HSA 515 DISCUSSION 9-PROF STEWART

UNIONS AND HEALTHCARE ORGANIZATIONS

Union organizational activity in the healthcare industry was minimal until the late 1950s. Many labor organizations have attempted to become the recognized collective bargaining representatives for employees in healthcare settings. Craft unions devote their primary organizing efforts to skilled employees, such as carpenters and electricians, and industrial unions and unions of governmental employees seek to represent large groups of unskilled or semiskilled employees. Professional and occupational associations, such as state nurses’ associations, historically known for their social and academic efforts, have involved themselves in collective bargaining for their professions. To the extent that professional organizations seek goals directly concerned with wages, hours, and other employment conditions and engage in bargaining on behalf of employees, they perform the functions of labor unions.

Limitations on Bargaining Units

A major area of concern for healthcare institutions is the number of bargaining units allowed in any one institution. Rules and regulations issued on April 21, 1989, by the NLRB allow up to eight collective bargaining units in healthcare organizations, as opposed to the three normally allowed before the regulations. The American Hospital Association brought an action to enjoin the NLRB from enforcing the newly promulgated regulation recognizing up to eight bargaining units in American Hospital Association v. NLRB. 2  A federal district court enjoined enforcement of the rule. The NLRB and intervening unions appealed. The U.S. Court of Appeals for the Seventh Circuit held that the rule was not arbitrary and was within the authority of the NLRB. No rule is necessary to confer the rights already conferred by statute entitling guards and professional employees to form separate bargaining units.

In making unit determinations, the NLRB is required to strike a balance among the competing interests of unions, employees (whose interests are not always compatible with those of unions), employers, and the broader public. The statute can be read to suggest that the tilt should be in favor of unions and toward relatively many, rather than relatively few, units.

This balancing act is not spelled out in the statute, thus requiring an NLRB decision. The decision is particularly difficult and delicate in the healthcare industry because the workforce of a hospital, nursing home, or rehabilitation center tends to be small and heterogeneous.

On appeal, the U.S. Supreme Court, on April 23, 1991, by unanimous decision, upheld the NLRB rule allowing hospital workers to form up to eight separate bargaining units, including those for physicians, registered nurses, other professionals, technical employees, clerical employees, skilled maintenance employees, other nonprofessional employees, and security guards. 3