Nursing Issue Paper: When Nurses Go on Strike
I. Introduction
Problem Identification
The 21st century is confronted by individualistic and liberalist mindsets with intensive professional setup. Among the nurses, one of the biggest union groups in United States aside from Service Employees International Union is the United American Nurses (UAN). Currently, UAN holds approximately 102,000 registered nurses as their members. According to Polifko-Harris (2004), unionization of nurses has been brought by their (a) extensive awareness and concern for their legal rights, (b) interests and desires for policy confrontation and (c) issue settlements (p.261). Staffing conditions have become critically compromised during union strikes of working RNs; hence, studying such issue and planning potential plans can aid in staffing preparations or preventions for future occurrence of such event.
II. Background
One of the major policies considered for resolving nursing settlement is the wage boosts offered by the hospital depending on the administrative-institutional policy. In the recent statistics provided by UAN, the total number of RN employed in United States as of 2003 is around 2.4 million, and in this number, only 472,000 approximately are members of the unions. Added by UAN, RN population is as small as 19.5% versus the 80.5% of unorganized total employee representation in the United States, which further drops the significance of union RN powers (UAN, 2005). However, according to Lovell (2006), despite the lower collective force of RN union members, these individuals are able to manipulate an increased wage boost of up to 13% from their private employers. Public RNs are more unionized summing to approximately 41.5% compared to the 9% from organized private RNs (UAN, 2005). In addition to this, UAN has determined dramatic surge of union membership over the last five years, which accounted to 17.9% for union membership increase and 21.1% for union representation only from 2002 to 2003 (UAN, 2005). As of 2005, the top three states of United States with unionized nurses are California with 11,780 members, Washington with 4,975 members and Georgia with 4,582 members (UAN, 2005). Under these circumstances, striking of this progressively increasing huge number of RNs can greatly impair the staffing conditions of nurses (Benjamin and Curtis, 1992 p.233).
Conflict Resolution through FMCS-Legal Procedure
Members of the union have always believed in the power of collective professional organization in terms of reinforcement issues for bargaining or conditional demands (Nash, 2006 p.159). The three principal concerns of union strike are staffing ratios, compensations and working conditions (Giacalone, 2001 p.76). According to the Nurse’s Legal Handbook (2004), there is a significant step to follow prior to the decision and commencement of any union strike. First, employer and employee require 30 days of settlement period prior to case filing directed to Federal Mediation and Conciliation Service (FMCS). If in such time frame and the issue has not yet been resolved, the case is extended for additional 15 days for further reconciliation; however, if this still doesn’t work out, union members’ strike votation is commenced. If majority of the union members agree, the strike is scheduled 10 days prior to the actual date and held according to the stated conditions (p.288). Such condition threatens most importantly the health care conditions of those patients requiring nursing care.
UAN HR. 2123 Policy: Demands of Nurses-on-strike
Union strikes of nurses, in general, have always been attributed to the concept of collective bargaining on a request of change for particular conditions, which most often are related to (a) salary raise, (b) patient-nurse ratio, and (c) staffing conditions (Bates, Dodd and Rosseau et al., 2005 p.220). In order to resolve this, Rep. Janice Schakowsky has introduced “Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007” or H.R. 2123 (UAN, 2005). Each nursing union has diverted their concerns from these three cited common concerns to more professional and deeper sense of political professionalism. The policy H.R. 2123 has enabled proportioned allocation of nurse staffing depending on the complexity of area; however, allocations of workforce are still confronted by further issues (UAN, 2005). For example, the union of Michigan Nurses Association (MNA) has emphasized the role of protectionism and legal security of their members as their collective bargain issue, while the Canadian Federation of Nurses Unions (CFNU) has focused in strengthening the rights of their members to strike in response to wage increase problems (Roussell, Swansburg and Swansburg, 2006 p.387).
