Critical Care Medicine - List
http://www.pitt.edu/~crippen/

Critical Care Nurse A:

As one of the RNs involved in the recent "union" discussions, I believe you are right that the central motive is anger. I'm not sure you have the source of the anger identified. The motive is not money. The anger is the exhaustion of working 13 and 14 hour shifts without break or lunch--of being so exhausted midway through the shift you can't think--of lifting, shoving and hauling 200 pound patients alone because Nuclear is waiting for your patient, or they've been lying in a pool of blood or shit for close to an hour and no help is in sight. It is going home totally exhausted; and yet knowing you failed to meet the basic needs of your patients. The constant struggle between your own welfare and the patient's needs.

My change to nurse activist began simply. I e-mailed Human Resources and asked what they were doing about the problem of nurses not getting breaks or lunch--thousands were documented on pay stubs. The reply was "as long as you are paid for your hours; you are not entitled to a break". The straw that broke the camel's back. Us soccer mom's can't cheer on the kids under current working conditions. (BTW, our spies were documenting the leisurely lunches of executives, where they ate and for how long. We even received calls from the waiters at a local restaurant--that's small town life).

And lets talk of patient care--I've yet to hear a float nurse in our ICU say, "Hi, I'm Sally your nurse today, I haven't worked in a hospital in years and can't read a monitor, but I had 2 days of orientation of each floor". We have no monitor techs and we have assigned patients to nurses who cannot read a monitor--and they are the only nurse who has report on that patient. Working in ICU, I've seen the result of the aide who gave a post op patient some of his "tums" for indigestion--only to have said patient arrive in ICU in pulmonary edema. The PA State Board says RN's must be ACLS certified to do conscious sedation; yet 75% of our ICU nurses are not currently certified and not only do conscious sedation but are to run codes in the absence of a physician (rural hospital). Would these "standards" be okay for your family member?

Individually nurses have no power--but we do have great value as a group--and must enter an adult to adult relationship with physicians and administrators--the paternalistic structure must end. For nurses, it has never been about money; but when personal satisfaction is eroded; family life is eroded--well, then the house of cards falls--our eyes are opened--and yes, money becomes an issue because we feel we've been idealistic fools for far too long.

I may not be privy to the "inner circle"--but I did get the IRS tax returns for 3 years and found top managers receiving raises of up to 48% while crying "broke", taking back a 3% raise, and freezing hiring. Meanwhile during this same 3 year period, the hospitals net worth grew by 38%--($20 Mil). We were told we were "lucky to still be employed--times are tough". Trust? I think not. Anger? well, in fact, while we thought we were "serving patients" we were in fact "lining the pockets of greedy administrators"--Emotional? Yes. Do we have any choice at all other than unionization? I think not.

Critical Care Nurse B:

Our hospital is a community owned non-profit 350 bed acute care hospital. XXXXXXXXX Florida has more millionaires and billionaires per capita than anywhere else in the State. Our hospital was started in the early 1930s by a Registered Nurse who began the hospital in her own home and through community support it has grown and moved into two new facilities over the next 70-some years. Our community thus is very proud of its hospital and its nurses.

During the early 1980s, Primary Care Nursing was our care delivery model. It worked well by all the national indicators of quality patient care, we were well below the national norms. Everyone was fairly content. Then the advent of Medicare reimbursement changed all that. Now we were told costs had to be cut further, and since nursing was the largest work force, our wages were frozen and benefits cut and staff was cut. Of course the oldest were let go first. Once the initial shock of decreased reimbursement wore off the powers that be let it slip to the community that we had achieved a several million dollar gain. Please bear in mind that never has this hospital in all its history lost money in any given year. This small hospital has over 100 million in reserves according to the end of year report in October 1998. We tried the committee way in 1986 to improve wages to meet the surrounding area norms.

