This resolution established the salary goal of not less than $6,500 for entry-level registered nurses, and called upon SNAs to use negotiation through CB to implement the goal (Ohio Nurses Association, n.d.). The establishment of a salary goal provided the impetus for many SNAs to secure higher entry-level salaries for nurses through CB. Not until 1974, however, were nurses in non-public hospitals offered protection under the NLRA. Therefore, before 1974, mass resignations were used as a collective action in lieu of strikes (Flanagan, 1986; Ketter, 1996; Patton, 1998).

In 1965, Patton (1998) used mass resignation as a method to change employment conditions following thwarted CB efforts. As a staff nurse in an Ohio hospital, she was part of a nursing staff that faced 'staffing and scheduling problems, no input in decisions affecting nursing, physicians controlling promotions, a low starting wage, few benefits, and no pension' (p. 80). She recounted, 'the final insult was management's offer of a 10-cent-per-hour raise for full-time nurses, with only five cents per hour for part-time nurses, which were most of us. This was later called the most expensive nickel in hospital history because it galvanized us to...organize [through the Ohio Nurses Association (ONA)] for [CB]' (p. 80). Unwillingness of an obdurate management to negotiate with ONA resulted in a mass resignation of 85% of the nursing staff. Assistance of a federal mediator was obtained, and thirteen days later, the nurses returned to work with 'a contract in hand' (p. 80). Patton's CBU was the first to be represented by ONA. Today ONA's Economic and General Welfare program includes more than 5,500 registered nurses in 29 local units (ONA, personal communication, October 21, 2003).

Once or twice each decade throughout the next twenty-five years, cyclical, short-lived nursing shortages occurred primarily as a function of an economic supply and demand (Phillips, 2003). When the national economy was on the upside and more employment opportunities existed for nurses, shortages would occur (Gelinas & Bohlen, 2002). Hospitals would attempt to fill RN positions with lower-wage workers, such as LPNs or nurse aides, and only as a last resort would raise RN wages (Phillips, 2003). During these times, CB was particularly useful for nurses because it provided a tool to demand a voice in decisions affecting them and their job security. Such demands continue to be relevant in today's health care environment (Forman & Davis, 2002).


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