In June, President Obama told a meeting of delegates of the American Nurses Association that "Nurses are the beating heart of our healthcare system."
Unfortunately, when it comes to working conditions and cuts, nurses across the country have more and more become the bleeding heart of our healthcare system. And the worsening conditions faced by the single largest section of the healthcare workforce have raised the stakes for unionization and collective bargaining battles in that sector.
In early October, a snapshot of this reality could be seen at the largest hospital in the nation's capital. Nearly 1,600 registered nurses at the Washington Hospital Center (WHC) voted overwhelming to affiliate with National Nurses United (NNU), the largest nurses' union in the country. Formerly members of the independent organization Nurses United of the National Capital Region, 1,121 nurses among a turnout of 1,190 voted in favor of joining NNU.
Tense relations between the nurses and hospital management were the backdrop to the NNU election victory. Hospital executives have taken an increasingly combative stance against the nurses' union in their efforts to cut costs.
When asked about the overwhelming turnout by nurses to vote to join NNU, Stephen Frum, an RN and lead negotiator for the union explained the nurses' support for affiliation in light of management's ongoing hostility against them.
"Nurses at WHC are impressed with NNU and want to seek broader and stronger allies in their fight for patient care at our hospital," Frum said. "Frankly, the attacks by management have been so terrible, we felt we needed to bring more power to the fight for justice at the hospital. Being a part of NNU will give us that additional power."
Nurses hope that the new affiliation with a stronger national union will not only give the nurses more power at the bargaining table to negotiate a fair contract, but also the extra muscle to reverse the hospital's latest attacks.
A week before the NNU affiliation vote, the hospital unilaterally cut take-home pay for most of the nurses. The imposed takeaway, which includes cuts in shift pay for evenings, nights and weekends, resembles similarly harsh takeaways in management's last contract proposal which 98 percent of the nurses voted against. The nurses have been working without a contract since June.
"Management has shown tremendous disrespect for the registered nurses and a callous disregard for the needs of our patients, and the hospital's latest move only adds insult to injury," Frum said in a press release following the election.
He also noted that understaffing and other issues have contributed to worsening work conditions and in turn have led to increased turnover, with over 220 nurses leaving WHC since the beginning of the year.
"The overwhelming decision by the Washington Hospital Center nurses to join NNU sends a strong signal to management that we're prepared to fight back."
While WHC management has tried to push through severe wage cuts, the nurses' union has pointed out that the hospital - which is run by a $3.8 billion non-profit called MedStar Health - has maintained healthy margins. MedStar Health's CEO makes an average of $2.7 million a year.
The hospital has been on the warpath against the nurses, particularly over the past year as it has sought to intimate and break their union. The hostile atmosphere was set by management ahead of contract negotiations earlier in the year when WHC terminated 18 nurses in March for not reporting to work during the biggest blizzard to hit Washington, DC in more than 70 years.
When this egregious attack hit the press, the union mobilized its members to challenge the firings and garnered the support of the local labor community.
Since the firings, nine of the 18 nurses were reinstated following an investigation. But nurses continued to stand in solidarity with each other. The union filed an Unfair Labor Practice (ULP) charge in July, citing the firings as a violation of the hospital's snow emergency policy.
In August, 80 percent of voting nurses approved a one-day ULP strike to demand that the other terminated nurses be rehired and receive back pay. The union ultimately called off the 24-hour strike because leaders assessed that there was not enough support.
But the remaining nurses who were unjustly fired last February may stand a better chance of getting their jobs back with NNU support. Last week, the hospital finally submitted to the first arbitration on the matter and while the union is confident it has a solid case, it is not ruling out other means to pursue justice for the terminated nurses.
Prior to the NNU vote, contract negotiations had made little or no progress as management continued to demand cuts in pay and benefits. The union held several pickets throughout the summer, including a nearly 2,000-strong picket of RNs and supporters at the hospital in May.
With the added clout of NNU, registered nurses at WHC have armed themselves with more leverage in their negotiations with an obstinate employer. But the issues facing nurses and their union at WHC are reflective of a nationwide crisis in primary-care hospital services.
Understaffing is rampant in hospitals throughout the country. Yet, as the new healthcare "reform" law takes effect, the role of primary-care givers is expected to grow significantly.
A year ago nurses and their unions were at the heart of the fight around healthcare reform, with many pushing for the public option or single-payer at a time when the White House had already removed those options from the table.
What ultimately passed as "reform" will bolster, rather than eliminate, the private health insurance industry as the central arbiter of who gets care and who doesn't. But with millions forced into private health insurance plans, the influx of new patients will heighten the need for nurses.
The growth of employment opportunities in nursing that is expected over the next decade will expand the nursing sector and could translate to more power for nurses - if they are organized. Currently, 21 percent of registered nurses in the country are union members, according to the Bureau of Labor Statistics. From an organizing perspective, this reality raises the stakes for unionization efforts among nurses.
With its most recent victory in DC, the National Nurses Union is building on its membership of more than 155,000 RNs across the country. NNU is a new national formation created last December with the merger of the several smaller and largely state-based unions.
This unification signified a break from nurse unionism's more fragmented history, offering the potential of a more powerful voice for nurses nationwide. NNU also represents a more militant alternative to the other large nurses' organization, the National Federation of Nurses, which is aligned with the American Nurses Association and its penchant for partnerships with management.
And the timing of NNU's inception may be pivotal. On the one hand, the recession has led to cost cutting and increased workloads in hospitals that are cutting back on staff and nurse training. The impact on the nursing profession in hospitals, both public and private, is devastating in many cases, leading to high turnover rates - to say nothing of the dangerous effect these practices have on patient care.
On the other hand, hospitals in general expect financial difficulties brought on by the economic crisis to ease as the new healthcare law is implemented. Hospitals will theoretically be less burdened by the costs of caring for uninsured patients. But as long as the economy remains weak and with private insurance companies still at the center of the healthcare equation, those potential benefits for hospitals may be negligible.
As Judy Shindul-Rothschild, a nursing researcher at Boston College, observed earlier this year, "If we don't find a way either at the state or federal level to once and for all put the private insurance companies out of business, we will see more of these cyclical efforts to squeeze the workers who provide care."
Understaffing and attacks on nurses' pay and benefits have led to a number of other labor disputes at hospitals in recent months, including 12,000 nurses at 14 Minnesota hospitals who came close to striking in July, and the 28-day strike by some 1,500 nurses at Temple University Hospital in Philadelphia in April.
Back in Washington, DC, NNU's role in fighting for lower nurse-to-patient ratios will be important for the nurses and patients at WHC. One nurse told the Washington Post that she has double the amount of patients that she has to care for at any given time compared to when she started working at the hospital 11 years ago.
"I feel like I'm not doing the job that I want to do," she said. "I'm not doing a good job of taking care of them, of meeting the emotional needs. It just breaks my heart."
But now WHC nurses have larger forces backing their efforts to win a decent contract. Their victory will be a victory not just for NNU, but for the labor movement as a whole and for all those at the heart of healthcare: the nurses battling for their patients on the frontlines of a profit-driven system.