We took the word of the "Gods in management" that we would get an increase in our wages, so we ceased our organizing efforts. We got a raise, 50 cents an hour, and the accrual of vacation time was taken away at the same time by an additional day. There have been since 1979 4 new CEO'S and we are working on number 5 who just started in January. Poor morale and patient dissatisfaction became the norm for our hospital. Then came TQM which promised input from all staff members on hospital policies. Like cattle we blindly believed them and allowed ourselves to be hustled into committees where our ideas and concerns were heard. Only to find that the policies that came out of these meetings were totally different from our recommendations. Our hospital CEO was making 450,000.00 (no typo here) per year in addition to 750.00 per month car allowance, 4 weeks paid vacation, a membership every year to a country club whose dues were well over 18,000.00 , stocked liquor cabinet and monogrammed towels in his office bathroom. Meanwhile no nurse had seen a pay increase of over 2.5% in 5 years. And patients were suffering because they could not get the care they needed and the community was forever sending in letters to the editor over this issue.

Even the District Board of Trustees which are elected by the taxpayers to oversee the hospital ran on a reform platform to get things changed through the political and legal process and the lease agreements to correct the injustices. The hospital Board of Directors and the District Board (the hospital board is responsible for the day to day operations) were now fighting in court. Meanwhile, back at the ranch, despite increasing written and verbal reports by the nurses and their various committees over unsafe staffing, we continued to have the nurse to patient ratio cut and re-engineering reared its ugly head and more unlicensed people many without a high school education and could barely read and write were now given quickie courses in nursing responsibilities. Meanwhile large profits were still being recorded yearly. In 1997, three weeks before JCAHO was to make its inspection, a very outspoken pro-patient, pro-nurse nursing supervisor with an exemplary record was fired because of a hand written Thank you note she posted on all units to thank the nursing staff for a particularly grueling weekend of short staffing. This was not approved by the powers that be and she was anti-management. So, she tried to take them to court. She went with all documentation from all her years as a nursing supervisor to several attorney's in the state and finally found a nurse- attorney who took her case.

First, they went through all the channels. Letters were written to the EEOC, AHA, JCAHO, Florida. Dept. Of Professional Regulations, Dept. Of Health, thinking that these institutions would listen to her and investigate the unsafe staffing at our hospital. She never received the time of day, although the attorney later found out that the EEOC received a visit from a member of the Hospital Board and it was dismissed that she was a "disgruntled employee" (this nurse was 61 years old!!!!) After this things were going downhill, our nurses and doctors were talking to the walls. In the spring of 1998, the finance people said they were behind 700,000.00 and further staff needed to be cut, so benefits were cut and less licensed staff were even more. Out of desperation, we began doing our homework into organized labor. After talking with the nurses in two other hospitals who were under contract with the Florida. State Nurses Association, we voted to go with the well known and well respected Teamsters Union. Oh, we did our homework, we talked with family, friends, and members of this union who were in all areas of business from the local governments, both city and county, to the small group of nurses at Cape Canaveral, to the UPS workers about this union. What the committee was doing was dangerous and we knew it. But we had no choice. We saw what the committees, and the channels of regulatory commissions could do-------nothing. Our campaign broke in the paper on a Friday and by Monday we finally had a full audience of the CEO and a few board members. Talk about a circus, 85 nurses blasted him about our unsafe staffing and many other issues, his pat answer was "I Didn't know"

HELLLLLOOO????? Where had he been for several years? Three days later 2 Directors of Nursing were fired. And our campaign was growing stronger. So two weeks later our CEO fired another director of nursing, the vice-president of patient care services and his second in command the v.p. of operations The hospital threw up a lot of dirt, but guess what, our teamster rep never lied to us about the teamsters, we saw all the videos he knew the hospital would show us and all the literature about the teamsters. we knew beforehand the hospital would do this and were ready when they started the mandatory antiunion meetings. But for the first time, we saw our concerns being listened to by the administrators. But we realized that had we not joined together with such a strong union our voices would have fallen on deaf ears. And this staunchly conservative Republican community were behind the nurses 10-1 during our campaign to have a union represent us.