a. Social Factors
Staffing of nurses can greatly be affected if these union nursing members proceed on strike during their working hours defying rally protocols (e.g. 1988-19 day illegal strike of United Nurses of Alberta, etc) (Bates, Dodd and Rosseau et al., 2005 p.220). According to UAN (2005), unionization of nurses across United States has not yet reached their expected union density with still 80% approximate RNs unorganized. With 472,000 members and 17% annually increasing population of union members, union density is expected to increase further. Meanwhile, according to Allen (2004), unions are targeting long-term care workers and critical care nurses in order to strengthen the impact of the union density (p.334). In effect, bargaining powers of the union are expected to increase its impact towards the hospital management in fulfilling their demands. The issue on continuity of patient care and maintenance of the hospital’s quality and competitive standards can greatly be affected if both (a) union density increased and (b) quality and critical employees pulled-out.
b. Economic Factors
As per general protocol, hospitals are obliged to continue health care delivery despite the occurrence of strike. In effect, hospitals are forced to hire reliever nurses for higher wage compensation, while also settling conflicts with the striking union creating another cost obligation. According to Reshef and Rastin (2003), hospitals are confronted by approximately U.S $30 for conflict settlement budget during strike (e.g. 1988- United Nurses of Alberta’s strike, etc) (p.303). From recent events, California Nurses Association went on strike last October 2007 covering up to 15 Northern Californian hospitals and approximately 5000 RNs. Economic implications involve (a) reliever cost of $1 U.S per day, and (b) further increase of health care costs from 60% salary component of the overall health costs paid per single admission (Tocolli, 2007).
c. Ethical Factors
Ethical considerations of such issue involve (a) duty of the nurse to continue patient care and (b) professional rights of the nurses to conduct strike. According to Tschidin (2003), nurses are expected to follow their professional duty to care under the ethical principle of role fidelity; however, due to political responsiveness brought by unionization, such ethical code is violated especially during strike commencements (p.180). According to Pozgar and Santucci (2004), a nurse who defies his or her duty of care in participation to union strike and has not properly ordained the length of strike accordingly breaches the patient’s right for continuity of care and the nurse’s role fidelity principle (p.38). Nurses possess their privileged right to rally; however, this privilege is still governed by legal procedures preventing breach in the health care system.
d. Political and Legal Factors
Nurses-on-strike must respect the patient’s rights of acquiring continuous care delivery and uncompromised quality of care. However, due to many instances of illegal strikes, breach on these legal and ethical rights of the patients are often inevitable. Nursing unions possessed their rights to rally and express their demands and bargain through their protestation; however, there are legal considerations that must be considered in taking such act (Gordon, 2005 p.296). From the different rights of the management, there are four principal rights applicable to the issue of nursing strikes during working hours affecting the staffing proportions, namely (a) management has the right to receive strike notice, (b) management has the right to prohibit Union activity during working hours ( 1974 Taft-Hartley Amendments to Wagner Act), (c) management has the right to prohibit supervisor participation, and (d) management has the right to hire replacement workers (Pozgar and Santucci, 2004 p.444). Despite the existing legal procedures, some events of nursing strike violate these protocols in exchange to the fulfillment of their bargained demands, such as 19-day (supposed to be an 11-day strike) illegal strike in Alberta in 1988, 7-day illegal strike of 21,777 of 300 hospitals in Quebec, etc (Bates, Dodd and Rosseau et al., 2005 p.221).
III. Issue Statement
How should hospitals handle dispute settlement among the rallying nurses during nurses’ strike commencements without compromising patients’ continuous and uncompromised health care delivery?
IV. Stakeholders
If the hospitals with nurses-on-strike fail to deliver adequate staffing and uncompromised care quality, the greater risks fall into serviced patients. Compromised staffing can lead to the quality health care delivery. In addition, failure to settle the conflict with the existing nurses can place the hospital in progressively increasing reliever costs, while at the same time, possibly increasing the demanded health care costs for the patients. As with UAN (2005), the number of union members is progressively increasing with an approximated rate of 17% annually, while Allen (2004) points out critical and long-term RN employees as the primary target of union campaigns (p.334). Depending on the strike coverage, relief costs can place the hospitals in grave financial burden, while compromising the health care delivery as well due to possible problematic staff replacements. Relief measures and settlement procedures must be planned well to prevent the consequences.
