Watch the three-part California Nurses Association History videos and determine the role of leadership in the success of this organization

(I AM INCLUDING A TRANSCRIPT OF THIS THREE PART VIDEO) **IF/WHEN CITING THIS VIDEO IN PAPER, JUST PUT \”(CNA VIDEO\”) AND I WILL EDIT IT ON MY PART WITH CORRECT INFO

Review the expectations outlined in the Writing Assignment Rubric–I have attached this as well    Collective Bargaining and Nursing Leadership

The paper should include in the review:

Comprehension: Briefly summarize the efforts and outcome of the CNA.
Application: Relate core leadership concepts to the success of the CNA. Include the relationship of empowerment, government, and cultural competency to the struggles and success of the CNA.
Analysis/Synthesis: Clarify understanding of the variables contributing to the success of the CNA group’s efforts.
Evaluation: Summarize the efforts of the CNA as a model to enhance APRN practice.

Collective Bargaining and Nursing Leadership

Introduction

Collective bargaining involves negotiations between the organizational management and employees who are represented by a labor union. The employees through the labor union and the management negotiate about conditions and terms of employment and try to agree. The negotiated conditions and terms of employment are then spelled out in a collective bargaining agreement (CBA). Nursing leadership has a key role to play in influencing and implementing practice standards within employment settings and ensuring that employment terms and conditions allow the provision of the best quality of nursing care (Joseph & Huber, 2015). Collective bargaining empowers nurses to facilitate changes within their general and economic welfare, as well as within the healthcare setting. This paper will analyze the role of leadership in the success of the California Nurses Association (CNA).

Comprehension

CNA negotiated for improved education and licensing guidelines for nurses and also for better terms and conditions for nurses. The negotiations and efforts lead to the minimum pay for nurses improved and also nurses given more important nursing activities to perform. Additionally, through the CNA and their call for mass resignations for nurses, if the poor working conditions continued, this led to the nurse-patient ratio improving (California’s Nurses Association, 2009). This addressed the issue of the nursing shortage and thus improved the quality of care. Evidence has shown that nursing staffing rations significantly impact patient safety in terms of patient safety events, mortality rates, and health outcomes (Rahman & Shamsudin, 2015). Additionally, through CNA, legislations were implemented that required an improved nurse ratio. CNA acted as patient advocacy by campaigning for better patient care. CNA negotiated with the hospital leadership and the government bodies to ensure better patient care. This significantly led to improve patient care and also improved patient safety.

Application

The leadership style employed by CNA is closely allied to the democratic leadership style and transformational leadership style. The democratic leadership style prioritizes people and interactions within the group. Democratic leadership is typified by helpfulness, motivation, friendliness, and participation of all. The leadership style assumes that everyone is self-motivated, trustworthy, accountable, responsible, and promotes collaboration and teamwork to facilitate improved performance and satisfaction (Fiaz et al., 2017). CNA leaders were aware that teamwork produced better efforts and as a result, the association included many members. Additionally, through the transformational leadership style, leaders in CNA were able to inspire and motivate nurses to fight for their rights and at the same time transform the working conditions and terms, as well as improve patient care (Asif et al., 2019). Through these leadership styles, CNA was able to advocate for better patient care, fight to win respect in the nurse profession, negotiate for better pay and improve nurse-patient ration, and also provide good quality of care. Through CNA, the nursing profession gained respect and was no longer viewed as a women’s job. This led to the establishment of strict nursing education and practice guidelines (California’s Nurses Association, 2009).  Collective Bargaining and Nursing Leadership

Analysis/Synthesis

Variables that contribute/ed to the success of CNA’s group efforts include teamwork, collaboration, effective leadership, and persistent determination. Through effective leadership styles such as transformational and democratic leadership style, the CNA has been able to inspire and motivate nurses to fight for their rights. Moreover, leadership styles have influenced changes in the nursing profession. The teamwork and collaboration among leaders and nurses from all cadres and different areas enabled nurses to speak in one voice. Speaking in one voice ensured that the government and other legislative bodies heard the demands of the nurses such as improved working conditions, funding for nursing education, and better terms for nurses (CNA video). CNA’s group efforts led to the ratification of nurse-patient ratio, increased funding for nursing education, better salaries for nurses, ban on the mandatory overtime for nurses, and addressing the nursing shortage. Additionally, the CNA effortlessly and persistently fought for a better quality of care and improved patient care. Through contract agreements, CNA managed to increase the collective power for nurses to advocate for patients; this has led to influence better care for the patients (California’s Nurses Association, 2009).

