IN EARLY APRIL, in the throes of the coronavirus pandemic, a group of obstetrics nurses at a hospital in Oregon’s Providence Health & Services system felt that hospital management was failing to protect them. Visitors entering the obstetrics unit were not being adequately screened, and nurses weren’t receiving sufficient personal protective equipment (PPE). So the nurses, who are unionized with the Oregon Nurses Association (ONA), jumped into action. They drafted a petition demanding that management address these issues, and presented it to their manager as a group, a tactic known in the organizing field as a “march on the boss.” Management quickly agreed to most of the demands for better visitor screening and equipment.
For the union, the successful action was unprecedented in its speed and energy. “Within two days, they generated a supermajority of support for that petition on their units,” said Gabe Erbs, an organizer for ONA. “That is one of the quickest turnarounds for a petition I've ever seen. I think it really speaks to the urgency of the moment.”
The Oregon nurses’ experience echoes that of other organizers and nurses union members across the country, who are seeing an uptick in interest in union work as the pandemic threatens nurses’ lives and, in many cases, exposes hospital management’s disregard for their interests. Organizers from three different unions said that in unionized hospitals, members who were previously tepid about union involvement are quickly mobilizing; meanwhile, nurses without union representation are newly considering organizing, and, in some cases, are proceeding with collective action even without a formal union.
There are plenty of obstacles: typical face-to-face organizing tactics are impossible given social distancing requirements, and new regulations passed by the Trump administration’s National Labor Relations Board (NLRB) last month threaten to drastically restrict workers’ ability to form new unions by making it easier for employers to interfere with elections. But nurses union organizers believe that Covid-19 has unleashed a new spirit of collective energy. The same is true in frontline sectors beyond nursing: in the last few weeks, Amazon workers in New York led warehouse walkouts, Instacart employees went on strike and successfully won health and safety equipment, and Los Angeles fast food employees organized a strike for better pay and protection. Nurses union members and organizers I spoke with were optimistic that the gains in organizing power would outlast the pandemic, potentially heralding a period of renewed strength for the US labor movement, with nurses playing an integral role.
The healthcare industry has expanded rapidly over the past several decades, as an aging population has boosted the demand for nurses and other healthcare and service workers. But while the number of nurses in the US has ballooned to 3.2 million—increasing by one million over the last 20 years—the percentage of registered nurses covered by a union contract has remained relatively steady over the last few decades, hovering at just under 20%, or around 590,000 nurses, according to data from the US Current Population Survey.
Even if membership rates have remained steady, the prominence of nurses unions has grown in recent years as the National Nurses Union (NNU), the nation’s largest nurses union, has embraced a more ambitious, left-wing politic. The union, formed in 2009, quickly garnered attention for its willingness to fight for a broad-based progressive agenda that included issues like climate change and consumer protection. The organization made an early endorsement of Bernie Sanders’s presidential campaign in 2016 and has been a leader in the campaign for Medicare for All. In a January 2020 Medium post reflecting on the previous year, NNU executive director Bonnie Castillo framed her union’s fight as key to the national struggle against the 1%: “The United States is a lot like the health care industry: Billionaires are at the top, cutting corners on working people to boost profits. But who takes on a billion-dollar industry every single day and wins? Nurses.”
Still, many nurses have been hesitant to organize. “Prior to this [crisis], we have had a lot of complacency, because a lot of the nurses really didn’t know how to get involved or how to use their voice, or there was fear of retaliation,” said one Oregon nurse involved in the effort at Providence hospital, who asked that her name not be used because the hospital has recently fired nurses who spoke publicly about their working conditions. “I’ve seen a lot more involvement since all of this happened.”
She and her colleagues are now working on expanding their petition to include nurses working in other hospital departments. They are also pushing for further demands, including a consistent, transparent policy on Covid-19 testing for nurses who are exposed to the virus or become ill, and alternatives to using their own limited paid time off if they become sick with Covid-19.
The need for safe social distancing has changed some traditional union organizing tactics, like face-to-face conversations between organizers and workers to build trust and support. But for Erbs, this limitation has had the positive side effect of reminding him how effective it can be for nurses themselves to take the lead on organizing while he plays more of a supporting role. “This is illuminating how many awesome leaders there are on the shop floor, stepping up to do a lot of the work that I was doing—working a list, contacting petition captains, talking to coworkers in meeting settings,” he said.
Even before the pandemic, ONA had been in the process of shifting from a “service union” model—in which employees of the union help resolve grievances, usually without grassroots pressure tactics—to the “organizing union” model, in which workers on the ground take responsibility for most of the organizing, ONA Communications Director Kevin Mealy told me. And the latter strategy, he said, is ideal for the current crisis.
The Oregon nurse said she’s even seen some advantages to shifting to virtual meetings. In-person union meetings are often hard to schedule, especially since many nurses have childcare conflicts. “I felt like this was a great opportunity to include more people,” she said. “People can be in their pajamas while their kid is reading a book.”
