Union Busting: Moving Nurses to the Gig Economy -A Shitty Medical Model Has Come Home to Roost During This Pandemic
Megan is an RN with a Bachelor of Science in Nursing from the University of Mary Hardin-Baylor in Texas. After a grueling four years in one of the country’s best nursing schools, she is deep in student debt. She struggled through college, graduating on the honor roll, overcoming illness, injury, military transfers, and a divorce, but she wouldn’t give up. Nursing is her passion, and she has put a lot of ICU work under her belt. On the night before she graduated, she tripped and broke her leg. The leg has healed, but this rocky start sent her into a career spiral.
This constant movement from facility to facility is blamed for the spread of COVID-19 from the Life Care nursing facility in Kirkland, Washington, ground zero for the spread of the virus in Washington State to other nearby nursing homes. Agency nurses and temporary hires cobble together a living, often working one facility and picking up extra shifts on another. Nursing home work, even for skilled RNs, is one of the lowest-paid jobs in nursing.
Now she finds herself struggling in her career in Texas, a state that has one of the lowest unemployment rate for nurses in the country, and few union hospitals. As a relatively new nurse, she found herself depending on agencies for contract work -eight weeks here, twelve weeks somewhere else. Her own health care insurance pops in and out as she is sent from hospital to hospital. Sometimes health care comes immediately with a new assignment, other times it never comes at all, because her contract is up before healthcare kicks in.
A single mother, she has struggled to keep up with student loan payments, rent payments, car payments and the money it takes to support her three children in an uncertain work environment. Gaps in work -even a two-week gap -makes it impossible to keep up with her student loans. With each contracted job, there is a lag until the next paycheck, missed days that chip away at her income. Eventually Megan got behind in rent, lost her home of three years and had to move with her three children, two who are still in primary grades, to an extended stay hotel. Her credit rating dropped with each missed or underpaid bill. Eventually she relinquished her full custody rights, sending her kids to live with their dad and his wife, trading her full custody for the visitation rights he agreed to after the divorce five years ago. She is heartbroken, and her children show signs of the emotional trauma of being removed from their mother, who has been their primary custodial parent since her divorce.
A fully accredited RN, with a Bachelor of Science in Nursing, she found herself and her three children effectively homeless in a state where there is a shortage of nurses.
Her story is all too common in Texas, which is a “right to work” state, where, when unions form or try to form, companies hire attorneys and consultant firms to harass and restrict union activity in hospitals and clinics. National Nurses United has been making inroads in Texas, but has faced an uphill battle They had a significant win last year. Nurses at the Hospitals of Providence East Campus in El Paso this last October, voted for unionization and won by a wide margin at the Hospitals of Providence East Campus.
As Megan tells her story, she breaks down frequently. It is hard to hear. She has never been away from her kids for two weeks at a time. Her ex-husband could afford to hire a lawyer, but Megan could not. Her kids went to church regularly with her, every Sunday. Now that church bond, a lifetime spiritual routine for Megan and her children is fraying.
“I thought everything would be better when I graduated. I worked so hard, I took pride in my grades, my skills. I volunteered to get more experience. I was ready to help, to be the best nurse on any ward, and teach nursing when I got older. I thought I would make good money, be stable, give my kids a better life. Instead, it’s worse.”
In her last contract nursing job, she was fired for making a patient note that appeared to criticize one of her patient’s doctors.
“The patient was sharply declining. The patient was critically ill, we knew that he wouldn’t make it. But I felt that he should be intubated for breathing. His advance directives specifically asked for attempts to be made, and to refer to his sister, who had medical power of attorney if it was clear that he could not breathe on his own. A pretty standard advance directive. But the doctor ignored that directive and did not order intubation for breathing.”
One sentence on the patient chart notes got her fired “Doctor did not change the order.” The next day, the patient died. When the doctor in charge of that patient read the notes, she was fired.