Evaluation

The efforts of CNA can be replicated to improve APRN practice. Efforts should be put to fight for advanced nurse practitioners to practice to the full scope of their training and education. This can assist in building the workforce required to meet the primary care needs. Additionally, the unique skills of APNs can be used to provide the necessary advanced care and patient-centered care. The CNA model can also be applied to negotiate for better pay for APNs, and for example address the issue of PMHNPs being able to prescribe narcotics and controlled substances independently (Peterson, 2017).

Conclusion

Through collective bargaining, CNA negotiated and fought for better working conditions and terms for nurses, education and licensing guidelines, respect for the nursing profession, and acted as patient advocates. CNA seems to have employed both democratic and transformational leadership styles in influencing changes in nursing practice. Through effective leadership skills such as teamwork, collaboration, and persistence. the CNA was able to influence changes in nursing. The CNA model can be used to implement changes in APRN practice.

References

Asif, M., Jameel, A., Hussain, A., Hwang, J., & Sahito, N. (2019). Linking Transformational Leadership with Nurse-Assessed Adverse Patient Outcomes and the Quality of Care: Assessing the Role of Job Satisfaction and Structural Empowerment. International journal of environmental research and public health, 16(13), 2381.

California’s Nurses Association. (2009). Taking Care: CNA’s First Century [Video]. YouTube. youtube.com/watch?v=5GhJ1NleS2Q&feature=emb_title

Fiaz, M., Su, Q., Amir, I., & Saqib, A. (2017). Leadership styles and employees’ motivation: Perspective from an emerging economy. The Journal of Developing Areas, 51(4).

Irimu, G., Ogero, M., Mbevi, G., Kariuki, C., Gathara, D., Akech, S., Barasa, E., Tsofa, B., & English, M. (2018). Tackling health professionals’ strikes: an essential part of health system strengthening in Kenya. BMJ global health, 3(6), e001136.

Joseph, M. L., & Huber, D. L. (2015). Clinical leadership development and education for nurses: prospects and opportunities. Journal of healthcare leadership, 7, 55–64. https://doi.org/10.2147/JHL.S68071.

Peterson M. E. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.

Rahman, H. A., & Shamsudin, A. S. (2015). The impact of the patient to nurse ratio on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals: a cross-sectional study. Asian Social Science, 11(9), 326.

EMAIL ME IF YOU HAVE ANY QUESIONS

Review the expectations outlined in the Writing Assignment Rubric (see below). The Leadership and Success of the CNA Paper should be 3–4 pages long—-3 pages is fine

Your paper should include in the review:

• Comprehension: Briefly summarize the efforts and outcome of the CNA.
• Application: Relate core leadership concepts to the success of the CNA. Include the relationship of empowerment, government, and cultural competency to the struggles and success of the CNA.
• Analysis/Synthesis: Clarify understanding of the variables contributing to the success of the CNA group’s efforts.
• Evaluation: Summarize the efforts of the CNA as a model to enhance APRN practice. (My APRN will be as a Psychiatric Mental Health Nurse Practitioner)

Watch the three-part California Nurses Association History videos and determine the role of leadership in the success of this organization.

I am including the transcripts of the videos below—if/when citing this video, please cite, “CNA Video” and I will edit it in on my part

California Nurses Association Part 1 Video Transcript

Speaker 1: I’ve always wanted to be a nurse.

Kay McVay: As far as women were concerned, in those days you were either a teacher, a secretary, or a nurse.

Speaker 3: Deciding between do I want to be a doctor or nurse, and for me, the nursing was the part where they got to spend the most time with the patients.

Speaker 4: That was something I wanted to do. I wanted to be a caregiver. I wanted to make a difference in people’s lives.

Speaker 5: Throughout the past century, nurses have been caring for the sick, the injured, the dying. They had advocated for their patients, and for the right of everyone to receive adequate healthcare. But nurses found that they had to fight to win respect for their work, and to have a say in how healthcare is delivered. It is a fight that has continued for 100 years.

Deborah Burger: It’s not just a union, or a professional organization. It’s a social movement.

Speaker 5: The 96 nurses who gathered in San Francisco to found CNA knew that only by being organized could they gain control over their work. Their first concerns were professional: to establish strict education and licensing guidelines. But hospitals controlled the delivery of healthcare. They used unpaid student nurses with only a few nursing supervisors, affording graduates few opportunities to do hospital work. Most sought employment as private-duty nurses. They used the association-run registries, and by 1927 more than 6,000 RNs had joined CNA.

