1. King, Susan RN, MS

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I would like to present a more enlightened and progressive view of collective bargaining organizing than did Block and Jamerson.1 Having been a member of nursing administration in a hospital and now both an Executive Director of an ANA/UAN state nurses association and a staff nurse in a represented facility, I have experienced this issue from several points of view.


First, let us examine the facts. Many professionals have employment contracts. Hospital administrators, NBA basketball players, executive directors of not-for-profit organizations, and others recognize that the terms and conditions of employment should not be left to chance or good intentions. While the public often comments on some of those terms, such as the salaries paid, the fact of a contract rarely, if ever, is questioned.


Nurses usually seek a collective bargaining agreement when the conditions in their practice setting are unacceptable. Issues of wages and hours of work are only part of the reason that nurses seek a union to represent them; staffing, patient outcomes, and ethical considerations are equally important. By their own admission, St. Louis Children's Hospital was in turmoil for several years as a result of a merger into another healthcare system. "Hospital reengineering," which in almost all cases means chaos, reduced practice authority, and a decrease in financial benefits, preceded the efforts by 2 unions and 1 professional nursing organization to organize the nurses.


Management campaigns against a union organizing are not the objective educational efforts that the authors describe. They are campaigns waged by costly consultants who help the facility carefully construct an approach that intimidates and discourages nurses from being a part of the organizing effort and ultimately convinces them to vote against it out of fear or false promises.


As a manager, I found that having my staff represented by the Oregon Nurses Association afforded all of us a consistent equally applied set of rules and provisions. It gave all of us a framework for insuring that the professional nursing staff had influence in our organization. In addition to the usual subjects such as compensation, vacation, and due process, the Professional Nursing Care Committee was established to deal with practice issues of concern to nurses across the facility. The contract was an adjunct, not a barrier, to my role as a manager.


I know the leaders of the Missouri Nurses Association and respect them immensely. They do excellent work on behalf of the profession through education programs, legislative efforts, and collective bargaining. If the facility administrators and their consultants truly wished to "mend relationships and move forward in a positive direction" they should have refrained from interfering in the decision of their nursing staff to achieve representation. Their "victory" is hardly worth congratulations or replication.


Susan King, RN, MS


Executive Director, Oregon Nurses Association, Tualatin, Ore (




1. Block VJ, Jamerson PA. Running a successful campaign against unionization. J Nurs Adm. 2005;35(1):29-34. [Context Link]