Modern day health care is a troubled industry. Enshrouded in a net of oft-conflicting regulations and entrusted with the safety of America’s sick and wounded, many of whom lack the necessary insurance to guarantee reimbursement to their providers, the financial stability of our nation’s medical facilities is called into question on a daily basis. Today’s hospital has the unenviable task of walking a fine line between caring for its patients and remaining solvent as a business, a laudable goal attainable at least in part by recognizing the inextricable connection between the institution itself and the nurses who form an infantry amongst its ranks. Even as these nurses form an ever-present “front line” on the hospital battlefield, their recent strike in California, threatened and averted strikes in New York, and a judicially-restrained “walk out” in Riverside County, California last month, shine a harsh if necessary light on certain issues plaguing our current health care system as it stands so precariously with one foot on either side of a dangerous fence.
The nature of the nurse’s role begs the question: does participation in a labor union extend to the right to strike?
Recently, this politically charged issue is facing strong rhetoric from both sides of the bargaining table as thousands of nurses throughout the nation have either held to their word and staged a strike in protest of sweeping cuts to health care, or threaten to strike in the near future. Certain vocations pertaining to the safety of the general public such as firefighter, police officer, doctor and nurse find themselves in the odd position of being too valuable to strike. For better or worse, their role in society precludes defining them as expendable. And yet, such categorization effectively curtails the ability of these professions to leverage firmly established and lawful tactics as they bargain for perceived worth, creating a disparity between their responsibility to society and their personal reimbursement.
While those in health care may disagree about the practical propriety of labor unions in the United States from a business standpoint, there should be no dispute that such organizations are legally recognized as bona fide representatives within the industry. Since the 1940’s, when the American Nurses Association first formally embraced collective bargaining, nurses have enjoyed the ability to organize themselves in such a manner.
Since the passage of the Emergency Medical Treatment and Active Labor Act in 1986, basic emergency medical treatment has risen over the years to a level where many Americans view coverage as an absolute right, and today’s hospitals find themselves the unenviable centerpiece for this theoretical 28th constitutional amendment. And yet, without the presence of nurses in a hospital environment, such entitlement means little. Just as nurses must recognize the effect such a strike can have on the patients they have promised to protect, Californians must be mindful of the critical contribution hospital nurses make in ensuring that our health care system operates without interruption.
Labor disputes, including strikes, are not a novelty in the health care industry, and much can be gleaned by earlier attempts at negotiating, both at home and abroad. On April 1, 1964, the parliament of the Kingdom of Belgium announced to the country that physicians had started a “total and unlimited strike” that sent its health care system into a state of shock. Well-coordinated and widespread, the organizers of the Belgian physician strike had both the foresight and the compassion to maintain a section of physician “guards” whose job it was to remain on active duty at all hospitals in the event of a medical emergency. A few years before and several thousand miles away, doctors in the Canadian province of Saskatchewan went on strike for 23 days, having first given the government plenty of advance warning to bring in doctors from other countries as well as other Canadian provinces.
Though the safety of patients is certainly of utmost importance, the fiscal ramifications of a nursing strike cannot be ignored. In today’s hospitals the ever-present nurse obviates the necessity of a similar showing by physicians. While national accreditation entities like the Joint Commission require physician visits by the day, California, for example, has established a staffing ratio between nurses and patients to be followed by all hospitals at all times. While some may dispute the levels at which these nurse to patient ratios are set, few will argue against a constant nursing presence of some meaningful measure.
Such demand underscores the critical role played by nurses in matters of life and death. It also paints an accurate picture of the contradictions at the heart of our nurses’ conundrum, especially on the eve of such a massive strike. Unless the nurses who strike develop an action plan to ensure patient safety if and when they abandon their posts, the question remains whether or not the option of striking should exist for nurses within their arsenal of collective bargaining. At the same time, if state or federal law should ever prevent nurses from walking off the job as a means to illustrate their worth in an effort to gain economic security and/or influence other employment issues, it is only reasonable to replace such a deprivation with a measure to ensure a level playing field between hospital and nurse. So long as nursing unions remain legally recognized under the law, there is a dire need to change the rules governing a nurse’s right to strike so that we might avoid any tragic consequences.