In Chicago, nurses unions are seeing increased interest not just in healthcare worker protection issues, but also in fights to challenge racial and socioeconomic disparities in the healthcare system. On April 4th, NNU nurses at the county’s public Provident Hospital on Chicago’s South Side were outraged to learn that the ER was about to be closed for a month, with only a few days’ notice for healthcare workers and the surrounding community. The Cook County Board President has said that the purpose of the closure was to better prepare the ER to handle Covid-19 patients in May, but the nurses believe that it’s irresponsible to close a hospital in the midst of a pandemic, and that the same decision would not have been made in a wealthy, white Chicago neighborhood. They held a socially distanced rally and press conference outside the hospital on April 6th, the day the ER closed. On April 17th, the county announced that it would reopen Provident on April 20th, after only two weeks of closure.
“I've been an activist for a long time, but a lot of my coworkers are not activists. And I definitely think that we’re in one of those times where more and more people are having their eyes opened to all of the [societal] disparities that have been exposed by this virus,” said Dennnis Kosuth, an ER nurse at Provident. Chicago’s coronavirus numbers are a stark illustration of pre-existing racial inequities in health care: black people account for nearly 60% of Covid-19-related deaths in the city, despite making up just 30% of the population. “I think nurses around the country, probably around the world, will be going back to work when we’re done with this and thinking about what to do and about what needs to change,” he added.
As nurses confront risks to their patients and themselves, many who work in non-unionized hospitals have been impressed with their unionized peers’ accomplishments, and have expressed interest in unionizing themselves. According to NNU organizing director Roy Hong, the union has recently seen a huge increase in non-unionized nurses reaching out to ask for help in getting the PPE they need. The crisis is too urgent to take these nurses through the full unionizing process right away, Hong said, but the NNU has been offering advice for taking their concerns to management and for filing Occupational Safety and Health Administration (OSHA) complaints if necessary.
But just as nurses and other workers are seeking to organize new shops, the Trump administration has thrown a formidable obstacle in their path. On March 31st, the NLRB—currently comprised of three Republicans—issued new rules for union elections. These changes will make it “nearly impossible” for workers to organize a new union, according to Celine McNichols, government affairs director at the Economic Policy Institute (EPI). One rule change stipulates that NLRB-organized union elections will proceed even if workers have accused their employer of an “unfair labor practice”—such as making false statements to workers about the consequences of unionization—making it easier for employers to illegally interfere with elections. Another rule allows a minority of members to file for an election to decertify a union just 45 days after an employer has voluntarily recognized it, incentivizing employers to put off bargaining in the hope of seeing the union dissolved.
These rule changes have been in the works for months, part of the current NLRB’s ongoing campaign to undermine workers’ rights. But right now, they could have especially painful consequences. “It’s disheartening to see the NLRB issue such a rule during a time of crisis, making it harder for workers to organize when they need to organize most,” Margaret Poldock, a policy associate at the EPI, told me.
Workers will have to find ways to take collective action without the help of the government agencies meant to protect them. “If labor organizations aren’t developing strategies to achieve their goals on the shop floor that don’t involve the NLRB, they’re behind,” Erbs said. “I would hope that working people in this country are waking up to the fact that while the state regulatory apparatus has some utility, no one’s coming to save us. We have to save ourselves.”
Nate Miller, an organizer for the Northeast Nurses Union, a federation of nurses unions in four East Coast states, is already helping workers mobilize outside of formal union structures. At one hospital in Massachusetts—which workers asked not be named, out of fear of provoking union-busting measures by management—Miller had been in touch with nurses hoping to organize a union before the coronavirus crisis, but the process was in its early stages. “There were some people in the hospital who seemed interested, but they also felt like, ‘Hey, my situation’s not that bad,’” he said. But when the pandemic hit, nurses were frustrated that the hospital was employing a host of unsafe practices, including failing to separate patients seeking testing from others in the ER, failing to provide healthcare workers with proper PPE, and requiring immunocompromised or pregnant nurses to work with Covid-19 patients.
The nurses Miller had been in touch with began organizing in a Slack group and invited other coworkers. Eventually, they got a majority of nurses in the hospital, as well as hundreds of other hospital workers like technicians and food service employees, to sign a petition demanding that the hospital adopt a range of industry best practices, including setting up triage tents outside the hospital for Covid-19 patients, fitting all nurses with N95 masks, and providing nurses with hazard pay. Management eventually agreed to implement a third of the nurses’ 12 demands and to work with a committee of nurses from every hospital unit, who will advocate for what they need. “We’re trying to go into overdrive to help them start acting like a union even when they don’t have a formal one,” Miller said.
These same nurses have also organized an independent drive to collect unused N95 masks and other protective equipment from the community, modeled after a successful effort by St. Mary, a Northeast Nurses Union-affiliated hospital near Philadelphia, which collected over 20,000 masks. When we spoke last week, Miller was in the middle of driving back to New York from Massachusetts, where he had dropped off masks and met some of the nurses he’s working with for the first time—from six feet away. “Usually, I’ve been in people’s houses by this time, I know their kids, they’ve really become my friends,” he told me.
Yet even without the standard in-person process, organizing efforts have proceeded at a faster pace than the typical pre-pandemic timeline, offering high hopes for what might be possible when the crisis calms down. “Hopefully, when we're able to meet with people again, they’ll already have a decent understanding of the power of collective action,” Miller says. “And it will make it easier to go through the normal process of forming a union.”