In the 1930s, most private-duty jobs disappeared, and the massive unemployment forced hospitals to start hiring RNs. These staff nurses worked long hours for low pay, and they had little means to pay for healthcare if they themselves got sick.

Workers everywhere were organizing, and for nurses, too, workplace issues were now their greatest concern. But CNA’s parent organization, the American Nurses Association, urged RNs not to join unions. CNA was in a bind; they knew they had to respond to the staff nurses’ urgent needs, or they would lose them to non-RN unions. The Association drafted an economic security program with minimum salary and benefit guidelines. But the administrators and educators who ran CNA asked hospital managers to comply with the guidelines voluntarily, a strategy that would prove short-sighted.

During World War II, RNs signed up to serve. They took care of the tens of thousands of sick and wounded. They were hailed as heroes. On the home front, other women entered the workforce and earned real living wages. But hospitals offered RNs such meager salaries that thousands left the profession.

CNA seized the opportunity. In 1946, it did what no state nurses association had ever done: it signed a collective bargaining agreement with six San Francisco area hospitals. The terms were groundbreaking for their day: a 40 hour work week, employer-paid health insurance, and a minimum salary of $200 per month. But the contract did not win respect, nor did the makeover that was changing the face of medicine in the 1950s and ’60s. New life-saving drugs, technologies, and procedures gave RNs important new tasks, but nursing was still dismissed as women’s work.

Kay McVay: The doctors were gods. You were supposed to stand and give them your chair when they came in, and if they wanted coffee you were to get it for them. And you waited on them. We were the handmaidens of the physicians.

Wilma McCarthy: We had to do something. We weren’t able to go out on strike, ’cause it wasn’t in our contract. So the only thing left that CNA could recommend to us was a mass resignation.

Speaker 5: The mass resignations were handed in by Wilma McCarthy, who became the nurses’ spokesperson. She said, “The nurse has assumed duties once only doctors performed: intravenous feeding, blood pressure, cardiac resuscitation, administering drugs intravenously. She often performs these functions through two straight shifts, yet earns less than the hospital gardener.”

Wilma McCarthy: This is what really stuck in my craw. Obviously they value their bushes-

Margaret Yu: I was gonna say-

Wilma McCarthy: …more than they do their patients.

Margaret Yu: …they took awfully good care of those bushes.

Wilma McCarthy: [crosstalk 00:05:16] Yes they did.

Barbara Mauser: Well it wasn’t easy to walk off your job, and to do it willingly and with all this feeling of trepidation. What’s gonna happen, are we gonna get our jobs back?

Margaret Yu: The doctors just could not believe that the nurses at Eden would do such a terrible thing. And there were so many that said, “It’s not gonna succeed. It’s not gonna succeed. You folks should just go back to work.”

Speaker 5: But the nurses stayed out for five days. The hospital finally granted substantial pay increases. The Eden RNs’ creative use of collective action had worked.

Wilma McCarthy: It encouraged other people then. Oh, if we could do it, by God they could do it too.

Margaret Yu: Yeah. You know-

Speaker 5: Inspired by the success of the Eden nurses, 2,000 other Bay Area RNs threatened to resign, and they too won big contract gains. Later that year, CNA rescinded its no-strike policy.

Beth Mar: I was working and followed it very closely on television, and never expected to work here, and I was a little surprised. I’d been working about a year when I found out these were those terrible nurses that went out on strike, and I just…I felt really honored to be there, because they really started the ball rolling for nurses all over the nation.

Gloria O’Shea: We read an ad in the paper that said, “Safeway checkers wanted for $550 per month.” We took a look at what we were making, which was only $350 per month. Nurses didn’t strike, but we said, the heck with that. Something has to be done.

Speaker 5: CNA’s first strike involved 550 RNs at five Bay Area hospitals. At issue were the patient care committees.

Gloria O’Shea: There were patient care committees but the staff nurses were never involved in those.

Kay McVay: It was the very beginning of staff RNs, bedside RNs, being able to have some say into how healthcare was delivered to the patient.

Speaker 5: But maintaining these professional performance committees, or PPCs, became a continuing battle. In 1974, 4,000 RNs from 42 northern California hospitals went on strike. After three weeks, they hammered out a contract, then convened at San Francisco’s Cow Palace to vote on it.

Kay McVay: When I went into the Cow Palace and there were people from all over, all these facilities, all these hospitals. For women to be there, to be that active, to be that involved, it was wonderful. And I think every other nurse that was there was feeling the same kinds of things. It was liberating.