After the shocking victory (shocking to the hospital) our CEO resigned. Then his good old boys on the hospital board also tumbled. and the community cheered. Now, a whole new administration is up and going strong. And we have through the attorneys for the union and the hospital have introduced an unsafe staffing form that is getting results. Once again, nurses are being hired. In Critical Care alone we have 16 new RNs and other units are the same. And the 700,000.00 budget problem? well, we netted over 1.8 million in October's report. We really tried to be "good girls" and listen and go along with what the "god's" told us. But it wasn't until we found the strength within ourselves to stand up for what is right for our patients and our community that effective and lasting change began.

We were the 7th hospital in the state to have a union. And now the effect is skyrocketing to other hospitals. campaigns are going on in hospitals much larger than ours. And at St.Mary's in West Palm, the nurses booted out their previous union the Florida.State Nurses Association, and voted in SEIU, They also had the opportunity to have no union at all. Once our contract is completed the nurses in our hospital are going to the governor with proposals for state legislation to protect patients and whistle-blower protection for nurses and physician's. We already have California's Legislation and Massachusetts legislation to go as a guideline. By the way, did you know that if a patient strikes a doctor, paramedic, fireman or policeman in the line of duty it is a felony, but if a nurse is struck it is only a misdemeanor? Food for thought.

David Crippen Reply:

"We took the word of the "Gods in management" that we would get an increase in our wages, so we ceased our organizing efforts. We got a raise, 50 cents an hour, and the accrual of vacation time was taken away at the same time by an additional day."

Clearly, no one would ever suggest with a straight face that typical hospital managers have any incentive to do right by anyone but themselves first, and you afterward if there were headroom. It is difficult to explain why hospital managers are so incredibly inept. If they are nuns, it's easier but I'll spare you that analysis. I think part of the reason is that hospitals were never considered much of a "business" until recently. Therefore, guys and gals graduating from the Harvard Business School had little incentive to get into hospital management. There was no money in it, and as we all know, the best and brightest all go where the money is. Nature of the beast.

Therefore, the bottoms of the barrel gravitated to the dumpy jobs. And remember also that a lot of hospital bureaucrats are former rank and file employees who ascend to that status not because they have any experience or training in management. Hospital mangers get that way because they have nowhere else to go when they reach the end of time-in-grade. They are hardly experts in effective management. They are much better at insuring blame for any problems are directed away from them and insuring that their niche is protected from fluctuations in the ether.

And THAT supplied a lot of the propulsion for unionization simply because hospital rank and file not only were lied to and mistreated, but in the end, hospital management didn't even know how to do anything effectively if they had wanted to which inevitably lead to: "Poor morale and patient dissatisfaction became the norm for our hospital. "

"Our hospital CEO was making 450,000.00 (no typo here) per year in addition to 750.00 per month car allowance, 4 weeks paid vacation, a membership every year to a country club whose dues were well over 18,000.00 , stocked liquor cabinet and monogrammed towels in his office bathroom. Meanwhile no nurse had seen a pay increase of over 2.5% in 5 years. And patients were suffering because they could not get the care they needed and the community was forever sending in letters to the editor over this issue."

I Certainly cannot comment about your local situation, but this is not a universally valid argument. If you want your hypothetical "organization" to run at maximum efficiency, make money, support jobs, enrich investors (including employee investors) and grow.......you get the "best" CEO you can afford. And the more you pay, the more it's worth. If you want a cut-rate, bargain basement CEO, you get commensurate quality work. If a CEO can make your organization a live wire in a competitive society, he or she is worth whatever the traffic will bear. And if he or she doesn't do the job according to expectations, they're chased through the street like a midnight rat. It's a tough, competitive and demanding job and they deserve whatever they earn.

And of course Unions are quick to capitalize on fat cats cleaning up while the needy suffer; the Politics of egalitarianism. It isn't fair for anyone to have something that everyone else doesn't have. So, resources must be redistributed so that all have a fair share. This is opposed to the reality of life in a capitalized society; the Politics of Altruism. If some members of society can accumulate additional resources because they have the ability to do so, it is unfortunate for have-nots but not unfair.

