Patterns and issues in health care collective bargaining

Unionization of health care facilities has grown significantly over the last twenty years. More than 20 percent of American hospitals have one or more union contracts and an equal percentage of the industry's labor force is represented for collective bargaining purposes. Union membership is concentrated in the Northeast, Upper Midwest and Pacific Coast and is to be found particularly among large metropolitan hospitals. Although many different unions are actively organizing in the health care industry four labor organizations predominate: American Federation of State, County, Municipal Workers; Service Employees International Union; National Union of Hospital and Health Care Workers - District 1199; and the American Nurses Association. One of the obstacles to union growth for many years was the absence of Federal legal regulation of labor relations. In 1974 Congress amended the so-called Taft Hartley Act to cover private nonprofit hospitals, the largest component of the industry. Since 1974 the application of Federal labor law has resolved old problems that arose from the lack of a basis to handle recognition disputes but at the same time created new issues. Among these issues are such legal questions as the legitimacy of the ANA to act as a labor organization, the proper bargaining classification for registered nurses, and the proper role in labor relations for hired consultants. The growth of unions in health care raised concern that collective bargaining would impose onerous new burdens on an industry already hard pressed financially. Research indicates, however, that the impact on hospital costs have not been great -- perhaps on the order of an increase of 10 percent over what would be the case in the absence of unions. The greatest effects seem to be in the area of fringe benefits, working conditions, and the provision for grievance machinery. Special problems have arisen in conjunction with the unionization of registered nurses. This particular category of health care workers occupies a strategic position in the hospital's work force. After a slow start nurse bargaining activity has come rapidly particularly as nonnursing unions such as 1199, SEIU, and the American Federation of Teachers have forced the ANA to respond to their efforts to make inroads among nurses. Union growth in the industry seems to have stabilized for the time being without the prospect for much change in the remaining years of the decade. Incidence of conflict has been relatively