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California Nurses Association Part 2 Video Transcript

Trande Phillips: The uniform which you got a picture of, it was a blue and white striped pinafore. The hospital laundry would starch the apron and the bib, and then we had to attach the bib and the apron together on the inside with safety pins. And our pinafores were so heavily starched that when we would get them back in the hospital laundry, we would stand them up in the corner.

Speaker 2: A good union is worried about social issues. They worry about people.

Narrator: RNs looked for ways to use their newly won power to improve patient care.

Trande Phillips: We had to somehow have some type of a staffing system, where we could safely ensure patients would get the care they needed. And so the first place that we fought that battle was in the Critical Care Units.

Narrator: CNA proposed legislation requiring that there be at least one RN to take care of every two critically ill patients.

Trande Phillips: It was a major battle. We had to fight the bureaucrats, we had to fight the hospitals, we had to fight the politicians. Everybody said it couldn’t happen.

Narrator: The odds were against, but CNA prevailed. Their critical care ratios were the first in the nation, but the staffing battle would continue for the next quarter-century.

By the 1980s, greed was good in America and hospitals had become big business. The corporatization of healthcare had dramatically escalated.

Malinda M.: When Good Samaritan was bought out by a corporation, that’s when we started to see tremendous changes. They had massive layoffs, nurses were given more patients to care for. If you had some issues about some of the nursing care and you came to them and express those concerns, they would say to you, “If you don’t like it, you can always go elsewhere.”

Narrator: To cut cost and maximize profits, the healthcare industry restructured its workforce. Hospitals hired less trained workers to take over duties previously done by RNs.

Martha Kuhl: My Hospital management decided unilaterally to layoff 20% of all the registered nurses and replace them and other skilled hospital healthcare workers at the same time with lower-paid, what we called unlicensed assistive personnel. And that was a huge change in our working conditions. The move to remove nurses from the bedside would not only just change the nature of the profession for me, but it would make it much more detrimental to our patients.

Speaker 6: In the hospital, there was no longer that supportive structure for the patient and the nurse. They removed that so that they could have their bottom line. So CNA, as an organization, had to step in and fill that void.  Collective Bargaining and Nursing Leadership

Narrator: But CNA was having problems of its own. The staff RNs, now 90% of CNAs members, were strongly opposed to restructuring while CNA’s board of directors supported it.

Malinda M.: The board was basically comprised of educators, managers, people that really weren’t the ones that were at the bedside giving the care to the patients. And they really didn’t know or understand what the needs were of the nurses and really of the patients.

Narrator: The conflict between direct care nurses and the board reached a breaking point during the Summit Strike. All hospital workers walked out for the right to support each other.

Martha Kuhl: We actually were attempting to work together with all the other labor unions in healthcare, and raise a standard for all healthcare workers. And I think that was threatening to them because they always thought that we were somehow better than separate than different interest than other healthcare workers.

Marilynne K.: The last straw I think was when they fired our staff just before Christmas.

Martha Kuhl: They fired a lot of Staff who they thought were actually in control of this movement, but really it was the nurses, and the nurses essentially rose up and said, “No, that’s not okay. We were going to get our staff back.” So we ran a slate of officers for the board of directors.

Marilynne K.: We won the election. We booted out of the ward. They couldn’t believe that we had done it. They could not believe it. We were ecstatic and we were all so scared. Very scared. What have we done? This real big organizational. What will staff nurses know about running something.

Martha Kuhl: Because nurses area of expertise is patient care and that’s what we do all the time, we know all about that. And we’re very good at advocating for our patients, but many of us do not have a labor background, and there’s labor staff, we’ve hired some really fantastic staff who come out of the labor movement, Rose Ann DeMoro is one of those.

Rose Ann DeMoro: You had the nurses as patient advocates with the power and the finances at this point in time, now they control the organization. They can use all of the resources to fight for their patients and fight for themselves, for the first time in history. You had staff who had phenomenal, phenomenal skills and backgrounds. And coming together with the registered nurse, putting together strategies, tactics, passion, politics, all of it coming together. And I can tell you from our perspective, it was a perfect fit. From the healthcare industry, it was the perfect storm.

It was the seminal moment in history I think for Registered Nurses Associations across the country because the registered nurse rose up, they said, “No more.” We are taking control.

Speaker 2: When we took over, it was a battle about how patients reviewed and how healthcare was delivered.