The reality is that salaries and benefits of individuals rarely if ever impact the resources of the much broader platform of the great unwashed. A perfect example is the battle cry of the Democratic Party...."Tax those Rich bastards and lower taxes for the little people". The reality is that those rich bastards (over $250,000 per capita income) only comprise less than five percent of the economy. Increasing their taxes is like a mouse peeing into the Atlantic Ocean. It raises the water level a measurable but insignificant amount. The Rich Bastards in America are YOU!

"Meanwhile, back at the ranch, despite increasing written and verbal reports by the nurses and their various committees over unsafe staffing, we continued to have the nurse to patient ratio cut and re-engineering reared its ugly head and more unlicensed people many without a high school education and could barely read and write were now given quickie courses in nursing responsibilities."

Of course this is because you (as nurses) are in the unfortunate position of being not too poor and not too powerful. Employees making near minimum wages can't be cut any more. Physicians are untouchable. But Nurses are caught in an interesting economic dilemma. If I give the ICU nurses 10 cents an hour raise because they work under harder conditions, have more expertise and make more critical decisions than floor nurses on the geriatrics ward, two things happen. First, the floor nurses squeal like pigs in hot oil that they put their panty hose one one leg at a time just like the ICU nurses (assuming an all female work force just for simplicity) and so if ANYONE gets a raise for any reason, they deserve one too. (the Politics of Egalitarianism). So to avoid lawyers making my life miserable, I would have to give them all an across the board raise. If you look at what it would cost me to give ALL the nurses a relatively small amount of extra money, it is absolutely unbelievable hit on my resources. But each individual nurse would not really notice an increase in purchasing power from a dime an hour. Therefore, they wouldn't be happy with it and it would cost me as an administrator a bundle for them to still hate me.

So, if I really want to save my resources, I simply find ways to get rid of nurses and spread the work load over a smaller supply. The savings to me for getting rid of one nurse is absolutely unbelievably HUGE, but the marginal increase in work load for the remaining nurses is not all that great. Besides, nurses are employees and they are pretty much at the mercy of the job description. There are a lot of nurses looking for jobs. If a spell out the requirements for the job to a room full of 100 pissed off nurses, the majority of them may say they won't lower themselves to work under those conditions, but there will be a few that timidly raise their hands in the back row. If I am a manager who cares only to have warm breathing bodies present, what do I care where they come from.

So, since nurses are employees and have little or no say in the logistics of the job, they can be dictated to and if they don't like it, the trap door opens and closes and the next applicant is shown into the room. This is nothing different than anywhere else in the ranks of corporations everywhere, and some are run much more ruthlessly than that. And "unsafe" conditions in a hospital are a matter of opinion. These same conditions can sometimes be spun into "work expands to fill the time allotted for it's completion". Unfeeling, uncaring management, bad working conditions, bad morale, unsafe conditions.......Clearly, the stage is now set for the silver tongued Union Organization team who will charge in on a white horse, sweep out all those rich bastards stealing all the resources from those needy and deserving and save the day......for a price.

"The hospital threw up a lot of dirt, but guess what, our teamster rep never lied to us about the teamsters, we saw all the videos he knew the hospital would show us and all the literature about the teamsters. we knew beforehand the hospital would do this and were ready when they started the mandatory antiunion meetings. But for the first time, we saw our concerns being listened to by the administrators."

Again, that is most admirable of your local Teamster rep. But remember, the fact that they treated you honestly and fairly does not mean that they have to if their incentives change. They have as much power over you as the hospital administration and they can fine you daily if you decide you don't want to go along with their agenda which may not have been voted on by a majority of YOUR interest group and it is VERY difficult to get them out once they are in power. If it is in their interest to help you out, they have lots of reasons to do so. If it is their interest to further some other agenda, they are more than happy to have you further that agenda too, whether you like it or not.

