The Appalachian Nurses Strike
I have always considered myself an individualist. I do not believe that the human condition is improved by permitting other people to make life-altering decisions for you. If a doctor recommends surgery, I've always felt it was my decision to make, not my doctor's. Similarly, if the boss advises me to commit a federal crime and falsify a record "to make things look good," I preferred getting fired to going to jail. This desire to make my own decisions, to keep my own counsel on matters of importance, has always served me well.
So, reports regarding the nursing strike in Appalachia gives me pause in large part because I can see both sides of the conflict, and I wonder, now that I am removed from health care, how I would handle the situation facing the nurses there.
According to media reports, the key issues in the strike are patient care and staffing. That's what the nurses say. The hospital says that the nurses don't want to take hikes in their health insurance premiums, don't want to have to settle for time and a half instead of double-time for holidays, and that the issues are economic and greed-driven.
As is often the case, the statements by union officials and the statements by hospital officials make it sound as though the two groups were talking about different universes rather than the same strike in a small rural town. The union is trying to be the nurses' advocate, and the nurses are trying to be patient's advocates. The nurses say that staffing is dangerously thin, and that patient care suffers when the staff is insufficient. The hospital says that a mandatory 2.5 hours of overtime a week is just "not that bad," and patient care never suffers. To be blunt, the nurses are far more likely to know whether patient care is suffering than the hospital spokesman who likely doesn't know a band-aid from a steri-strip.
That said, I need to state my bias up front: I do not think unions are good for health care. I believe that smaller service units (like physical therapy, respiratory therapy, dietary, radiology, and similar ancillary services) wind up under the thumb of the nurses union because what the 800 pound gorilla wants, the 800 pound gorilla usually gets. As a result, innovation in health care, new service ventures, and changes in how procedures are done - many of which would benefit the patient - are often bogged down and defeated because the biggest hospital union doesn't want to play ball.
Also, unions tend to be driven and managed by people who are more interested in perpetuating the union than necessarily doing good for the workers. The impact of the unions in the automotive industry, who pushed that industry into near extinction in the 1980s, are one good example.
But, I also understand that it would be easier to negotiate compassion from the leader of North Korea than it would be to get a pay raise from many hospital administrators. Hospitals in isolated market areas (like Appalachia) may be able to command an undue economic influence on wages because in most cases they are the biggest non-factory employer in the region. hey can simply refuse to pay more. No one wants to leave home to get a better job, and in the end people often take what they can get. While the hospital might lose one or two nurses a month for economic reasons, it is likely not to see a major interruption in service because in a non-unionized hospital there is no credible threat of an interruption of patient care. Wages remain stagnant.
But where there is a union, there is economic clout to rival that of the hospital. To get what it wants, the union takes a strike vote. If there are 500 nurses in the union, and 251 vote in favor of the strike, it doesn't matter if there are 249 who voted against it. The union speaks with one voice, and whether they wanted to or not, hundreds of nurses walk off the job.
So here's the question: if there was a problem with staffing before the strike, when all the nurses were working at the bedside, what is the effect on patient care of having 500 nurses walking a picket line instead of tending to patients. The hospital can claim that the nurses really do not care about patients because if they did they'd be on the job. The nurses shoot back that if the hospital paid better, they'd be on the job. And the circle goes around and around. The arguments escalate, producing more heat than light. And federal mediators are called in to try and get a resolution so people can get safe health care in their community.
When a union issues a strike vote, the majority rules. That means that persons of conscience who feel compelled to be at the bedside, and who do what they do because they value their profession and the work, are compelled to stay out of work even though their heart tells them to go in. As noted in media reports, nurses who have crossed the picket line in Appalachia have had their names added to a "wall of shame" and some have suffered tire-slashings and damage to their homes and property. This is why professionals should not join unions.
Tough tactics and intimidation against "scabs" harkens back to the 1930s and the days of labor unrest in this country when unions were needed in many factories to prevent management from abusing the work force. Solidarity with the group was most important because without it, the union could not force change. Times change. Economic conditions change. The role of unions change. Tactics should change with it.
In the 21st century, when patient care is at issue and lives on the line, intimidation and similar nonsense makes health care workers into little more than armed thugs without conscience. If I did not believe that a strike was the right thing to do, I would cross the picket line, and I would hold my head up high. Following your conscience shouldn't be something you pay a price for. It should not cost you friends. It should not cost you respect. It should earn you gratitude for thinking about the patient first. I salute those workers who crossed the picket line not because I endorse the position of the hospital, but because I believe that as nurses they are acting in accord with the ethical dictates of their profession, and should be accorded respect for that.
As far as the hospital goes, it should negotiate in good faith and remember that as a charitable institution, charity truly begins at home.