Narrator: With frontline nurses in charge, CNA focused on patient advocacy. The patient watch program help those who are harmed by unsafe medical practices. CNA co-chaired a state initiative that would have established asingle-payer healthcare system. Then in 1995, CNA shock the nursing world by cutting its ties with the American Nurses Association.

Martha Kuhl: It did make a huge splash in nursing because ANA purports to speak for nursing nationally in America, and it doesn’t actually.

Speaker 6: We realized that we were handicapped by belonging to ANA because they were going along with the industrialization of healthcare.

Martha Kuhl: So it seems silly that we went to all the trouble to take over CNA to change the direction of protecting our jobs and protecting our practice and patient care, and then send, at the time, a million and a half dollars a year to this organization that then was trying still to remove us from the bedside.

Marilynne K.: That was a very powerful time because that enabled us to have the funds to go on and organize CNA as we wished it be organized.

Narrator: Now totally independent, CNA set out to establish a new identity.

Martha Kuhl: I would say the biggest change is that we said we would focus on the members’ concerns. Those members are going to come to the forefront, they’re going to set the direction of CNA, they’re going to set the direction for their professional practice, they’re going to set the direction in the kinds of legislative battles we had in Sacramento.

Narrator: The RNs of CNA turned out one patient oriented reform after another. They joined forces with consumers for HMO reform and a patient’s Bill of Rights. They sponsored laws strengthening the RN’s role in patient care and giving workers who expose unsafe conditions in hospitals whistleblower protection.

Speaker 2: There is nothing that we do that does not have something to do with patient care. Ratios, Whistleblower Bill, it’s so that we can deliver better care. We believe, fully believe that it’s going to be the nurses, the RNs who will lead the change in healthcare.

Narrator: In their mission to put patients first, CNA nurses faced a monumental battle with the biggest HMO in the country.

Zenei Cortez: We, us Kaiser nurses, always was the first one to negotiate our contract, and then all of the hospitals will follow afterwards. So we really needed to fight not only for the Kaiser nurses, but for all of the RNs in California and even the United States.

California Nurses Association Part 3 Video Transcript

Speaker 1: One of the things that led up to the Kaiser strike was the fact that Kaiser as an organization and really made a conscious decision to devalue the roll of registered nurses and their hospitals and clinics.

Speaker 2: The first day of bargaining they immediately told us we are taking away 15 of your benefits. And so that sort of set the tone.

Speaker 3: The takeaways Kaiser proposed were staggering. The giant healthcare provider seemed to disregard its employees’ rights and its patients’ needs.

Rosemary: It was the quality of care that was the issue. And I believe the good old boys thought well if we give these little girls some money, they’ll just go away and be with their good act taking care of people. Well that wasn’t the case and they found out soon enough.

Deidra: The registered nurses here at Kaiser have gone on strike. Rosemary Wood has been working as a registered nurse for Kaiser for 25 years.

Rosemary: This is about the quality of care that patients are not getting. In the last three years or less, 1400 registered nurses have been laid off.

Speaker 6: We worked out a strategy to get the public and our patients behind us. We ended up going out on a series of six one to two day strikes throughout northern California that galvanized not only the nurses but the community and our patients.

Deidra: Kaiser nurses are now more than 15 hours into their 24 hour walk out.

Stan: Managers of Kaiser hospitals throughout northern California are bracing tonight for another nurses strike.

Mike: The issue here is quality of care. Kaiser’s registered nurses say that care has been compromised by recent cutbacks.

Speaker 6: And each time we came back from those strikes there was even more support when I was on the advice phones. The patients would say way to go. Keep fighting. Don’t let them take you out on this one. You’ve really got to fight for us.

Speaker 3: And fight they did. Never knowing whether they could outlast the HMO Goliath. One day after 18 months of bargaining, they had their answer.

Speaker 2: They went out for a caucus and when they came backthey said everything that you have asked for we’re giving you and we’re like is it over. Is this real? Are we dreaming?

Speaker 3: CNAs victory made headlines. The California RNs hadwon a new role as patient care watch dogs while proving to the nation that they were a force to be reckoned with.

Speaker 6: Once we had beat Kaiser it was like we can beat the world because we took on kaiser and we won.

Speaker 2: We maybe small in size but we think big, we fight long and hard.

Speaker 1: It really became an incredible bond of the nurses and the patients and their families together fighting Kaiser Permanente. And it really made me understand that its power of people working together totally focused and committed.

Rosemary: It was really a history making time that if I had to do it over again you bet I would.

