Attorneys

• E. Donald Ladov (1948-2007)
• John E. Lyncheski

Related Practices

• Healthcare Business
• Labor and Employment

Unions are aggressively attempting to organize healthcare employees and are winning NLRB elections at an unprecedented rate, particularly among registered nurses. The trend is accelerating. Nonprofit healthcare institutions were first subjected to NLRB jurisdiction in 1974. The level of union organizing activity today is unmatched as compared to any time since.

The upsurge in union organizing activity over the past year provides a quick refresher course in U.S. geography: San Francisco, Los Angeles, New York, St. Louis, Cleveland, Boston, Durham, Miami, Honolulu, Denver, Dallas, Detroit, Reno, Tampa and, yes—Pittsburgh and the entire tri-state vicinity. Organizing drives are either underway or elections have been held or scheduled, for example, at St. Anthony’s Medical Center in St. Louis involving more than 2400 employees; Sparrow Hospital Association in Detroit for 2600 employees; and Duke University Medical Center for some 1400 employees. There are many more. In our backyard, District 1199P recently won bargaining rights for 1500 nurses at Allegheny General Hospital and, within the last year or so, union NLRB elections (at some hospitals more than one election) have been held at Forbes Regional, Indiana, Uniontown, Armstrong Memorial, South Hills Health System and Wheeling, among others. It’s public knowledge that aggressive organizing drives are underway at UPMC Lee, Heritage Valley and elsewhere.

If a tri-state healthcare institution has not yet been subjected to a serious organizing effort, management can be reasonably certain that one is being considered or planned by a union, your employees or both. Unions have made no secret of the fact that over the past year healthcare employees nationwide are approaching them in increasing numbers seeking union representation as a means of addressing their workplace concerns. The employees are frustrated, insecure, feeling helpless over their fate and, in some cases, downright angry.

Strikes and threats of strikes also are becoming more commonplace as a means of achieving healthcare workers’ goals. Nyack, N.Y., Boston, and Denver have recently had fairly protracted strikes by nurses. Locally, Brownsville General Hospital has experienced sporadic strikes and Canonsburg Hospital recently averted a threatened work stoppage.

Another burgeoning nursing shortage only adds to and complicates the problem. The causes of this surge in activity are not difficult to fathom. Healthcare management teams face an unenviable combination of pressures that create the business equivalent of swimming in a riptide. Revenues have been severely pinched by the Balanced Budget Act of 1997, the market-driven competition in the managed care industry, and even the bankruptcy of some large HMOs that have fallen prey to the competitiveness. Healthcare institutions are rising to meet these challenges through mergers, alliances, staff reductions, and other moves to economize and, in some cases, survive. Nurses and other caregivers are forced to work under increasing time and staffing pressures while still facing the same or greater demands for quality patient care. It is certainly no secret that the acuity level of inpatients has been driven skyward by a number of factors. Just as this is a most demanding, perhaps least rewarding time for healthcare administrators, it is even more so for those involved in direct patient care. And, the outside challenges to management are drawing their attention away from workplace and human resource issues at a time when attention to these issues is critical. Healthcare executives are being pulled in seventeen different directions and, more than ever before, are facing workplace problems driven by factors beyond their control.

A number of concerns run through each and every situation like a steel rod: staffing, pulling, short-notice overtime, flexing, “belt-tightening” and, above all, lack of an effective voice. These are wedge issues that unions have used very shrewdly and effectively in their organizing drives. With respect to the staffing issue, in many cases the manpower resources needed by many employers simply aren’t available. Many institutions, departments and workforces are being forced to do more with less. As to pulling, overtime and flexing demands, employees have experienced a decline in the quality of their work life and increasing inroads on their guarded personal life. Yet these demands have always “come with the territory” for healthcare and will never disappear. We simply cannot turn off the switch and go home when there are patients, indeed more acute patients, needing our care. Needless to say, these infringements on the comfort zone for most healthcare employees have been exacerbated by the outside forces at play in the healthcare marketplace.

Pay and benefits likewise are attacked in organizing drives, elections, strike scenarios, and at the bargaining table. Like it or not, as noted above, most healthcare facilities now have to do more with less financially in order to remain viable and, among other things, to provide job security for most of their workforce. Institutions that were financially healthy are now bleeding red ink from operations and are staying alive only by dipping into reserves. The end is not yet in sight.

All of the above and more have diverted the attention of administrators from internal issues and their workforce and have required them to pay more heed to the bottom line because of the unfriendly and even hostile environment in today’s healthcare marketplace. Employees, too, are impacted and they want to be heard. They are frustrated and oftentimes don’t understand or aren’t informed of what’s happening and, more importantly, why. Needless to say, they feel, and somewhat legitimately, that they no longer have a voice and they are searching for whatever means available to have their say. The unions are standing in the wings awaiting their call.

Union strategies and tactics in organizing the healthcare industry have evolved quite effectively to attract and respond to the highly professional atmosphere of the industry. The increased availability of information on employees’ names, addresses and phone numbers have given unions easier and quicker access to their target audience, making the union effort more efficient by requiring less resources and field work to make the initial contact. Clumsy, ham-handed sloganeering has given way to effective use of email, the internet, low-pressure home visits and phone calls. Employees are often not even urged to sign union cards immediately but are subtly persuaded to do so over time. The unions have adapted to their audience and know the “hot-button” issues. They are finding employees willing to become involved and to lend their efforts to the union in increasing numbers. It’s no longer just the disgruntled employees on the brink of discipline or other corrective action who are turning to unions. Unions also often make promises free of ultimate accountability if they are not fulfilled and point to the concessions they claim to have achieved on staffing, overtime and pay issues at other vulnerable institutions.

While all these dynamic crosscurrents increase a healthcare institution’s vulnerability to union organizing, the altruistic nature of the healthcare professions still runs strong and deep. Thoughts of work stoppages and a strict work-to-rule ethos infringing on the quality of patient care still strike a deeply dissonant chord in the minds of many. If management is proactive in seeking to meaningfully address the proven core issues—staffing ratios, short or no-notice overtime, flexing pay and benefit inequities and, above all, regular, effective and credible two-way communication—it will markedly increase the ability to resist having employees seek an intermediary to manage the employment relationship for them. The importance of identifying and utilizing every vehicle available to keep employees informed and to provide them with a “voice” has never been more critical. An audit which assesses vulnerability to union organizing, performed honestly and objectively, will help to focus an institution’s limited resources on the areas where it can achieve the most “bang for the buck.” All healthcare institutions are presently vulnerable. Take steps now to minimize exposure, involve and train your managers and supervisors and open lines of communication and your institution will benefit many times over. If you don’t immediately set a proactive course of improving employee relations, you’ll find yourself at the Labor Board embroiled in a serious and difficult union organizing drive. It is extremely important that you identify your areas of vulnerability and take steps to become less susceptible before it is too late.

For more information, please contact jlyncheski@cohenlaw.com or dladov@cohenlaw.com.