Running head: COLLECTIVE BARGAINING

Collective Bargaining in Nursing

Ferris State University
Ashleigh Windel

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Abstract

Collective bargaining gives nurses a voice to be heard that is used to advocate for patient safety and better
working environments. The minimal involvement of nurses in unions, as well as, the lack of knowledge
about the goals of nursing unions is a growing issue. This issue analysis provides information from peerreviewed journals identifying causes and ways to improve them. Two theories relatable to the topic are
also identified in order to provide additional support. The purpose of this analysis is to assess the causes,
implications and recommendations for change to improve participation in collective bargaining in
nursing.

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Collective Bargaining in Nursing

Collective bargaining is often used interchangeably with the word union which immediately
bestows a negative stigma. Therefore, in the nursing realm, the small amount of attention this concept
receives is mostly unfavorable. Many nurses do not realize collective bargaining can be used as a
valuable tool providing the discipline with a voice that is actually heard. Collective bargaining is utilized
to advocate for quality and safe patient care through better working conditions for the nursing staff
(Manthous, 2014). According to Clark (2006), unions not only work to implement change in hospital
policies, they use political/legislative processes to bring about change. This issue analysis specifically
focuses on collective bargaining in the nursing field and the reasons why it is a concern, as well as, any
implications, outcomes and changes that need to occur. In addition, two theories relatable to the nursing
issue will be addressed.
Collective Bargaining and Unions
According to Unions Plus, How do Unions work, ((HDUW), 2015), collective bargaining is a
process of negotiation between employees and their employers to come to an agreement that regulates the
working environment. A bargaining unit, or group of workers, must be identified by the employer as a
union before any contracts can be negotiated (HDUW, 2015). Employers can legally try to persuade
employees from unionizing but they cannot threaten them (HDUW, 2015). Typically, union members
will vote for officers to carry out discussions with employers for wages, hours, benefits and safety
(HDUW, 2015). If an agreement is made than a collective bargaining agreement is signed and the
employer cannot change details without approval from the union officers (HDUW, 2015). The collective
bargaining agreement lasts for a set period of time (HDUW, 2015). According to Union Plus (HDUW,
2015), if an agreement is not reached the union can decide to strike but they must give advance notice.

Theory Base

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Betty Neumans Systems Model is a nursing theory that is considered a wellness model and is
based on concepts of stress and reactions to stress (Neuman, 1995). In Neumans model, there is a central
basic structure representing the client that is surrounded by three layers of rings serving as the lines of
resistance, normal line of defense and flexible line of defense (Neuman, 1995). When the client is
affected by stressors they are first resisted by the flexible line of defense, also known as, the protective
buffer for the normal line or wellness state (Neuman, 1995). If the stressor is successful in penetrating the
two lines of defense it meets resistance with the innermost rings that directly protect the basic structure
(Neuman, 1995). The lines of resistance only activate after the normal line of defense has been invaded
(Neuman, 1995). According to Neuman (1995), their purpose is to allow the basic structure to
reconstitute after invasion of a stressor. Neumans (1995) Systems Model addresses three levels of
prevention as intervention to assist the client in making adjustments to maintain an optimal wellness
level. Primary prevention focuses on identifying potential stressors before they have occurred, in order to
prevent them from resulting (Neuman, 1995). Secondary prevention develops after primary has failed or
a reaction to a stressor has materialized (Neuman, 1995). At this point, the lines of resistance are
strengthened and appropriate actions are taken to attain optimal wellness again (Neuman, 1995).
According to Neuman (1995), tertiary prevention is used as reconstitution or as a learning opportunity on
how to deal with or avoid the encountered stressor.
For the purpose of applying the Systems Model to the focused nursing issue, the center of the
basic structure will be labelled collective bargaining. Stressors that can harm collective bargaining
include; negative image of unions, lack of education and lack of workplace compliance with unions. The
lines of resistance or first lines surrounding the basic structure include laws regarding unions and rights to
collectively bargain. These laws protect collective bargaining from stressors that have permeated the
previous lines of resistance. The normal line (or wellness state) is made up of the unions unselfish
campaign for patient safety, quality of care measures and professionalism in bargaining. The wellness
state creates a positive image for collective bargaining and accomplishes ultimate desired goals. The

