1. Chapter 11 Organized Labor
Overview of Unionization
The Labor Relations Process
A Review of Legislative and Judicial Rulings
Developments in Organizing Healthcare Workers
Management Guidelines
Copyright 2011 Health Administration Press

2. Copyright 2011 Health Administration Press
Introduction
A union is an organization formed by employees for the purpose of acting as a single unit when dealing with management.
The labor relations process is the process by which management and union jointly decide on and administer terms and conditions of employment.
Copyright 2011 Health Administration Press

3. Union Membership in the United States
From the 1950s to the 1970s, union membership represented 25 to 30 percent of the US workforce.
During the 1980s and 1990s, union membership decreased.
Of the 4.3 million healthcare workers in hospitals, 471,000 belong to a union.
Of the 5.4 million workers in other healthcare sectors, about 246,000 belong to a union.
Copyright 2011 Health Administration Press

4. Labor Relations Process
National Labor Relations Act (NLRA) is the legal framework for labor relations (1935).
The National Labor Relations Board oversees the implementation of the NLRA.
Participants in the labor relations process include:
Management officials
Union officials
Government
Third-party neutrals, such as arbitrators
The labor relations process includes three phases:
Recognition
Negotiation
Administration
Copyright 2011 Health Administration Press

5. Copyright 2011 Health Administration Press
Recognition Phase
In this phase, unions attempt to organize employees.
Management strategies have become more aggressive in recent years in trying to prevent unionization, but the NLRA identifies unfair labor practices, which are disallowed.
Unions solicit authorization cards that designate the union as the employee representative.
If successful, groups of employees are designated as a bargaining unit under the NLRA.
Processes are also included in the NLRA for union decertification.
Copyright 2011 Health Administration Press

6. Copyright 2011 Health Administration Press
Negotiation Phase
Once certified, unions negotiate on behalf of employees; known as collective bargaining
Collective bargaining includes both mandatory and voluntary issues
Mandatory bargaining issues are issues that must be bargained
Voluntary issues can be bargained only if both sides decide to discuss them
Collective bargaining may take several forms:
Concessionary bargaining, in which the employer may ask the union to accept reductions in wages or other commitments in light of financial constraints
Integrative bargaining ,in which both sides attempt to arrive at win-win solutions
Distributive bargaining, in which negotiation ends with a winner and loser
An impasse may result if agreement is not reached
This could result in a strike or lockout, where the employer shuts down its workplace in an effort to pressure workers into accepting management’s contract proposals
Copyright 2011 Health Administration Press

7. Copyright 2011 Health Administration Press
Administration Phase
Once an agreement is signed, the contract must be administered.
The agreement includes information about grievances and processes of employment, such as discharges and discipline.
A grievance may be filed by an employee if the employee feels that the terms of the contract were violated by management.
Due process is followed during a grievance.
In some cases, an arbitrator decides the outcome of a grievance.
Copyright 2011 Health Administration Press

8. Legislation and Judicial Rulings
In addition to the NLRA, various other federal laws and court rulings have changed certain aspects of the labor relations process.
The Labor Management Reporting and Disclosure Act of 1959 defines procedures for regulating the internal affairs of labor unions.
Managers cannot be members of a labor unions, but in healthcare there are not always clear distinctions between who is a manager and who is not (most commonly among nurses who have supervisory responsibilities).
A number of courts have ruled on who is eligible to be in a union.
Most notably, NLRB v. Kentucky River Community Care, Inc., and subsequent Supreme Court decisions clarified the definition of an employee.
The Taft-Hartley Act (1947) defined rights of management during the labor relations process.
Copyright 2011 Health Administration Press

9. Copyright 2011 Health Administration Press
The Taft-Hartley Act
A union shop is an arrangement whereby an employee must join a union after being hired.
This act gave states the right to enact right-to-work laws, which prohibit union shops.
21 states have such laws
An open shop is a provision whereby no employee is required to join or contribute money to a union as a condition of employment.
A closed shop is an arrangement whereby an employer is permitted to hire only union members.
This action is illegal under the Taft-Hartley Act.
Copyright 2011 Health Administration Press

10. Copyright 2011 Health Administration Press
Healthcare Employees
The 1975 Health Care Amendments allowed for unionization among healthcare workers, with special provisions for conflict resolution and strikes.
In 1989, the NLRB established eight bargaining units that could be organized in acute care hospitals:
Physicians, nurses, all other professionals, technical employees, business office clerical employees, skilled maintenance employees, guards, and all other nonprofessional employees
Copyright 2011 Health Administration Press

11. Developments in Organizing Healthcare Workers
The Service Employees International Union is the largest healthcare union.
Physicians are a special case in healthcare labor issues because only employed physicians may be eligible for union membership.
In 1999, the NLRB ruled that house staff at Boston Medical Center were employees and not students and therefore were covered under the NLRA.
Nursing unions have addressed a number of issues including increased workload, working hours, and staffing issues.
About 18 percent of registered nurses are unionized.
National Nurses United is the largest union representing nurses.
Copyright 2011 Health Administration Press