V. Policy Options and Alternatives
The primary goal of union strikes is to address nurses’ concerns in terms of (a) salary adjustments and/or (b) staff restructuring. Policies associated to these modifications can be decided by the management or through FMCS standard proceedings. The following objectives have been proposed to assess the policies:
a. Established policies must not compromise the image of hospital authorities by any means including protest-based salary increases
b. Assess the need for possible restructuring of the workforce in relation to the current prevailing patient-nurse ratio
c. Establish stress-reduced & efficient working environment for staff nurses
VI. Policy Goals and Objectives
a. Reorganization of Staffing condition Option: Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007 or addresses H.R. 2123 reestablishes one of the nurses’ primary concerns – staffing. Restructure patient-ratio according to the policy recommendation to alternatively resolve the crisis of nurses’ union strikes.
b. FMCS-Standard Procedure Option: Follow FMCS directed protocol of conflict settlement under court mandates and judgments.
c. Major Change Option: Resort to wage boosts according to institutional policy on salary increase.
VII. Evaluation Options
Analysis: Implementing Nurse Staffing Standards for Patient Safety and Quality Care Act is considered the best possible option to resolve the crisis involving nursing strikes. By addressing their concerns in staffing proportionality, expensive salary increase can be prevented. However, staffing restructuring shall require additional number of staff depending on the computed ratio based on Safe Staffing Ratio.
Reorganization of Staffing condition Option
a. Criterion 1: Consumes lesser implementation time frame
Pros: By restructuring the hospital’s staffing conditions, working stress and ratio disproportions can be reduced exercising and emphasizing the managerial task of workforce restructuring. According to UAN (2005), staffing is the primary concern of nursing unions employing their right to strike.
Cons: Re-staffing the workforce environment can provide additional hospital expenses through recruitment costs. Hiring period can also possess invariable time frame (Roussell, Swansburg and Swansburg, 2006 p.387).
b. Criterion 2: Uncompromising to patient’s continuity of care
Pros: Implementing the policy can reduce relief period facilitating continuation of care by progressive resolution of staffing concerns of union protest (UAN, 2005).
Cons: Staffing propositions may not be immediately reconsidered by union committees due to its longer hiring frame (Giacalone, 2001 p.76).
c. Criterion 3: Reduction of Reliever Costs
Pros: Implementing H.R. 2123 act can provide the efficient means of reducing the time span of nurses’ protest, which consequently reduces the relief period (UAN, 2005).
Cons: Act H.R. 2123 may elicit higher disruption on health care continuity due to the unpredictable return of duty for those nurses-in-protest (Allen, 2004 p.334).
FMCS-Standard Procedure Option
a. Criterion 1: Consumes lesser implementation time frame
Pros: Since this is a standardized protocol conflict, the two conflicting parties may settle their concerns under due process of law (Giacalone, 2001 p.76).
Cons: Considering the FMCS three-month settlement period, court results may further prolong the institution-union conflict (Pozgar and Santucci, 2004 p.444).
b. Criterion 2: Uncompromising to patient’s continuity of care
Pros: FMCS proceedings may require return of post for those rallying nurses based on 1974 Taft-Hartley Act to prevent the disruption of patient continuity of care (UAN, 2005).
Cons: Despite the option of implementing return of post, health care provision is at the greater risk of being compromised due to conflict unsettlement (Giacalone, 2001 p.76).
c. Criterion 3: Reduction of Reliever Costs
Pros: By implementing return of post, FMCS proceedings may actually reduce reliever cost in response to Taft-Hartley Act (Pozgar and Santucci, 2004 p.444).
Cons: With unresolved issues between workers and administrations, relief period may still prolong due to decreased retention rate among nurse staffs (Allen, 2004 p.334).
Major Change Option
a. Criterion 1: Consumes lesser implementation time frame
Pros: Wage increase may immediately resolve the conflict since this is one of the proposed demands of the union in most cases (Polifko-Harris, 2004 p.261).
Cons: Increasing the wage based on strike occurrence may damage the authoritative figure of the institution encouraging other organizations with similar context to conduct rallies in the effort of increasing their compensations (UAN, 2005).
b. Criterion 2: Uncompromising to patient’s continuity of care
Pros: Providing salary increase can immediately restore the previous working condition, which consequently resolves the conflict on health care delivery system (UAN, 2005).
