Unions in Health Care: Shaping Labor Relations in a Changing Landscape

The health care industry is experiencing significant shifts, with labor relations and union activity emerging as central issues. As health care professionals strive to provide the highest standards of care, they are also advocating for a stronger voice within their workplaces, leading to a rise in labor relations and unionization efforts the industry. Understanding these dynamics is critical for health care leaders, administrators, and professionals who wish to master this evolving landscape effectively.

In a recent episode of The Risky Health Care Business Podcast, Dr. Paul Clark, Professor of Labor and Employment Relations at Penn State University's School of Labor and Employment Relations, shared his insights on the history, challenges, and opportunities of labor relations in health care. Dr. Clark's extensive experience in studying labor-management relations across various industries, including health care, offers a valuable perspective on how health care leaders, administrators, professionals, and unions may influence the future of health care.

The Evolution of Unions in Health Care

The history of unions in health care is relatively recent compared to other industries. Before 1974, health care workers did not have the protections of labor law to organize. It was only after the passage of the 1974 amendments to the National Labor Relations Act that health care workers gained the legal right to unionize. Even so, it took another decade or two for unionization to gain momentum in the health care industry.

"Health care workers got that protection in 1974 and that's where you saw unions in health care come online. However, it took a decade or even two for them to generate much momentum," Dr. Clark noted. It was not until the 1990s and early 2000s that unions began to see significant growth among health care workers, including nurses, support staff, and even physicians.

Today, unionization continues to expand within the health care industry, driven by various factors, including concerns over wages, working conditions, and staffing shortages. As Dr. Clark observed, "The momentum has been building and building over the last couple of decades, and I think that's going to continue."

Differences in Labor Relations Between Health Care and Other Industries

Labor relations in health care differ significantly from those in traditional blue-collar industries. While unions in manufacturing or construction often focus on securing a larger share of profits for their members, health care unions have a unique set of priorities.

"In an industry like health care, where there is a for-profit sector, but largely you're talking about a not-for-profit sector, you're not talking about companies that are making billions and millions and billions of dollars in profit. You're talking about organizations that are providing services to people," Dr. Clark explained.

Health care professionals, from nurses to physicians, often enter the field with a deep commitment to helping others and improving lives. This shared mission between employees and employers can provide a foundation for collaboration rather than conflict. "Employers and employees have something in common that they don't have in the for-profit sector, and I think that provides a common ground for unions and employers," Dr. Clark said.

The Benefits and Challenges of Unionization

The rise of unions in health care presents both opportunities and challenges for employers and employees alike. For health care workers, unions offer a means to gain a greater voice in their workplaces, advocate for better working conditions, and ultimately improve patient care.

Dr. Clark emphasized that health care workers often seek unionization because they want to have a say in how care is delivered. "Nurses are highly committed, and they are there seven days a week, 24 hours a day. They see through their day-to-day experiences what's working and what isn't, and they really care that the system is working as well as it can," he explained.

However, for health care administrators, unionization can be seen as a potential threat to their control over the workplace. The fear of increased operational costs, legal challenges, and disruptions to patient care can lead some managers to oppose union efforts. Yet, as Dr. Clark pointed out, this adversarial approach can be counterproductive. "Workers don't bring in a union to wreak havoc and make a hospital or a clinic work less well. They want to have a greater voice in how care is delivered," he said.

Misconceptions About Unions in Health Care

One of the most common misconceptions about unions in health care is that they lead to a loss of control for management and create chaotic workplaces. In reality, unions often contribute to creating fairer and more transparent workplaces, particularly when it comes to discipline and decision-making processes.

Dr. Clark explained that with unionization, "The case becomes, if I discipline somebody or if I fire someone, I have to be able to justify that action. I have to be able to prove that what I'm doing meets the definition of Just Cause, that it's fair." This focus on fairness can lead to higher job satisfaction and lower turnover among employees.

Furthermore, the presence of unions does not necessarily mean that strikes will become commonplace. While strikes are a tool available to unions, they are often a last resort. "Strikes are really pretty rare. Unions don't want to go out on strike. Workers don't want to go out on strike," Dr. Clark reassured. The reality is that most collective bargaining negotiations are resolved without resorting to strikes.

The Role of Collective Bargaining

Collective bargaining is a fundamental aspect of union activity, particularly in health care. Through collective bargaining, unions and employers negotiate over wages, benefits, and working conditions, often leading to agreements that reflect the needs and priorities of both parties.

"Management still has to decide, or gets to decide, what its positions will be in bargaining. That decision making isn't taken away from them by the government," Dr. Clark clarified. While collective bargaining may introduce new dynamics into the workplace, it also provides an opportunity for management to understand the concerns and priorities of their employees.

The collective bargaining process can be challenging, especially in a highly regulated environment like health care. However, it also offers a platform for collaboration and problem-solving. As Dr. Clark noted, "Management is going to learn in the process of bargaining what its employees' highest priorities are," which can lead to improved satisfaction and lower turnover.

Emerging Trends in Health Care Labor Relations

As unionization continues to grow in health care, several emerging trends are shaping the future of labor relations. One notable trend is the increasing organization of interns, residents, and physicians, who are seeking to protect their interests in a rapidly changing health care landscape.

Physicians, in particular, are becoming more active in unionization efforts as they transition from independent practice owners to employees of large health care organizations. "Physicians who in the past, owned their own practices and were essentially self-employed, now, when they're treated like employees who are supposed to just take orders, shut up and do what you're told, they really push back," Dr. Clark observed.

Another significant trend is the impact of external factors, such as the tight labor market and pro-union governmental support, on the rise of strikes and union activity. These trends suggest that unionization in health care is likely to continue growing in the coming years.

Leadership’s Role in Managing Labor Relations

Effective leadership is critical in managing labor relations, whether or not a union is present in the workplace. Health care leaders who are willing to engage with their employees, listen to their concerns, and share decision-making authority are more likely to foster a positive and collaborative work environment.

Dr. Clark provided an insightful analogy: "It's sort of like a Chinese finger puzzle, where you've got the bamboo on both fingers, and the harder you pull, the tighter it gets. If you loosen up a little bit, the thing slips right off." This analogy underscores the importance of flexibility and openness in labor relations.

One effective strategy for managing labor relations is the establishment of labor-management committees and teams, where employees and management work together to address workplace issues and improve operations. "In those places where administrators have done that, they've often seen really impressive results that they wouldn't have got any other way," Dr. Clark explained.

Uniting Forces for a Stronger Health Care Future

The rise of organized labor movements and unions in health care presents an opportunity for collaboration and improvement, to enhance patient care, improve employee satisfaction, and build stronger, more resilient systems. By recognizing the value of giving health care professionals a voice in their workplaces and fostering open communication, health care leaders can create environments where both employees and patients are empowered.

As Dr. Clark thoughtfully stated, "Giving these dedicated health care practitioners a greater role in how the system operates, in the decisions about how you provide patient care, I think those are the people who should be making those decisions, and I think that's a positive thing."

To dive deeper into these topics, the full conversation with Dr. Paul Clark on The Risky Health Care Business Podcast provides further valuable insights and is available on the podcast webpage and podcast listening platforms.  Subscribe, share, and engage with the podcast to stay informed about the latest developments in health care risk.