The Pros and Cons of Unions for Healthcare Professionals
Key takeaways:
Unions negotiate with organizations on behalf of their members to get the best salaries, working conditions, and benefits.
Union members tend to make more money, work less overtime, and have better benefits. But, they aren’t necessarily more satisfied at their job and don’t have less burnout.
Despite concerns that a strike will harm patients, patient mortality doesn’t increase during a strike.
In 2020, about 10% of American employees belonged to a union. Historically, unions contract with organizational management to promote fair wages and improve benefits and working conditions for employees. Job strikes, while used as a last resort, are one of the ways that unions can gain the attention of an employer and negotiate change. In healthcare, strikes are even more controversial than across the general public because of healthcare workers ethical concerns regarding patient abandonment.
While issues like pay and safe staffing ratios have long been concerns across healthcare, the COVID-19 pandemic has emphasized the need to protect and care for healthcare professionals (HCPs). As of the end of 2020, National Nurses United (the largest U.S. nurses union) estimates that at least 1,700 HCPs have died due to COVID-19.
Are unions an answer to improving the working conditions of HCPs?
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Why do healthcare workers unionize?
HCPs unionize for many of the same reasons as the general public. Unions address issues like pay and working conditions through a process known as collective bargaining. In healthcare, unions can also advocate for improvements in patient care and safety. HCPs affected by the COVID-19 pandemic through a lack of resources and staffing issues see unions as a way to make sure their work environment is supported.
Unions represent their members have been shown to:
Decrease required overtime
Increase health insurance benefits
Increase salaries/wages
Lower discriminatory practices
Lower income inequality
How do unions impact the healthcare industry?
Currently, about 11% of HCPs and technical workers are union members. Among physician residents, about 15% of house staff across more than 60 hospitals belong to unions. Overall, about 7% of practicing physicians belong to a union. And 20% of registered nurses and 10% of licensed practical or licensed vocational nurses belong to unions.
Studies that evaluate the impact of unions in healthcare have shown mixed results:
Despite concerns, strikes have not been shown to raise patient mortality rates.
One study found that nurses that belonged to unions were less satisfied with their jobs. But, the researchers believed the findings were because the nurses felt secure enough to express job-related concerns without fear of retaliation.
Physician residents in a union were more likely to get housing stipends and enjoyed more vacation time. But, union membership didn’t lead to a drop in burnout, higher job satisfaction, fewer duty hour violations, higher salary, or a better educational environment.
Pros of joining a healthcare union
Increased job benefits
Along with salaries, unions negotiate benefits like education grants, uniforms or workwear, and travel discounts. Other benefits include medical and dental coverage, vacation and sick pay, and even bank loans. And unions continue to negotiate improvements in benefits through the length of a contract.
Job security
Contracts that address discipline and layoffs improve HCP job security. HCPs can’t be terminated without cause and are given a representative to make sure they get fair treatment during a disciplinary action. Non-union workers are often subject to what is known as “at-will employment.” In this arrangement, an employee can be let go for any reason at any time.
Higher pay, better conditions
Union members earn guaranteed wages and pay increases. Increases occur automatically based on the contract terms. Employers can’t lower wages simply because of budget cuts. Compensation is reviewed and negotiated often. It's based fairly on cost of living. The median weekly earnings of union employees are about 20% higher than non-union workers. For nurses, this translates to about $300/week more.
Unions advocate for safety rules and protocols that protect HCPs, including measures to address workplace violence and harassment. Mandatory overtime is often avoided as well.
Legal representation for work-related suits
If a union member is faced with disciplinary action or has a grievance against the employer, the union will assign a representative. These representatives advocate for the HCP and help resolve any issues.
Cons of joining a healthcare union
It can be costly
You’ll have to pay to join a union. Initiation and membership fees will be deducted from your paycheck. If your union decides to strike, you’ll continue to pay dues through the strike even if you aren’t collecting pay.
Because wages are fixed through a contract, some employees lack the motivation to perform at a higher level. There’s no incentive to perform better since you’ll make the same wage. Often, seniority is valued more than performance. If you’ve been working toward a promotion, a more senior employee might get the job over you.
You strike when they strike
Union workers are mandated to join strikes. You won’t get paid during a strike and could be replaced permanently if the company finds workers willing to cross picket lines.
Patient care may suffer
Union procedures that can make it difficult to fire employees are guaranteed representation. HCPs that are incompetent or exhibit poor work ethic can slip through the cracks or remain employed longer than they would without the union.
In the event of a strike, organizations may have trouble finding HCPs willing to cross the picket line to care for patients that still need services.
You may face workplace dissent
While union mediation can be a benefit for many issues, the constant need to go back and forth between management and employees can create a hostile work environment. Simple problems may become magnified for fear of union-imposed sanctions.
Things to consider before joining a union
If you’re thinking about joining a union, you’ll need to consider all the pros and cons. Make sure that the union's goals align with your personal goals and values. Actions of the union will reflect on you and can affect your relationships with patients, colleagues, supervisors, and future employers. Refusing to join the union can also affect these relationships.
What’s more, there is no single union that represents HCPs. Instead, various unions that may also represent other industries perform collective bargaining on behalf of HCPs.
Active nurses unions include:
Pennsylvania Association of Staff Nurses & Allied Professionals (PASNAP)
National Nurses United (NNU)
The NNU is the largest nurses union, representing over 42,000 nurses in the U.S.
Some examples of unions for physicians include:
Pharmacists have options like the Pharmacists’ Defence Association (PDA) and United Steelworkers Health Care Workers Council.
To join a union, though, you must be an employee. Private practitioners and independent contractors are typically not eligible. Physicians must be employees of a hospital or healthcare system. Usually, this means you are paid with a salary reported on a W-2 tax form. If you receive a 1099 tax form, you will not be eligible for union membership.
Hospitals and health systems have actively acquired physician practices. Currently, about half of all physicians are employed by a hospital system and it’s estimated that eventually about 80% will become health system employees.
Many HCPs worry that joining a union may present an ethical dilemma to their duty of being present for their patients. But, it's been deemed ethically acceptable to strike as long as the reason for doing so is on behalf of improving patient care.
The bottom line
Unions negotiate with organizations on behalf of their members to get the best salaries, working conditions, and benefits. In exchange for these services, members must pay membership dues and give up the ability to negotiate a personalized contract in favor of one that is more equitable to all employees. While unions may address some important life concerns — such as pay, time off, and overtime — union membership has not been proven to lower burnout or raise job satisfaction.
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