Nurses need to step up and speak for themselves

By Donna McNeese-Smith

On Oct. 3, the federal National Labor Relations Board (NLRB) categorized permanent charge nurses at Oakwood Heritage Hospital in Michigan as supervisors, thereby barring them from unionizing. While businesses and administrators cheer the decision, unions condemn it because of its potential impact not only on nurses but possibly 8 million workers and 20 million professionals who exercise “assigning and directing” supervisory duties.

Because the NLRB does not regulate the University of California, the ruling does not affect UC facilities or the nurses employed there. At stake, however, are not only union memberships and millions of dollars in union dues, but overtime as well. But the real question is, why do professional registered nurses need unions?

As a registered nurse with 10 years in nursing-related education, 17 years as a nurse administrator, and now 14 years of teaching nursing administration at UCLA, I have always seen myself as an advocate of the best patient care possible. I have supported nurses in decision-making at the bedside by providing administrative support for expert clinical leadership. Unions have always seemed to me the antithesis of professionalism.

I therefore cheer the NLRB decision. I know the unions are outraged, but I feel this is primarily because of their loss of union dues. However, there is another side to this view that partially explains why nurses have often turned to unions.

Nurses work 24/7 in an environment where they are often not treated as professionals and are in fact bullied by physicians, administrators and even patients. Nursing hours of care are determined by hospital administrators who often have no clinical background or experience. The number of nurses was decreased in the 1990s when hospitals decided to save money by having unlicensed aides do more of the care, even care involving sterile procedures and professional judgment. Thousands of nurses left the profession even as patient loads increased.

Schools were then less able to attract potential nurses because students realized nurses were often not treated as professionals. Because administrators dictated staffing patterns, nurses were no longer able to provide staff to meet patient needs. In response, California laws were passed, legislating staffing ratios that increased the cost and demand for nurses. Now we are seeking millions of dollars to expand schools of nursing to increase the supply of nurses. Doesn’t this cycle seem absurd?

Nursing education has not prepared nurses to be advocates for themselves and for the profession, especially below the master’s degree level. Nurses have spent years developing and improving clinical skills, but not skills for negotiation. Thus, nurses have turned to unions for power and expect labor boards to define nurses’ professional status.

It is time for nurses to step forward, become politically active and lead their profession. It is also time for physicians, administrators, legislators and school officials to provide support for nursing and to engage nurses in professional decision-making, thereby creating an environment that supports the professional practice of nursing.

Only then will a genuine partnership between nurses and others within health care develop, providing safe, affordable, excellent care.

McNeese-Smith is associate professor in the School of Nursing, where she coordinates the nursing administration graduate program.