Unions in Healthcare 

On January 9, 2023, 7,000 nurses walked out of Mount Sinai Hospital and Montefiore Medical Center in New York City (1). Driven by an expired union contract, the nurses stood outside the hospitals, holding signs that demanded “better patient care” and chanting “Safe staffing saves lives” (1). After three days, the nurses’ union and the hospitals reached an agreement with critical stipulations: a lower nurse-to-patient ratio, a 19.1% wage increase over three years, lower healthcare costs, and 170 new nursing positions (2). Though not as widespread as in some other industries, unions in healthcare similarly aim to protect and support their members in the workplace. 

The strike, as well as the resulting gains, were enabled by the New York State Nurses Association (NYSNA), an alliance of 42,000 nurses across the state (1). NYSNA exemplifies a typical healthcare union, a democratic organization that represents groups of healthcare workers and advocates for their rights. Currently, 11% of healthcare workers belong to a union, including 7% of practicing physicians and 20% of registered nurses (3). Union representatives often interface with employers to attain higher wages, better schedules, and improved benefits. To achieve these goals, unions practice tactics such as collective bargaining and striking, which can result in stigmatization and chaos in the healthcare industry (4). The recent NYSNA strike, for example, caused significant temporary delays in patient care, but ultimately resulted in more nursing positions and better staffing ratios (2). Thus, healthcare unions possess both benefits and drawbacks. 

Healthcare unions, like labor organizations in other fields, offer advantages to members, such as increased job benefits, job security, better conditions, and legal representation (5). Union officials, typically employees of the employing organization elected by the union members, represent the union and advocate for their rights by meeting with management to discuss labor contracts. Driven by the needs of the collective, union officials typically bargain for fair structures for disciplinary action, consistent standards for promoting and terminating employees, stipulations for raises and bonuses, and rules about workplace safety (5, 6). Benefits such as healthcare are also provided by many unions — indeed, 95% of union workers had access to medical benefits in 2019, compared to only 68% of non-union employees (7). Unions allow for continual negotiations and adjustments by ensuring the contracts last for a short period of time, typically a few years (6). 

In addition to benefits, healthcare unions also present disadvantages. One common concern about unions within the healthcare industry is the lack of incentive to perform, as union contracts typically fix wages, value seniority over performance, and protect members from unfair termination (5, 6). As a result, hardworking employees can be passed over for promotions, and incompetent employees can remain employed despite their ineptitude (6). On an individual level, union membership costs money, and dues are taken out of members’ paychecks (6). Additionally, strikes also present a problem, as all members of a union are required to join the strike, which causes patient care to suffer (5). Finally, unions address workplace issues by communicating with management, which may cause a disconnect between employees and management and may lead to a hostile work environment (6). 

Despite these disadvantages, studies have shown that healthcare unions are associated with better patient outcomes (8) and better salaries (9) compared to similar workers who do not belong to unions. Since the beginning of the COVID-19 pandemic, during which healthcare workers across the world experienced overwork, burnout, and, at least initially, greater exposure to the virus, healthcare unions have risen in popularity due to their power to negotiate for improved patient and employee safety (10). Given these advantages and disadvantages, healthcare workers must consider both sides of the argument when contemplating whether or not to join a union. 

References 

1: Oladipo, G. 2023. “More than 7,000 nurses go on strike at two New York City hospitals.” The Guardian. URL: https://www.theguardian.com/us-news/2023/jan/09/nurse-strike-mount-sinai-montefiore-new-york-city.  

2: Otterman, S., Goldstein, J. and Gross, J. 2023. “Nurses’ strike ends in New York City after hospitals agree to add nurses.” New York Times. URL: https://www.nytimes.com/2023/01/12/nyregion/nurses-strike-ends-nyc.html.  

3: United States Bureau of Labor Statistics. 2021. “Union members — 2021.” News release. United States Department of Labor. URL: https://www.bls.gov/news.release/pdf/union2.pdf.  

4: Vesper, D. and Konig, C. 2022. Ever thought about strikes? Development of a scale to assess attitudes and behavioral reactions to strikes. Journal of Business and Psychology 37(2022):1275-1298. DOI: 10.1007/s10869-022-09801-7. 

5: Clarke, E. 2022. “What are the pros and cons of joining a nursing union?” Nurse Journal. URL: https://nursejournal.org/resources/nursing-union-pros-cons/.  

6: Watt, W. 2022. “The pros and cons of unions for healthcare professionals.” Good RX. URL: https://www.goodrx.com/hcp/nurses/pros-cons-unions-healthcare.  

7: Luhby, T. 2019. “Many union workers really love their benefits. That’s a problem for Bernie.” CNN. URL: https://www.cnn.com/2019/09/22/politics/union-health-care-medicare-for-all/index.html. 

8: Dube, A., Kaplan, E. and Thompson, O. 2016. Nurse unions and patient outcomes. Cornell University ILR Review 69(4):803-833. DOI: 10.1177/0019793916644251. 

9: Gaines, N. 2022. “Should I join a nurses union? Pros and cons.” Nurse. URL: https://nurse.org/articles/pros-and-cons-nursing-unions/.  

10: Pattani, A. 2021. “For health care workers, the pandemic is fueling renewed interest in unions.” NPR News. URL: https://www.npr.org/sections/health-shots/2021/01/11/955128562/for-health-care-workers-the-pandemic-is-fueling-renewed-interest-in-unions.