1. Shields, Anne RNC

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Unionization has no place in my practice as a professional nurse. The mandate of the Florence Nightingale Pledge to "devote myself to the welfare of those committed to my care" is best served by a nurse who thinks and speaks independently. I oppose anything that comes between the nurse and the patient, for that can erode nursing's professional freedom and status. All healing professions are first and foremost servants of the patient. In my opinion, it is the patient who is missing from the American Nurses' Association's (ANA) pitch for collective bargaining, including contract negotiations, grievance handling, data collection, standards, leadership development, political action, and litigation. When economic considerations take priority over patient care, we are no longer set apart from trades in our honorable tradition of service. Ethically and morally, the needs of the patient must always come before the needs of the nurse.


Unionization of professional nurses is an oxymoron. Our struggle to establish nursing as a profession carries with it a relinquishment of self-interest and a dedication to a moral high ground. How amazing that nurses bristle at the use of Unlicensed Assistive Personnel (UAPs) yet enthusiastically join a union for truckers, meatpackers, or foodworkers! Collective bargaining by the ANA is a flagrant conflict of interest; a labor union and professional association represent divergent goals and should not exist under the same umbrella.


The reality of a workplace is subtly structured by the natural leaders on staff who model "the way things are done here." Unions make it difficult to individually reward these silent leaders, who are the true interface between nurse and patient. A supervisor deserves the freedom to compensate exceptional nurses without the constraints of a contractual agreement. Likewise, nurses satisfied by "good enough" should not be rewarded-or even retained-regardless of their seniority or title. Union agreements impede managerial freedom to accept only the best. In our profession, the stakes of borderline incompetence are too high: managers must have the authority to decisively advocate for the patient without fear of union repercussions.


Unionization of nurses does not promote quality care. The expense of negotiation and contract administration-over and above wage and benefit costs-is passed along to the patient. Thus, unionization tilts the allocation of resources toward the "economic and general welfare" of the nurse and away from the patient. Nursing strikes devastate patient care and necessitate the use of alternative providers who may or may not provide the same standard of care.


Innovative patient care is the result of the give and take of experienced nurses with new graduates; fresh perspectives and enthusiasm are powerful catalysts for change. Unfortunately, some working nurses are able to hide behind the protection of union contracts; excellence may thus subtly slide into mediocrity. Unions discourage individual initiative. Even the jargon "collective voice" grates on an independent thinker. From what I have seen, labor unions are usually male-dominated organizations with leaders who are more interested in political action committees and maintaining power than in the real needs of rank and file members. Haven't we as nurses had enough of male-dominated health care? I can speak for myself, and the last thing I need is protection by a union leader far removed from the bedside who may or may not even be a nurse.


A high-acuity unit may invigorate one nurse but overwhelm another; weekend shifts may stress one nurse but allow another to complete advanced education. Offering options without union rigidity keeps the system as fluid as our patients' problems. Flexibility is power. Union guidelines are a hindrance when tailoring work schedules to the ever-changing desires and needs of a nursing staff and the ability to cover all shifts to adequately provide patient care.


The higher wages of unionized workers in the United States are often touted as a reason for unionization of nurses. However, in my opinion, we should look beyond the paycheck. The intangible rewards of nursing cannot be negotiated at a bargaining table. I believe the survival of our profession is dependent on refocusing on the rewards at the bedside-such as our privileged presence at the moments of birth and death-rather than wages and trade union activities.