The hospital administration was legitimately terrified of most unions, and especially the Teamsters, who, irrespective of their local persona, have a well deserved National reputation for greed, corruption, violence and negotiating without regard for any economic reality. Of course they tried to undermine them, any way they could. What did you expect them to do, set out coffee and donuts? I am sure they did listen to your concerns, but the stage is set differently now. They are facing the option of slicing up the pie not according to the dictates of economic reality but by threats of work disruption that would waste their resources both in the short and long run. Double trouble. So they do what they always do, take the path of least resistance. Where do you think they got these added resources you demanded? They robbed someone else's resources to give you your demands. Other resources that may not come into play till much later in the game.

"The NLRB strongly supports unionization as the only way for fair working conditions."

Which makes them essentially worthless as a body whose purported function is to "do the right thing" by the National labor force. Doing the right thing by the NLRB is to insure each side fights with weapons of destruction rather than construction. The LAST thing in the world the labor force needs is a biased regulation body. You will also note that the Federal Government isn't as stupid as it might seem by reading the front page of the New York Times. The "Government" pays lip service to Unionization but at the same time does not allow them to strike if they represent Government employees, or if they do so, they are quick to issue orders forcing them back to work. The Government is more than happy to pay lip service to Unions, but they don't have to deal with them. Great deal because it allows the government to do what it does best; preach one gospel and follow another.

If unionizing was as great a deal as they say it is, everyone would be in one. It's a lousy deal and that's why their influence continues to diminish. Unions have only one priority and that is power brokering at the National level. In order to do that they need money and to get that they need to sign as many dues payers up as possible. And so you can be sure that they share ANY concerns nurses have about anything as long as they can sign them up to pay dues toward a union's National agenda (and a contract that assures they cannot be removed should the romance sour). Nurses are as happy as clams about their new found authority to walk tall and kick ass until their agenda may take a different tack from the unions. Then they find out quickly who's in charge. Platitudes offered by union organizers about "working with management to solve problems" have not historically proven to be accurate and should be viewed with extreme skepticism. Fair working conditions are fair only if the union deems them fair.

"My husband is an attorney--and he tells me continually that I just don't get it--without a union I have absolutely no rights--I can be fired for having blue eyes and all I am entitled to is unemployment comp."

I am not a lawyer and I don't know if that's true or not, but I can assure you having had some experience with unions and hospitals that the illusion that unions can solve all your problems is an illusion of great magnitude. But it is an equally vapid illusion that work schedules and patient safety issues are the root of this issue. These things are simply the manifestation that INDIVIDUALS observe. The root of the medical-industrial complex administrative problems is MONEY and don't you believe otherwise. In fact, there is NO cure for an economic system that allows resources to be expended without any way of knowing how they will be financed, and a reimbursement system that allows retrospective denial of payment on whims.

What you avowedly desire is to hide behind the skirts of a much bigger, badder and meaner negotiator as they march into the administrator's office and tell them how it's gonna be or else. And you will probably get that. Teamsters are famous for it. But after you get it, the same system is still there running the same way and so as the Teamsters squeeze one end of the balloon, the other end gets bigger and vice versa. You will get short term benefits and the entire system will finance them by stiffing some other factions with less ability to make noise than you. The problem is NOT that you work cumbersome and unfair hours. The problem is that this is the way the system MUST apply your labor on the basis of reimbursement realities. Changing your hours and paying you more will disturb the delicate entropy of the system and it simply become more unstable somewhere outside your vision.

But then, you are an advocate of nurses problems, not of reorganizing the entire system so it works better. And until that happens, here's what's in store. The reimbursers want the health care system to revert back to the way it was in the '60s and they are trying their best to make it happen by simply not financing increases in demand. I have little doubt that reimbursers would be pro union as well since it would hasten the apocalypse by further decreasing hospitals ability to cost shift.....hastening their insolvency and their ultimate demise. Reimbursers do not want hospitals to merge with bigger hospitals. They want hospitals to DIE....fold....go out of business.....disappear..........and that end will be furthered by classic union techniques of increasing slices of the pie until they are bigger than the sum of the parts. You and unions will work well together to rearrange the deck chairs so your interest group are closer to the Titanic's band, but in the end, the ship sill still sink unless someone sees the iceberg in time and steers around it.

