Nurses Unionism: Defending Privilege or Defending the Public

“We are a genuine social union. We believe the interests of our members and the public interest are identical. Nurses have a legal obligation to advocate for their patients; they function outside of the profit motive,” is how Rose Ann DeMoro, California Nurses Association (CNA) executive director, explains her union’s outlook. Giving content to these words, CNA has become an unwavering advocate of single-payer health care (government-funded universal health insurance that eliminates private insurers) – and has formed the National Nurses Organizing Committee (NNOC) to unionize nurses throughout the country. The linkage between public and workplace advocacy is rooted in CNA’s history. Originally part of the American Nurses Association, a conservative professional group dominated by supervisors, the California state organization split from its parent body and reformed itself as a union (a process loosely analogous to that by which the National Education Association transformed itself from a teachers professional society into a union). Driving this was the transformation of the health care industry with the mushrooming of for-profit hospitals, and the growing national influence of private insurers and pharmaceutical companies—a process which has undermined public health, leaving tens of millions uninsured or inadequately insured. The same process has led to heightened work pressures on nurses, with increased nurse-patient ratios, with attempts to lower medical skill requirements to growing obligatory overtime. The combination of pressures have been particularly threatening to nurses, still overwhelmingly women, with home personal responsibilities in addition to work, with a long history of struggle for professional credentials and respect in the medical field.

CNA’s trajectory, however, has put it into a direct conflict with the Service Employees International Union (SEIU), which, since its merger in 1998 with the New York-based hospital workers union, 1199, aggressively organizes skilled and unskilled health care workers. Their response to the transformation of the industry has, however, moved in the opposite direction of CNA’s: legislative and bargaining compromises to save jobs. This led to conflict in California where CNA backed a bill in the state legislature providing for single-payer health insurance, another union (and SEIU local) backed proposal was for basic but not as far-reaching reform, and SEIU’s national leadership supported a much weaker third bill—all three being narrowly defeated. Contradictory approaches are also taken to contract negotiations in which SEIU is willing to sacrifice nurses’ particular job needs in order to obtain overall agreement. Marilyn Albert, a registered nurse, NNOC organizer (and former 1199 member), makes explicit the difference between the two unions in her critique of SEIU as a union that “did not take up the struggle of the rights and responsibilities of health care workers and their unions to advocate for patients against corporate health care and the hospital industry ... Whether in collective bargaining, or in enforcing contracts and reacting to on-the-job, day-to-day working conditions and patient care conditions, the union did not take up important struggles of nurse-to-patient ratios or work overload for other workers …”

To which SEIU responds that CNA is a “craft union and elitist organization” uninterested in the needs of the vast majority of health care workers. The defense of skilled workers and their particular needs is not, however, contrary to the defense of unskilled workers; in fact, clear job definitions provide all workers with a defense against arbitrary management practices. That was key to 1199’s emergence in 1950s New York, as it was formed when skilled unionized pharmacists built an organization of the unskilled—preserving, enhancing, existing jobs, creating ladders between jobs, and never ceding the right of job definition to management. The security that gave its members gave 1199 the union the strength to defend a broad progressive political agenda, to defend the public interest against private greed.

In many ways, CNA today is carrying out 1199’s legacy—but that legacy is not furthered by defining SEIU as the enemy—as CNA does in its website Serving Employers Instead of Us. SEIU still represents a huge number of health care workers who benefit from that membership, skilled and unskilled workers with whom CNA must find a way to cooperate—even in the face of SEIU’s leadership’s aggressive hostility. As the fate of health care reform legislation in California is a sad reminder, disunity costs—and it makes little difference to be right in an argument if the result remains defeat. That unity is especially necessary because CNA is challenging the enormously profitable and politically powerful pharmaceutical and insurance industries, challenging hospitals similarly powerful in state and municipal politics. How to achieve that in a principled manner is something only those engaged in the union’s actual work can determine, but without a determined effort to do so, CNA will not be able to fully realize the goals DeMoro sets forth.