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flexible line of defense (or protective buffer for the normal line) includes; the quality of working
conditions, number of nurses involved and professionalism of union members. If negative opinions
(stressor) penetrate the flexible line of defense then the number of nurses involved in unions decrease and
the campaigning for better working conditions deteriorates. The stressor then reaches the normal line.
The factors affected in the flexible line start to affect the unions campaigning for patient safety and
quality of care. If the stressor is able to permeate the normal line, the lines of resistance will be activated
and laws regarding union rights will protect collective bargaining from ceasing to exist.
Albert Banduras Social Learning Theory (1977), new patterns of behavior are acquired through
direct experience or the observation of others. People learn the consequences of their actions and develop
thoughts about the type of behavior that will be successful (Bandura, 1977). In nursing there is much
opposition to collective bargaining. This behavior is commonly observed in the workplace and carried on
through new nurses. Bandura discusses, people typically do not wait to be discomforted by a torrential
downpour to decide what to wear (1971). Therefore, much like donning a raincoat to avoid being soaked,
nurses do not join unions in order to avoid being thought of negatively. Unfortunately, many nurses do
not venture to find out more about collective bargaining on their own but instead follow the general
opinion. Through observation of resistance to union there is decreased participation in collective
bargaining.
Assessment of the Health Care Environment
There are many occupations well-known for having unions advocating for workers rights.
National Nurses United (NNU), the nations largest union of registered nurses, works to improve the
general welfare of nurses, provide a quality work environment, protect nurse and patient safety; and
influence nursing practice standards (Michigan Nurses Association, n.d.). The main concept is that
working together in a union will help solve many of the health care industrys challenges (Michigan
Nurses Association, n.d.). However, in the medical field, less than 20% of physicians and nurses in the
United States are involved in unions (Manthous, 2014). In the United States, the National Labor

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Relations Act protects the rights of employees to unionize by making it unlawful for employers to
interfere or restrain unionization (Michigan Nurses Association, n.d.). The act also states that any
collective bargaining activities must be handled out of patient care areas and during free time so as not to
interfere with deliverance of health care (Michigan Nurses Association, n.d.).
Upon research of collective bargaining in hospitals in Michigan, it was found that the University
of Michigan in Ann Arbor has a 273 page contract with a union known as the Association (MNA
agreement, 2013). The collective bargaining contract that was signed began in 2013 and is set to end in 5
years. Upon orientation to the hospital, each registered nurse receives a copy of the contract and is told
they are required to pay union dues of $57.25 monthly (MNA agreement, 2013). Failure to pay dues
result in termination from the University of Michigan Health Systems (MNA agreement, 2013). In
hospitals where there is a strong union presence there will be more participation in collective bargaining,
but, in hospitals where there is not a union presence, nurses are less likely to participate or even know
about collective bargaining. For example, Spectrum Health lacks union presence in their hospitals.
A few causes can be contributed to the decreased number of nurses utilizing their right to
unionize. These causes include; misconceptions, lack of education and lack of workplace support. The
theories previously included addressed the causes of dwindling union involvement as stressors. This
section will delve into the main causes that occur in the healthcare environment. It is not uncommon to
hear negative misconceptions about collective bargaining in healthcare. Such adverse impressions are
largely due to the well-known actions of unions in other fields of work. According to Manthous (2014),
historically, the chief goal of unions have been for selfish interests of the members, such as; wages and
working conditions. Furthermore, the common tendency of unions to engage in job actions that include
work slow-downs or strikes as primary weapons have created a negative stigma surrounding the right to
collectively bargain (Manthous, 2014). The large amount of nurses not joined in unions mostly results
from the common belief that involvement is inappropriate and unprofessional (Clark & Clark, 2006).

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Accompanying misconceptions, is a general lack of knowledge about the purpose of a nurse

union. Nurses tend to be selfless caregivers with patient wellbeing as the primary focus of their job
(Clark & Clark, 2006). Negative attitudes towards unions added to lack of awareness about the purposes
of collective bargaining in nursing repels more nurses from joining organizations. In addition, it has
become more common for employers to stop posting workers rights in the workplace, some employees
may be unaware that they have a right to unionize (Manthous, 2014).
Lastly, nurses may fear hostility from employers and co-workers if involved in collective
bargaining, even though it is a right protected by national law. According to Manthous (2014), employers
may not support unionization and go as far as to discourage membership because it has the potential to
drive up operating costs. Every hospital has a finance department that worries over costs and places
pressure on managers to keep down costs as much as possible. The Michigan Nurses Association (n.d.)
discusses, although the National Labor Relations Act prohibits employers from interfering with
employees rights to unionize, that does not mean there is absence of strong opposition to unions from the
employer. An employer may express their aversion as long as there are no threatening actions towards
employees and unions, unfortunately, this expression may be just enough discouragement to prevent
nurses from joining (Michigan Nurses Association, n.d.). The exclusion of supervisors from participating
in unions may also influence the membership of staff nurses (Albro, 2008). Floor nurses may feel that by
participating in collective bargaining their supervisor will feel unfavorably towards them.
Inferences and Implications/Consequences
There are many implications supporting the need for increased involvement in collective
bargaining. Collective bargaining gives nurses a voice to ask for better working conditions so that they
are able to provide safe care. Better working conditions for nurses will make the profession more
appealing, which will, attract people to nursing school and therefore, result in a lessening of the nursing
shortage (Albro, 2008). Albro (2008) discusses, unionizing is the most effective way to improve patient
care and the nursing work environment. On average, nurses working in unionized hospitals earn higher