Speaker 9: These are the women and men who have really transformed history and they’ve opened a door that can never be closed again.

Speaker 3: CNAs three decade campaign for hospital wide RN to patient ratios would reach a climax with AB394.

Speaker 6: It started bringing nurses in out of the woodwork andreally got nurses involved in lobbying.

Speaker 10: I wrote letters to the elected officials. I participated in the rallies, the rally at Sacramento where we had it was just amazing. Just that capitol rotunda was just filled with registered nurses.  Collective Bargaining and Nursing Leadership

Speaker 11: These nurses’ hands save lives. But today they join together in the state capitol to try and lower the nurse to patient ratio.

Speaker 1: There was such enthusiasm that spontaneously people burst into the capitol building. And they started to march through the capitol building chanting that they wanted ratios that they were going to win. That this had to happen.

Speaker 10: We had senators coming out talking to them, letting them know that in the capitol in the senate they could hear us out there chanting and it gave nurses, it showed them how much power they actually had.

Speaker 3: Ab394 passed, was signed into law by the governor and has become a model for RNs and patients across the nation and throughout the world.

Speaker 12: The more members we have, the louder the voice for patient care will be.

Speaker 6: We realized that the only way we were going to enforce one level of care for all patients in California was to organize not only just in northern California but in southern California as well.

Speaker 3: Organizing was successful like never before. CNA doubled its ranks in less than a decade winning victories in one facility after another including the two largest hospitals on the west coast.

Margie: It’s a really exciting time in southern California right now. The nurses are really energized and the landscape has changed and we are going to have CNA in every hospital in southern California in fast order.

Speaker 9: It’s really no surprise that we doubled the membership in the last eight years. What the registered nurses see in CNA is an organization that will fight unrelenting for the right of the registered nurse to advocate for patients. That’s what they love. That’s why they come here. If you look at the history and you see the courage and commitment and the dedication and the fight, the CNA nurses are really willing to do whatever it takes to transform healthcare and provide better patient care. Because collectively registered nurses frankly are unstoppable.

Here is an additional source of info—if you use this, just cite “Labor relations” and I will edit it on my part

Labor Relations and Collective Bargaining Lecture Transcript

Slide 1

This slide presentation is on Labor Relations and collective bargaining.

Slide 2

In this PowerPoint presentation, the objectives are:

• To understand the process of collective bargaining.
• To outline some of the history of collective bargaining in nursing in the United States.
• To identify and define key terms in collective bargaining and Labor Relations.
• To cite major labor law legislation in the US.
• To examine the pros and cons of organizing in nursing.
• And to understand and state the implications for nursing leadership in the management of collective bargaining and Labor Relations issues.

Slide 3

Why is it important to know about labor unions? When we look across the United States, about 25% of the nurses in the US are represented by a union. As leaders, we may be responsible for managing Labor Relations in a unionized environment. We need to understand the laws related to Labor Relations management.

Slide 4

Our definition for the process of collective bargaining is “collective bargaining consists of a process of negotiations between the management of an organization and a group of employees, typically represented by a labor union. Management and employees negotiate over terms and conditions of employment, and they attempt to reach an agreement on items that the employees believed to be fair and management believes it can live with in terms of the organization’s operational needs and the financial resources of the organization.” The negotiated terms and conditions of employment are spelled out in a document that we call a collective bargaining agreement or a CBA.

Slide 5

The process of collective bargaining, which is a major component of labor relations, this process is governed by federal and state laws. It involves negotiation of formal labor agreements. It includes managing the implementation of a written contract or document called the CBA. Concerns responding to grievances and it also concerns responding to arbitrations, if they should be filed. It is very important that we consider parity for non-represented employees in terms of wages and scheduling, and this means whatever is afforded to an employee in a collective bargaining agreement we have to think of the fairness, the equity, the parity of this in regards to other employees who are in a like work situation.

Slide 6

As far as managing Labor Relations, we know that we must adhere to the National Labor Relations Act or the Wagner Act, which was enacted in 1935. This legislation provides employees with the right to organize and seek union representation through a collective bargaining agreement, and any attempts to interfere may constitute what is called a ULP, or an unfair labor practice. These attempts may be done by individuals in an organization or by the organization as a whole. The definition of Labor Relations is the relationship that exists between the management of the hospital or the healthcare setting, health service organization, the staff and the labor union if the staff has voted them in to represent them. The collective bargaining agreement, as we have talked about before (the written document or written agreement) encompasses rules and conditions concerning wages, schedules, working conditions for the employees it represents and other aspects of bargaining.

