On June 10, 2010, over 25,000 nurses are set for a one day strike in California and Minnesota1. If the strike comes to pass, this is expected to be the largest strike in US history. In the case of California, the decision to strike comes with the failure to agree on a contract. This step in California follows a long period of negotiations that included a special neutral fact finder who weighed in on issues of nurse staffing and nurse relief for breaks. Minnesota nurses state that their strike action is scheduled because of the failure of management to negotiate in good faith about a range of issues from pension to staffing2. While historically unions and other collective bargaining entities have been viewed as dealing with issues of salary and benefits, in reality, the conditions of work have always been central to the growth of nurse “militancy”. In both California and Minnesota, the nurses say that issues of safe staffing are a primary concern.
California nurses affected include the registered nurses from five University of California Medical Centers: San Diego, Irvine, Los Angeles, San Francisco, and Sacramento; along with four other facilities: Citrus Valley Medical Center (Covina), San Pedro Hospital (San Pedro), Marina del Rey Medical Center (Los Angeles) and Olympia Medical Center (Los Angeles). These nurses are represented by the California Nurses Association/National Nurses Organizing Committee. Their primary concern is that the hospitals are trying to roll back the legislation that mandated nurse to patient ratios3. In reality, given the mounting budget crisis in California, the nurses concerns are real. There has been support from more than forty legislators for implementing the recommendations of the fact finding process. But at the same time, there is a growing movement by a small group of legislators and other policy analysts to try to overturn the nurse staffing ratio laws4. This is on the rise despite recent research by Aiken (2010) that demonstrated that such ratios really make a difference. According to Aiken, “nurse staffing ratios mandated in California are associated with lower mortality and nurse outcomes predictive of better nurse retention in California as well as in other states where they occur"5 .
Historically, during times of economic recession, businesses seek to claim concessions on union contracts. The question of which side comes out on top is an important one, as it ultimately affects patient care. The role of unionism or industrial action by nurses served as a catalyst or push for change in the United States and many other countries of the world. In the 1980s to present, the threat of unionization was one of the most powerful drivers for hospitals to move to professional models of practice6. As the education of nurses in college programs emphasized practice based on knowledge and skill, blinders of paternalism no longer held in hospitals7. Taught to be patient advocates, staff nurses recognized that they needed to pay attention to the conditions of work.
Collective bargaining efforts by nurse are not easy. Now in 2010, as in 1974 when the Taft-Hartley Act was amended to protect nurses right to organize, the decision to strike is not an easy one. Months of negotiation without results, perceived failure of management to negotiate in good faith, and the frustration of not being able to practice are commonly voiced concerns. Nurses are faced with accusations of greed in a profession long viewed as selfless service. Nurses are told that strike actions are abandonment of patients.
This year, striking nurses face a new challenge in that, unlike many previous years, the recession has temporarily suspended the nursing shortage in many parts of the country. Filling nurse positions with new graduates waiting in the wings is a very real possibility. It is also not clear if the younger nurse generation understands the sacrifices of the nurses who were willing to throw their jobs away to have hospital administration simply talk with them at the onset of collective bargaining in the late 1960s. Too often viewed as “nurses eating their young”, the staff nurses of today need to reach out to young nurses and embrace and educate them about the struggles fought to make safe staffing a reality. The history of nurse efforts to advance the practice of nursing through professionalism will be shaped once again by what happens on June 10th. Nurses face a new set of socio-economic challenges and will add to the chapter of the history of nursing’s work place politics.
2. http://minnesota.publicradio.org/display/web/2010/05/28/nurses-set-strike-date/ and for information from the Minnesota Nurses Association go to http://www.mnnurses.org/.
3. Read more about the ratios at: http://www.calnurses.org/nursing-practice/ratios/ratios_index.html and http://www.calnurses.org/assets/pdf/ratios/ratios_booklet.pdf.
4. Burehaus, P. (2007). Avoiding Mandatory Hospital Nurse Staffing Ratios: An Economic Commentary. Nursing Outlook, 57(2):107-12.
5. Aiken, L., Sloan, D., Cimiotti. J., Clarke. S., Flynn,JA., Spetz, J, Smith H. (2010). Implications of the California Nurse Staffing Mandate for Other States. Health Services Research (epub ahead of publication) retrieved from http://www.nursing.upenn.edu/chopr/Documents/Aiken.2010.CaliforniaStaffingRatios.pdf
6. Wolf, K. (1996). The Slow March to Professional Practice in L. Andrist, P, Nicholas, and K. Wolf. Boston:Jones & Bartlett.
7. Ashley, J.A. (1978). Hospitals, Pateranliism and theRole of the Nurse. Columbia University-Teachers College Press.