Nurses have been driving unionization efforts since the 1950s, but the pandemic spotlighted the urgent need for further action. Faced with unsafe working conditions, patient safety risks, and ongoing pay disparities, strengthening nurses' collective voices through unionization has never been more critical.
According to the US Bureau of Labor Statistics, around 20% of registered nurses (RNs) and approximately 10% of licensed practical nurses and licensed vocational nurses currently belong to unions.
The pandemic threw adequate workplace safety standards for nurses sharply into focus and remains an issue today.
"The understaffing, the lack of preparation for an infectious disease outbreak, the lack of PPE, and how cavalier employers were about our lives became clear," said Michelle Mahon, RN, director of Nursing Practice at National Nurses United, the largest nurses' union in the United States.
"If we felt disposable before the pandemic, we felt very disposable during the pandemic. This is what prompted nurses to create unions in Asheville, North Carolina, in 2020 and Portland, Maine, in 2021. Nurses collectively said, 'Enough is enough'."
While California and New York have long been union strongholds for nurses, the South is one of the country's regions currently experiencing a tidal wave of unionization among nurses.
Such is the case at University Medical Center (UMC), a Level 1 Trauma Center in downtown New Orleans. In December 2023, the 800 nurses working here voted to join National Nurses United.
"We started unionizing because there were clear problems with staffing, high patient ratios, and nurse pay," said Michael Robertshaw, RN, an ICU nurse at UMC who is actively involved in current union negotiations.
Moving forward to achieve their goals has remained challenging for the nurses here, Robertshaw told Medscape Medical News.
"We have been in negotiations since April, when we did our bargaining rally," Robertshaw added. "Since then, the hospital has been dragging its feet. They have no interest in remedying issues with workplace violence and safety, which we think is crucial considering we work in a hospital where people come in with guns, and we have no metal detectors."
According to Robertshaw, with no raises for nurses in a decade, UMC nurses are planning to strike, although there is no date set yet for the work stoppage.
"Our hospital can't operate without our labor," said Robertshaw, who has worked as a nurse for nearly 5 years. "We're trying to advocate for ourselves and our patients, but the administration still ignores us, gaslights us, and makes us out to be the bad guys."
Medscape Medical News reached out to UMC for comment but has yet to hear back.
While some headlines repeatedly point to concerns over a mounting nursing shortage -- in 2022, the American Hospital Association predicted that half a million nurses would leave the field by the end of that year -- representatives from National Nurses United, which counts 225,000 members across the nation, stress that the issue isn't shortages of nurses overall but, rather, a shortage of nurses willing to work in hospitals, especially ones that aren't addressing workplace conditions.
If nurses aren't staying in their jobs for long periods, the entire workforce is affected, and, in this case, the numbers are troubling. According to a decade-long RN Work Project study, nearly 17% of newly licensed RNs leave their first nursing job within the first year, and 33% leave within 2 years.
"We hear about shortages a lot from the hospital industry, but if you look at Bureau of Labor Statistics data and compare the data coming out of the state boards that license nurses, we're seeing a steady inflow of new nurse graduates," Mahon said.
The disconnect often occurs after nurses get their degrees and licenses and begin working on a particularly stressful unit that isn't properly staffed.
"Nurses are aware of the responsibility placed on them to care for patients and to live up to the standards the hospital sets," said Robertshaw. "They often then find that there is little support from the hospitals themselves. After a certain amount of time, they decide they want to work in a better environment."
However, at West Penn Hospital in Pittsburgh, where a historic new union contract was achieved just last week, shortages are a major issue.
"Nurses are often unable to provide the care we were trained to provide because understaffing forces us to sacrifice time with patients," said Theresa Perini, BSN, RN, BS, an operating room nurse at West Penn Hospital. "That is why Pennsylvania still has the worst nursing shortage in the country, with 20,000 unfilled nursing positions. That is what is driving us away from the bedside, and that is why nurses are standing up for our profession and patient care."
Perini says that West Penn has 650 union nurses.
With their union contract now in place, these nurses have finalized new standards to "help retain nurses, staff their facility safely, protect their health benefits from cost increases, and provide new safety measures for both nurses and patients."
"Four years ago, before we formed our union, there were nurses who had been on staff for 20 years and had their pay capped at less than $40 per hour," Perini said. "In this new contract, we've won a guarantee that no nurse with 20 years of licensure will make less than $50 per hour. That's a massive investment in experienced nurses, and it is a completely new standard for western Pennsylvania."
A spokesperson for West Penn Hospital added that "the new contracts are reflective of our organization's commitment to providing competitive wages and benefits and a fulfilling work-life experience for all of our employees, including both represented and nonrepresented team members."
For Robertshaw and others who favor unionization, more work must be done to foster better conditions for him and his nurse colleagues, but he believes a union is the best way to achieve these goals.
"We successfully organized a union, which was great, but a union is only a tool, a voice, a seat at the table, and a counterbalance of power," he said. "Our power is staying together and working as a unit because, ultimately, the hospitals still have all the power. They have the power of the bully pulpit. When they want to gaslight nurses, they send out a blast email about us."
That's why Robertshaw is committed to ensuring that his union continues communicating a unified message.
"We need to always express our value to the hospital in a very unflinching full-throated voice," he said. "That gives us power to make things safer for our patients and make things more sustainable for nurses to do this job for a long time."
No matter what your opinion is of unions generally, it's a huge step forward that we're in the midst of a labor resurgence, Mahon said.
"The support for the labor movements and unions generally is higher than it's been in decades," she said.
By joining a union, nurses may be making history.
"We want nurses to know they have a home with us," said Mahon. "We are a national union that has a history of powerful advocacy for our patients and our profession. We have achieved so much, including winning the first in the world minimum mandatory patient-to-provider law in California in 1999. We won that law after 13 years of fighting, and we're going to keep fighting."
This is the second of a three-part series on healthcare unionization; an article on physician unionization was recently published, and one on residents unionizing is to follow.