By A. Kevin Troutman
It has often been said that the very purpose of a hospital is to provide nursing care. In today’s sophisticated, high-tech medical world, that statement actually may be truer than ever. Although more and more procedures can be performed on an outpatient basis (usually with nurses involved), patients admitted to a hospital are there primarily for the nursing care. This statement is not intended to diminish in any way the role of the incredible doctors and other members of health care teams. But nursing care remains the lynchpin of a hospital, especially for inpatients.
To illustrate, one only needs to consider who spends the most time with hospital patients each day. During a typical hospital stay, a patient may see the doctor(s) once or twice a day. A nurse, on the other hand, coordinates implementation of the doctor’s orders, interacting with the patient around the clock. Nurses also generally coordinate activities with other caregivers, from nursing assistants to professionals from the hospital’s many ancillary departments.
This framework illustrates how and why Texas hospitals benefit from maintaining strong employee relations programs in which employees would not consider turning to a third party, such as a union, for help. Additionally, strong employee relations and a union-free status help minimize operational disruptions and ensure the continuity of patient care. After all, a strike would at least interrupt regular staffing, with a ripple effect likely extending to other departments and possibly even the hospital’s supply chain.
Additionally, a union-free environment is far more flexible and nimble, and thus more responsive to fluctuating workloads, changes in patients’ conditions and other dynamic circumstances. This environment is also less stressful for both nurses and supervisors. Unions often rely upon an opinion that management cannot be trusted, effectively making supervisors the object of suspicion or even antagonism. In short, committing to strong employee relations and maintaining union-free status is a business decision that affects business results.
After a flurry of activity that resulted in organizing about a half dozen Texas hospitals approximately ten years ago, nursing unions have not been able to gain much more traction in the Lone Star State. Nevertheless, Texas remains an enticing target for union organizers, precisely because it has such a large number of nurses who are not union members. In fact, the high-profile nursing union, National Nurses United (NNU), aka National Nurses Organizing Committee (NNOC) and California Nurses Association (CNA), remains active in Texas. During the past few months, the union has coordinated events, issued political statements and organized nurse “rallies,” even attempting to put pressure on selected hospitals with which it has disputes.
The Service Employees International Union (SEIU) is the largest and most active union in the health care industry. It represents mostly service nursing home workers, lab techs, environmental service workers, and dietary aides. Both the SEIU and the NNU/NNOC/CNA work hard to present themselves as advocates for patient care, “working people” and public safety. The SEIU also has assumed a high-profile role in championing efforts for a $15/hour minimum wage. Over time, these unions have become more and more polished and effective in delivering their message.
Unions are, however, also businesses. Like other businesses, they continually seek to grow their revenue and market share. In a union’s case, that means trying to attract new members by organizing more hospitals. In that vein, they have again become more sophisticated. The SEIU won an impressive 83 percent of its representation elections in 2018. (For a union to attain recognition as the collective bargaining representative of a group of employees, it must normally win a secret ballot vote or “election” among the employee group it seeks to represent.) The NNU and its affiliates are even more deliberate in selecting hospitals for potential organizing, which enabled it to win all of its elections in 2018. Their strategy has even included pulling out of representation elections when the prospects for success appear to be in doubt.
In short, the NNU is methodical and patient in its organizing attempts, nurturing relationships with potential members over time by discussing issues, such as staffing, that are important to nurses. Nevertheless, where unions are in place, the threat of strikes exists. Journals and online postings among nurses frequently discuss unionization, as well as questions regarding nurses’ ethical duties to patients in the event of a strike.
With this in mind, effective and genuine employee relations programs, fully embraced by management, still represent the best way for hospitals to maintain their union-free status and to avoid the uncertainties and potential disruptions caused by strikes or just tense relationships with a union. As many Southeast Texas hospitals have long demonstrated, a strong employee relations program ensures a great foundation for success. As those facilities recognize, happy and engaged employees are more likely to take better care of patients and their families. And positive, responsive employee relations keep nurses and other employees from ever feeling that they need to turn to a third party to listen to or resolve their concerns.
As nurses are the core of hospital services, so too is the essence of listening and responding to their concerns. This permits nurses to concentrate on their primary function of patient care. A positive, collaborative environment also helps reduce turnover, which is always an important concern. And a positive workplace helps reduce the rate of nurse burnout in a high-pressure environment.
As any patient who has ever depended upon nursing care can attest, the importance and value of their care is immeasurable. The genuine concern of outstanding nurses lies at the heart of a hospital’s mission. Thus, it is worth great effort and attention for employers to continually nurture positive, constructive relationships with its nurses. In almost every case, those nurses constitute the heartbeat of the hospital.