Slide 7

Labor law: Know what it is!

We have already mentioned the National Labor Relations Act or the Wagner Act enacted in 1935. Since then, there have been National Labor Relations Act amendments, so what are they? What is the Taft-Hartley Act in 1947. It allows the president of the United States to appoint a board of inquiry when a strike is judged to be a danger to national health or safety. One example of an enacting the Taft-Hartley Act was Ronald Reagan, President Reagan, when he enacted the Taft-Hartley Act in the air traffic control strike. If all of the air traffic controllers went out on strike, it would bring all of the air travel to zero and make a very unsafe situation in the United States. When the air traffic controllers filed the strike, they were warned by President Reagan not to go on strike or he would enact the Taft-Hartley Act, and they did so anyway and it put us in a situation in the United States of endangerment and the Taft-Hartley Act was invoked by President Reagan, and it was supported by the judicial branch of the government and the air traffic controllers were told to return to their positions or they were fired. Extension of the National Labor Relations Act is the next amendment, and this was enacted in 1974. Prior to this law, nonprofit hospitals were excluded from the right to organize. In this extension, Congress extended the law, the NLRA, or the Wagner Act, to include nonprofit hospitals and nursing homes. All could be represented and all employees could seek legal representation or union representation.

Slide 8

History of Labor Unions in the Nursing Profession

In this slide, I have outlined starting back in the 1960s, the process in nursing of organization that has occurred in terms of labor unions. There were strong gains in unionization and nursing with large numbers of nurses organized at first in the Veterans Administration hospitals across the US in the early to mid-1960s. In 1969, RNs’ representation went from 8,000 to 30,000 in terms of being represented by a labor union. In the 1970s, organized RN numbers jumped to 90,000 and more than 100 collective bargaining agreements were negotiated for nurses.

During the 1980s while the US labor unionization in all fields decreased or stayed the same, nursing increased in numbers. There was also a significant strike in Minnesota of 6000 nurses across 17 hospitals for 39 days. However, in the nurses’ settlement of the contract, the original offer that had been made prior to the 39-day strike held and the nurses were not able to achieve any additional concessions through that strike and had a significant loss in pay.

In the 1990s, there was major redesign of nursing, cutbacks and this caused strong union response regarding patient safety. Also there was major focus on reducing mandatory overtime and floating and a huge push to increase registered nurse staffing.

In 2007, almost 20% threshold was reached across the US of RNs being organized through the United American Nurses Association and the California Nurses Association, also the Service Worker’s Union (the SEIU) and seven other non-healthcare unions organized and represented more than 220,000 nurses across the US. Today in 2017 we have more than 25% of all registered nurses in the US represented by a labor union.

Slide 9

We look at the pros and cons of union membership, what would lead somebody to vote in a union and what would lead someone to not have a union represent them. On the yes side the perception that it would be an increase in power and solidarity amongst the nurses. It could also be that the nurse feels that she or he is required to do so. There may be a big organizing push and a lot of pressure from peers. The nurses may believe in the individual agenda of the union, or the nurse may feel it would eliminate management bias or favoritism if she or he works in an environment where that is prevalent.  Collective Bargaining and Nursing Leadership

On the con or no sigh, the nurse may feel that he or she wants their own voice, or there may be a belief that belonging to a union or voting in a union is not professional. The nurse may fear reprisal (retribution) or the nurse may support the organization’s (management) views on issues of pay and scheduling and working conditions.

Slide 10

Union organizing strategies, how do they typically unfold? Well there are group and individual meetings. There is usually prounion literature that is distributed (leaflets or brochures) disease. The union may write letters to individuals, groups, politicians, healthcare board and senior hospital or healthcare leaders. Corporate campaign strategies may occur. There may be media, marketing and public relations work or high profile lawsuits or labor actions. There could be political activism (reaching out to civic groups, churches, labor councils and community organizations.) There could also be establishing websites through the use of Internet and email, and there sometimes is financial pressure.

Slide 11

For the leader during an organizing effort, what is it important not to do?

• Do not threaten, interrogate, spy or discipline anyone regarding union activity during a campaign to organize. Remember, employees have a right to seek unionization through the National Labor Relations Act.
• Do not reward for cessation of union activity or interest.
• Do not make promises regarding wages, compensation, schedules etc. during a campaign. For example, “If you don’t vote for the union, the organization [or hospital] will make sure you have every weekend off.” That is interfering with the process and making a false promise.
• Do not accept any union organization cards from any employee under any circumstances.
• Do not provide lists of names, addresses etc. of any employees to union campaign representatives. That must be confidential. All of that kind of information in the organization should not be shared with anyone including union campaign representatives.