Her supervisor was sympathetic, and frustrated. As an Intensive Care Unit nurse supervisor, it is a disruptive and disheartening part of her job. Megan had just settled into the routine and the processes, and with Megan gone, she lost a nurse who had been specializing in ICU care during her internship and honing those skills by picking up ICU contracts when she could. Now, with Megan abruptly pulled off the schedule, her supervisor is left short for days in the ICU until the agency can send her another qualified nurse, which she would have to train into her unit.
The recruiter and the Human Resource department were sympathetic. But doctors have tremendous power in a non-union shop . Texas is a “right to work” state. This firing tipped her already precarious financial situation, and within two months she was evicted from the home she had been renting for the past three years. With an eviction record, finding a new home for her kids became nearly impossible.
Anti-union activity especially targets nurses from recruiting agencies. Each new nurse hire from an agency could be a union organizer, and they are watched carefully by administration and management, written up for the slightest mistake, like being ten minutes late for medication during a busy shift. Administration keeps them worried about getting fired, a typical strategy practiced and encouraged by union-prevention consultants hired by hospitals. A phone call to the agency, and the next day the job is gone.
Although statistics vary across states, up to one-third of nurses quit the profession within two years.
A 2019 report the UK Guardian describes the problem in a story about union organizing at Johns Hopkins, one of the premier medical facilities in the US: “Across the US union-busting policies and practices are causing nurses to leave the profession in shocking numbers. The article describes how anti-union opposition by administration hit back hard against a union drive to organize the 3200 nurses went public in 2018. Johns Hopkins was listed on the 2019 National Council for Occupational Safety and Health’s “dirty dozen” list of most dangerous places to work after a survey by National Nurses United discovered that nearly 80% of nurses experienced violence in the workplace.
When the movement went public, Johns Hopkins hired union-busting firms and consultants to quash the union movement. The story at Johns Hopkins is repeated across the country: “There were issues on units where people would talk about unionizing and their managers or administrators would tell them they couldn’t talk about it and that there would be punishment if they continued to talk about it,” said Josh Pickett, a nurse at Johns Hopkins for over three years.
“Pickett claimed management has sent out anti-union emails, distributed anti-union content in break rooms, held captive audience meetings hosted by anti-union consultants, and called security on nurses trying to engage in union activity in break rooms.”
At Johns Hopkins, complaints of unfair labor practices filed with the National Labor Relations Board resulted in a settlement in June, 2019 that mandated management post signs which affirmed worker’s rights to unionize, and agree that management would not interfere or retaliate against nurses for engaging in union activity.
In Texas, and across states, National Nurses United has ramped up union efforts.
But for agency nurses, “newbies” those new to the profession who don’t have robust social contacts are almost never direct hires by hospitals. Agencies provide nurses who come in. They are seen by their peers as competition for high-paying jobs with good benefits. They are viewed with suspicion by both hospital-hired nurses and by the administration. Any agency nurse could be a union organizer. For Megan and others like her, the gig economy in the form of temporary agency hiring leaves them vulnerable.
During this national pandemic, 123,000 people hold active RN licenses in Texas, but do not work as nurses, according to the National Nursing Database and the Bureau of Labor Statistics. Some of these RNs are retired or unemployed while others are choosing not to work in the field. Short staffing, high turnover, workplace violence, and not being able to provide optimal care to their patients drive nurses out of their profession. National Nurses United continue their efforts to bring union protections into hospitals.
Whether agency-hired nurses would benefit from joining unions is less clear. The Texas legislature has fought to deny unemployment benefits to app-based gig workers -for instance there is an app that sends nurses out, like calling an Uber, but Texas is insisting these contract workers are independent workers and voted to deny them unemployment benefits. Handy, a lobbying firm for special-interest groups successfully pushed legislation through approving this rule for app-based worker last April.
The problems are much deeper than job insecurity -but it is a major driver of the exit from the profession, when demand continues to rise during this pandemic. Demand for nurses has been rising due to the aging cohort of Baby Boomers -nearly 17% of the US population are 60 years old and older, and the percentage is projected to rise to 20.6% in the next ten years. Burnout, work culture, patient load, emotional strain, and the constant push against unionizing leaves our most needed front-line health care providers, nurses, giving up and walking away just when they are needed most, to work on the front lines of this pandemic.