For many years now, the façade of effective safety measures designed to protect nurses in the workplace has troubled nurses. Yes, carefully-worded policies were in place, and appropriate PPE appeared to be stocked, but something seemed…off. And then along came 2020, and this issue broke wide open. 

During the ever-evolving Sars-CoV-2 pandemic, state nurses have bore the brunt of a front line exposure to a novel virus. As a result, we have seen dramatically increased rates of both infection…and death. All the while, our employers have struggled to protect us. No matter what statements were released via PR departments to the public, the policies, procedures, and federal regulations designed to keep healthcare workers safe have been inconsistent at best, and at worst—abject failures.

Everyone has heard about these well-publicized stories: one week, employees are barred from wearing surgical masks due to the potential for offending patients; the next week, these same masks are suddenly necessary as a minimum first-line defense. Another example—the ongoing saga of dissipating N95 availability dictating how their use is recommended.

Lots of masks? Great! Change them daily, and if visibly soiled. Short supply?

Well, then, now it’s okay to keep them incubated in brown paper bags in your locker for weeks at a time. 

The kicker is that nurses are more than capable of understanding rapidly changing supply chains, especially during crisis situations—but we weren’t given the respect to discern that. Instead we were fed lines about “following federal guidelines.” Hashtag—puh-leaaaaase. 

As it turned out, PPE shortages were just the tip of the pandemic iceberg. Next came waffling recommendations for dealing with exposed workers; the requirements to use personal PTO to cover mandatory quarantines; then, an ever-increasing limit on what constitutes unsafe staffing ratios. To be fair, over the past year and a half, some of these issues have been addressed and improved upon, but the traumatic impact of living through them—and all the while caring for intensely sick patients—has taken its toll.

Nurses have had enough. 

In fact, we had enough a few months into the pandemic—but our loyalty to our patients and profession has kept us coming back, shift after shift, for months on end. 

This commitment is admirable, yes, but many nurses have privately (and not so privately) decided to withdraw their trust from the institutions they work for. One of the ways this has manifested is through joining forces to combat these unsafe working conditions. 

Otherwise known as…unionizing. 

The direct—and objective—effect of nurses unionizing on patient care is positive. And in fact, looking at the data, we see that healthcare facilities with nursing unions have measurably better patient outcomes.  Of course, this should come as no surprise—safer worker conditions for nurses directly benefits the patients we care for. 

Last fall, a study looking at rates of mortality from COVID-19 in unionized long-term care facilities found a dramatic decrease compared to those without unions. These findings resulted because workers there were able to negotiate access to PPE supplies and had clearly outlined infection mitigation procedures in place early on.

Overall, the desperation and outrage felt by nurses has primed an opportunity for union membership to explode. This is a trend confirmed by the president of National Nurses United (NNU), Zenei Triunfo-Cortez. 

One notable unionizing effort took place at Mission Hospital in Asheville, NC in September of 2020. While conditions worsened there in the height of the pandemic, the nurses at Mission Hospital collectively banded together, resulting in the biggest hospital unionization in the South since 1975. By the end of their month-long campaign, over 70% of the nurses there voted to unionize, resulting in a landslide victory.

Of note, the start of these efforts was initiated largely under the radar. Like many nurses nationwide, these nurses feared the punitive retribution from their employers that talks of unionizing would likely elicit. Indeed, HCA—the largest hospital corporation in America—fought valiantly against their efforts in a well-publicized campaign.

In the end, the nurses’ commitment to their safety and the safety of their community prevailed, and their story made national headlines. Since then, with the help of the NNU, Mission Hospital nurses are actively negotiating core issues, such as improved staffing ratios and higher wages.

Enduring surge after surge of COVID-19 has illustrated to many nurses that one-off protests and strikes do little to change working conditions permanently. However, collective bargaining does have the power to crack outdated and rigid corporate policies that no longer serve frontline workers. 

Just as waves of coronavirus have ebbed and flowed over time, the shift in nursing issues has too.  PPE availability and recommendations gave way to discussions of safe staffing ratios and  mandatory PTO for quarantined workers bowed to concern over nurses leaving the profession in droves.

A review of current headlines finds hospitals scrambling to lure agency nurses with large signing bonuses in order to fill staffing gaps; they do this, while simultaneously furloughing their elective care staff nurses whose departments have been converted to makeshift COVID units. 

To a lot of nurses, it feels like madness. And unionizing is one way for nurses to regain their power and voice in a sea of bureaucratic noise. Because if there’s one thing nurses are good at, it’s finding the shortest, evidence-based point between Are you effing kidding me) and B(itch, please, I’m a NURSE). 

Historically speaking, unions tend to fluctuate with the economy, seeing increased membership under times of stressful working conditions.  This trend is industry-independent—except for the healthcare sector.  Healthcare union membership, surprisingly, has remained at a stable 7%, even during the economic downturn of 2020. This fact alone belies the notion that nurses are anti-union. 

Even considering all the bargaining power that unions seem to promise, there are still nurses who regard unions as inherently “anti-nurse.” Common misconceptions include the fear that the largest unions are run by politicians and lawyers, and not nurses (nor healthcare-savvy personnel). Nurses also worry that when union negotiations reach a breaking point, and a strike is deemed necessary, they will be forced onto the picket lines, forgoing wages (not to mention the heartbreaking moral dilemma of leaving their patients uncared for).

These union-wary nurses would do well to remember that healthcare is an ever-evolving entity. And one that is woefully due for some major changes, because the current state is inherently broken—as such, it serves no one efficiently.

Indeed, the bottom line for many nurses lies in truly assessing how much health care has changed already. Not just in the past year plus, but in the decades prior to the COVID pandemic. The healthcare system at large already feels like a sinking ship to most nurses—the introduction of Sars-CoV-2 was simply the iceberg that broke it all open.

Time will tell if unions provide the buoyancy nurses so desperately need in these stormy waters.