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wages than those in non-unionized hospitals which leads to higher job satisfaction, more appeal to the
profession and, consequently, improved patient care (Albro, 2008).
Nurses with heavy patient loads or those required to work mandatory overtime are often unable to
provide appropriate and safe care to patients, which results in; greater stress, decreased job satisfaction
and a decrease in the number of practicing nurses (Clark & Clark, 2006). According to Albro (2008), the
physical exhaustion from working long hours with heavy patient loads due to a lack of collective
bargaining has caused many nurses to leave the profession. It can be inferred that without increased
involvement in collective bargaining the better work environments will not be achieved, the nursing
profession will appear unappealing and the shortage will not improve.
Recommendations for Quality and Safety Improvements
Less than 20% of registered nurses are joined to a union (Manthous, 2014). This percentage is
relatively small to make an impact and influence change in patient care practice decisions. As the nursing
shortage continues, it negatively effects the quality of care delivered and leads to decreased job
satisfaction among nurses. Therefore, it is important to realize that nurses need collective bargaining not
only for patient care interests but for self-interest. Collective bargaining has long been associated with
negative stigmas and unprofessionalism, this has prevented nurses from participating. Negative views
need to be changed so collective bargaining is seen as a tool to be utilized by nurses to advocate for safe,
patient-centered care and implement quality improvement processes (QSEN, 2014). Nursing unions
provide leadership to change practices that adversely impact patients by working with employers to
update policies and with the government to create new legislation. The act of collective bargaining meets
standard twelve, leadership (ANA, 2010). A competency of leadership is that nurses participate in
endeavors to change healthcare policies involving patients and the profession of nursing (ANA, 2010). A
recommendation to increase membership in unions is to have recruiting opportunities several times a year
in healthcare facilities. Hospitals would like to be staffed with nurses that demonstrate leadership in the

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profession so having the opportunity to be involved in collective bargaining would promote leadership
skills among employees.
One recommendation is to educate nurses on how they can have a significant role in patient care
practice decisions by being involved in a union (Clark, 2006). Education and awareness could start in the
nursing program. Students will be taught how collective bargaining works to improve patient-centered
care and strive for quality improvement through changing legislature and working conditions (QSEN,
2014). Standard eight, education, of the standards of professional nursing practice states, The
registered nurse attains knowledge and competence that reflects in current nursing practice (ANA,
2010). One of the competencies for standard eight states that a way to meet this standard is for the
registered nurse to participate in consultations that address issues in nursing practice as an application of
education and a knowledge base (ANA, 2010). Nurses can achieve the education standard by becoming
aware of how unions want to change nurse to patient ratios and mandatory overtime.
Many hospitals have quality improvement teams or programs in order to improve practice and
patient outcomes. For example, Spectrum Health Butterworth Hospital had a quality improvement
process that tested outcomes for no-pass call light zones. When it was seen that this practice benefited
patients it was implemented throughout the entire hospital. Since unions also strive for quality
improvement they could work with hospital quality improvement team members to help change and
create policies to improve patient care and health care delivery. Standard eleven, communication,
states, the registered nurse communicates effectively in a variety of formats in all areas of practice
(ANA, 2010). Collective bargaining uses communication with a variety of people and organizations to
convey important healthcare processes and decisions that are in the best interest of patients (ANA, 2010).
Through communication, unions can team up and collaborate with hospitals in order to implement quality
improvement practices and provide superior patient-centered care. Hospitals need to realize that it is in
their best interest to begin promoting joining unions so that legislation can be passed to improve patient

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care. Through the QSEN (2014) competency, teamwork and collaboration, hospitals patient outcomes
and retention of nursing staff will improve.
Conclusion
Collective bargaining may not be a popular topic in nursing but it is an important issue. The
small percentage of unionized nurses in the United States are not going to cut it when it comes to fixing
other healthcare problems like, nursing shortage, job dissatisfaction, mandatory overtime, nurse to patient
ratios and quality of patient care. Union membership must be increased. Through education and
teamwork between hospitals and unions, the negative stigmas walling off people from participating in
collective bargaining will begin to dissipate. Nurses will become more informed of union efforts to
change policies and legislation in order to improve healthcare and membership will increase. Collective
bargaining is a voice heard advocating for patients and nurses.

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References

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NLRB decision threatens to limit the ability of nurses to unionize. Northwestern Journal of Law
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American Nurses Association (ANA) (2010). Scopes and standards of practice (2nd ed.). Silver
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Quality and Safety Education for Nurses (QSEN) (2014). Competencies. Retrieved October 4,
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