In just the past year, nursing union strikes have made national headlines. If you’re a nurse working now—particularly if you're a bedside nurse working in an acute care setting—you are intimately familiar with the stressors affecting the nursing profession. These issues—unsafe working environments, wage gaps, unsafe staffing, to name a few—are the same ones named in recent nursing strikes. And if unions are responsible for bargaining on nurses’ behalves, then why are they so polarizing? 

Unions are one of those insidious political talking points; in fact, you may have a readily formed opinion as to whether you are “for” or “against” them simply based on how your chosen political party feels. But have you ever really examined the pros and cons of nursing unions? You may feel passionate about the need for change within the world of healthcare, but are apprehensive if unions are the way to accomplish it. In this article, we break down the advantages of joining a nursing union, as well as the downsides. Then, we take it one step further in a call for action from all nurses, no matter your opinion on unions. 

Unions 101

Labor unions have been around since the mid-19th Century. Following the Industrial Revolution, workers joined unions for their collective bargaining power when it came to negotiations over fair pay and safe work environments. By the mid-20th Century, as union membership was peaking nationwide across all trades, the American Nurses Association (ANA) began to advertise its collective bargaining capabilities. However, the ANA was steadfastly against striking as a means of forcing action. 

During that time, the ANA was heavily advocating for nursing as a profession, rather than a trade. Striking, with all of its demanding aggression, they argued, would damage nursing professionalism.Although they reversed their No-Strike policy in the mid-1960s, a division had already been created in the nursing world: nurses passionate about joining forces to further the wellbeing of the field collectively began to feel alienated by those who prioritized professional individuality. As a result, some nurses were compelled to join state nursing unions who wholeheartedly believed in tactical bargaining, like strikes, while others were not.  This trend is the basis for a division in union endorsement today.

Nationally, nursing union membership has only been tracked since 1983. With 200,000 members, the National Nurses Union (NNU) is currently the largest nursing union. State nursing unions vary in activity; in totality, the Bureau of Labor Statistics estimates that only 20.4% of bedside nurses report as union members, but predict that that number will increase as a result of the COVID-19 pandemic.

The most obvious reason is that the pandemic amplified the core problems long present in the nursing field. Many nurses feel that the struggles of the bedside nurse were downplayed in favor of corporate interests during the height of the pandemic. The ANA in particular has been accused of catering to “nurse-executives” rather than bedside nurses. This trend has nurses reconsidering union membership and the power of collective bargaining like never before. 

Pros

Membership within a nursing union promotes the following expectations:

• Better pay and benefits. This is one of the primary line items advocated for by nursing unions. In addition to higher wages, unions petition organizations for consistent and substantial raises, as well as bonuses. The U.S. Bureau of Labor Statistics reports that union nurses earn an average of $200 more weekly than non-union nurses.

• Job security. With the increased criminal prosecution of nurses in the past year, union membership is an added protection against unjust terminations and disciplinary action. 

• Improved work environments. Safer nurse:patient ratios, restrictions on mandatory OT,  stricter safety protocols, and enforcement of protections against workplace violence are all areas of concern for nursing unions.

• Clear escalation processes. Ever feel like your complaints fall on deaf ears? Unions work on your behalf to promote resolution of common nursing workplace grievances.

Cons

Nurses who have had bad experiences with union membership (or union members) tend to be the squeakiest wheels when it comes to nursing union opinions. Here are the main concerns they voice:

• Dues. Union membership comes with fees, and these fees are typically drawn from your paycheck. Some nurses feel that union fees and dues are mismanaged.

• Incompetent nurses. Organizations who wish to terminate nurses often cite the difficulty they face when trying to fire union nurses for just cause, and highlight the danger this poses for leaving incompetent nurses in practice.

• Seniority biases. Though wage increases are a top priority for union members, oftentimes those raises are contracted based on how long a nurse has worked for an organization, rather than any standout qualifications. 

• Adversarial processes. Because unions utilize mediation to work through disputes—even minor issues may be unnecessarily escalated. This can exacerbate already strained relationships between management and bedside staff. 

• Strikes. Even though it’s used as a last resort tactic, striking is a powerful tool to force movement in stalled negotiations. Strikes are mandatory, unpaid, and vary in unpredictable length; many nurses feel a moral and ethical dilemma in abandoning their patients. What’s more, strikes don’t always result in a favorable outcome for unionized nurses, and “scab nurses” (those brought in to fill the absence of striking nurses) are sometimes hired permanently—meaning nurses on strike are not guaranteed continued employment.

Overcoming the controversy

The decision to join a nursing union is decidedly personal. It depends on the pressures of your current work environment, the push-and-pull between advancing better working conditions for all nurses in the long-term with how it will affect you in the short-term, not to mention your political viewpoints and worldview. 

For the science-minded (ahem, all of us, right?), you might be interested to learn whether research supports a positive link between nursing unions, job satisfaction, and patient outcomes. So far, the data is inconclusive. Various studies report conflicting results. For example: unionized nurses report higher levels of job dissatisfaction (perhaps a byproduct of being “woke” to what nurses deserve compared to what we make do with); it’s also true that heart attack mortality is improved by 9.1% in hospitals employing unionized nurses. One study reported a 33% increase in pressure ulcer occurrence for patients cared for by unionized workers; while another more recent survey of New York nursing homes found that residents cared for by unionized workers had drastically lower mortality rates (likely due to more stringent infection control and heightened access to PPE). Which is all to say: more data is needed.  

What’s not in dispute? The profound unrest of nurses in acute care settings. Like a bustling mecca of frenzied activity found beneath an overturned stone, the deep-rooted and heavily pervasive desperation felt by bedside nurses was present long before COVID revealed it for all to see. Accelerated by the pandemic, the problems within the nursing field transcend political party, geographic locale, and speciality…and while we have the spotlight, it might be time to revamp nursing unions as we know them. 

Anecdotally, to some, union workers are reported to be lazy; watered and fed under union protection, some argue that there’s no incentive to keep up with the frantic pace non-unionized nurses have indirectly consented to. But isn’t that a classic fallacy? Instead of villainizing the union nurses for resting on their contracted laurels, shouldn’t we instead be scrutinizing the systems that created this adversarial dichotomy to exist in the first place?

What will always be true is that a workforce of millions holds power. It’s up to today’s nurses how best to wield it. Unions are one way. And if they’re not for you, we challenge you to envision how best to harness the wave of dissatisfaction within our entire nursing community. You have our attention—and nurses everywhere are listening. 

Breanna Kinney-Orr

NurseDeck Ambassador

Breanna has been a Registered Nurse since 2008. Her clinical background in is neuro, trauma, and ED nursing, as well as nursing leadership. After having two sets of identical twins (yes, really!), she started her career as a nurse-focused writer and content creator. Breanna has a passion for story-telling and amplifying the collective nurse voice. She doesn’t shy away from controversial, political, or taboo topics and believes wholeheartedly that nurses play a pivotal role in healthcare reform. Most of all, through her writing, Breanna loves bringing nurses together and creating communities where nurses feel seen and supported. Outside of NurseDeck, Breanna enjoys anything outdoorsy, riding horses, books books and more books, and keeping her children out of the ER.