Slide 12

Also:

• Do not allow organizers in patient care areas. There may be organizing activities, but they should not involve patients or families.
• Do not visit a voting area during a National Labor Relations sponsored union election. That area should be free of the presence of anyone who is in management or not represented by a labor union.
• Do not tell employees how to vote even if ask for your opinion. If they should ask, you say “it is a very serious and important decision.” Make sure that you are fully educated about it, and at that point advising them to vote for or against is not something that is appropriate for a nurse leader, nurse manager, or advanced practice nurse to give in terms of advice so you do not give your opinion.

Slide 13

The leader role during organizing.

It is important to listen to your employees respectfully and attentively. You want to answer any questions factually and honestly regarding pay, compensation issues and scheduling. You want to communicate with human resources, senior leadership and any legal counsel to be sure that you know the facts of organizing and understand the hospital or healthcare’s campaigning facility’s position and communication plan. You want to become educated regarding labor law and Labor Relations protocol during an organizing event. It is important to have someone seek out a person or mentor to answer your questions.

Slide 14

You also want to communicate with your employees regularly according to your facility’s communication plan. You want to seek guidance and resources (that might be from human resources; it might be from a chief nurse or director; it might be from an attorney within the healthcare setting) for any questions or uncertainties that you have.

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Slide 15

There is a process for unions to represent nurses. It is a public petition signed by the majority of the nurses who would be represented in total for the election, and you must have, in order to hold an election, 30% of the signatures of all of the nurses who would be represented by that collective bargaining agreement, so if 100 nurses work in the facility you would need to have 30 of those nurses signed cards to say they would like an election in order for it to be held. The National Labor Relations Board sets the date with the employer and the union and hospital or healthcare setting officiates at the election site. There must be a majority +1 (50%) of the membership must vote the union and. A tie (50% for and 50% against) is considered a loss, so it must be 51%. Upon certification (that means reaching the 51%) the employer must legally acknowledge that the union represents its RN employees. All terms and conditions that develop for the contract, including dues being paid by the members, are defined and appropriate to be paid by all nurses in that job category. The employer and the union must bargain in good faith to draft a collective bargaining agreement and the employer cannot interfere with an election or selection of union representatives for negotiations.

Slide 16

Bargaining to an impasse results in mediation, fact-finding and potentially arbitration. This means that the healthcare organization in the union may need to have outside mediation assistance or arbitration from the National Labor Relations Board to help them if there is an impasse or dispute. There are three stages to the bargaining process once the labor union is voted in. There must be negotiating teams defined, proposals drafted and a schedule of how the bargaining will take place developed. In the second stage the bargain together. They identify common interests, any conflicts and they attempt to reach consensus. In the third stage you reach agreement or consensus and the final document is created and then ratified or voted in by a majority of the membership.

Slide 17

The collective bargaining agreement, what does it contain?

• A definition of union membership.
• Scheduling practices.
• Language about mandatory overtime and floating.
• Talks about hourly wage scales and wage differentials.
• Information regarding off shift pay, holidays, or time etc.
• Vacation and holiday pay.
• Any policies regarding bereavement, jury duty and leaves of absence.
• Anything around reduction in force, layoffs, and it may also be job recall rights or the right of termination pay.  Collective Bargaining and Nursing Leadership

Slide 18

CBA cont:

• Grievance and arbitration procedures are outlined.
• Termination for cause, language and rights are included.
• The definition of membership.
• Time and pay when staff members represent in a grievance situation or negotiations, how they will be paid and relieved from duty.
• Orientation to the union in the collective bargaining agreement for employees must be divine.
• Any continuing education time or compensation must be outlined for anyone who is represented by the CBA.

Slide 19

In summary, what is the major focus on the nurse leader?

Slide 20

Work collaboratively to govern meeting contractual responsibilities if you have a CBA in place.

• Recognize employing rights and reasons why employees seek unionization.
• Govern fairly, creating a positive work environment where employees are included in decisions and recognize.
• Keep abreast of changes in employment legislation and labor law, and be sure you are adhering to the law.
• Seek resources and counseling if you have questions.
• Of course, be visible, engaged and communicate well and often.

Slide 21

Thank you for your attention. This concludes the PowerPoint slide presentation on Labor Relations and collective bargaining. Thank you.

Slide 22

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Collective Bargaining and Nursing Leadership