Cons: Conflict resolution must be done without compromising the authorities’ disposition as well as the patients’ continuity of care (Polifko-Harris, 2004 p.261).
c. Criterion 3: Reduction of Reliever Costs
Pros: By increasing the wage of union nurses and retrieving them back to post, relief period is eventually terminated reducing as well the reliever cost (Allen, 2004 p.334).
Cons: Even with the wage increase, the absence of staff restructuring may still compromise the health care delivery due to disproportionate work load (UAN, 2005).
VIII. Results and Analysis
As for the results of policy analysis, policy restructuring with emphasis on staffing requisites is the most feasible way of resolving the conflict between the institution and union protestors. Instead of increasing the salary, which can compromise the image of the institution and still maintain the disproportionate workloads, or implementing FMCS method, which can take up to three months prolonging further the conflict, it is best to implement the restructuring of staff to further mobilize health care delivery and reduce the work load of the nurses.
IX. Summary
Despite of the policy of strike procedures, hospitals are still confronted by such issue concerning nurses’ settlement and patient’s continuous care. The primary concerns of nurses in most of these strikes are increased of wages due to the increased work load they are receiving from disproportionate patient-nurse ratio, or restructuring of staff according to the Safe Staffing Ratio. Upon analyzing the three different policies proposed, the most policy advantages are directed to the restructuring of the staff ratio. Instead of increasing wages of resorting to the long-method of FMCS, signing an agreement proposing staff restructuring can best resolve the conflict of union protest. Implementing H.R. 2123 policy can reduce relief costs, resolve the conflict progressively and retrieve the continuity of care in the health care system.
References
Allen, J. E. (2004). Assisted Living Administration: The Knowledge Base. New York, U.S.A: Springer Publishing Company.
Bates, C., Dodd, D., & Rousseau et al., N. (2005). On All Frontiers: Four Centuries Of Canadian Nursing. New York, U.S.A: University of Ottawa Press.
Benjamin, M., & Curtis, J. (1992). Ethics in nursing: Martin Benjamin, Joy Curtis. Oxfordshire, U.K: Oxford University Press US.
Gordon, S. (2005). Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care. New York, U.S.A: Cornell University Press.
Lovell, V. (2006, January). Solving the Nursing Shortage through Higher Wages. Retrieved September 27, 2008, from Institute for Women’s Policy Research: http://www.iwpr.org/pdf/C363.pdf
Nash, A. (2006). Through the Lens of Social Justice: Using the Change Agent in Adult Education. New York, U.S.A: World Education, Inc..
Polifko-Harris, H. (2004). Case Applications in Nursing Leadership & Management. New York, U.S.A: Thomson Delmar Learning Press.
Pozgar, G. D., & Santucci, N. M. (2004). Legal Aspects of Health Care Administration. New York, U.S.A: Jones & Bartlett Publishers.
Reshef, Y., & Rastin, S. (2003). Unions in the Time of Revolution: Government Restructuring in Alberta and Ontario. Toronto, U.S.A: University of Toronto Press.
Roussel, L., Swansburg, R. C., & Swansburg, R. J. (2006). Management and Leadership for Nurse Administrators. New York, U.S.A: Jones & Bartlett Publishers.
Springhouse Corporation, . (2004). Nurse’s Legal Handbook. New York, U.S.A: Lippincott Williams & Wilkins.
Tocolli, B. (2007, October 22). Looming Sutter nurses’ strike raises costs for business. Business Journal. Retrieved September 27, 2008, from http://www.busjrnl.com/article/20071022/BUSINESSJOURNAL/71017040/1209
Tschudin, V. (2003). Ethics in Nursing: The Caring Relationship. New York, U.S.A: Elsevier Health Sciences.
UAN, (2005, March). Legislative Issue Brief: H.R. 2123 – Legislation to Ensure Appropriate Acute Care Staffing. Retrieved September 27, 2008, from United American Nurses: http://www.uannurse.org/legislative/pdfs/RNratioIssueBrief110Congress.pdf
UAN, (2005, March). Registered Nurse Unionization. Retrieved September 27, 2008, from United American Nurses: http://www.uannurse.org/research/pdfs/unionization.pdf