XXXXXXXX Union Organizer:

To all... Crippen's animus is wonderfully false. Let's assume that he's had a personally 'bad' experience with one union... With his small personal experience he's managed to extend his anger to 'broad-brush' ALL unions with his false generalizations (... ALL unions mismanage funds... ALL unions are corrupt... ALL unions threaten violence... ALL unions strike without concern for patients... ALL unions are adversarial and unreasonable...)

. The FACTS are:

a) unions are audited annually and file special IRS tax reports on financial activity... and MOST national unions have additional rigorous auditing requirements of locals. FACT: unions operate under stricter IRS guidelines and scrutiny than ANY business. What Crippen also refers to, tangentially, is the movement to restrict union PAC (political action committee) funds... which is a move to silence union political contributions... FACT: business 'soft-money' outspent union PAC funds TEN to ONE in the 1998 elections...

b) the 'union violence' stigma is a left-over from the beginning days of organized labor, when company 'goons' routinely beat the crud out of union activists. Mr. Crippen sounds like he's operating in a '1930's TIME WARP', where he's confusing the cinematic stereotype of unions with reality.

c) The 'strike' is a weapon of last resort for ANY union... strikes ONLY happen when bargaining has broken down irretrievably... and when a strike is contemplated by nurses, IT'S OFTEN OVER PATIENT SAFETY / UNDER STAFFING CONCERNS... they're trying to get action on a reasonable request that management refuses to address... AND... even where a strike is called (... which is very infrequently...) hospitals are given ample notice so that a reduction of non-essential services can be planned (... nurses from the bargaining unit continue, in most cases, to staff essential/emergency units...). Talk to the CNA (California Nurses Association) about the strikes they've supported (with the assist of AFL-CIO affiliates in California)... the few that have been necessary have been humanely conducted on the union side with an eye to patient safety.

d) Mr. Crippen's allegation that ALL unions are unreasonable and adversarial just isn't true... Years ago, AFL-CIO unions AND management decided that the 'old style' of adversarial, litigious labor-management relations hasn't worked... and... collaboratively... have begun to develop 'PARTNERSHIPS' that recognize the mutual interests of both labor and management (... labor must realize that businesses must be run efficiently and turn a profit, or, they'll go under and there won't be jobs... on the other hand... businesses must recognize the needs of their workers: reasonable wages and benefits... that satisfied employees work more efficiently... that businesses must 'invest' in the value of 'human capital' and stop treating workers like replaceable 'cogs' in the corporate machinery...).

'PARTNERSHIPS' have worked well in many major US industries (auto, aircraft construction, steel, trades, federal sector...) and are showing real results: improved efficiency, better employee benefits/contracts, labor/management 'work team' approach to problem solving, rather than the 'file-a-grievance' approach. PARTNERSHIPS don't work without both labor AND management buy-in and commitment... and they DO work... ANOTHER LABOR MANAGEMENT PARTNERSHIP effort is the CONTINUOUS LEARNING INITIATIVE/INTELLECTUAL CAPITAL PARTNERSHIP kicked off January 12... creating a federal tax incentive for companies to create education programs for employees (both retraining, continuing education, and university-based education programs...

Please... the labor movement is growing by leaps and bounds in 'non-union-shop' states (where employees AREN'T required to belong to the union...)... where the union MUST make the case annually for employees to continue paying member dues... and yet... the majority of members understand the benefit of belonging and having the union present to represent them. This is because unions ARE democratic organizations (... officers are elected on a two or three-year term basis) ... officers aren't reelected if they aren't delivering the representation and benefits the membership wants.Mr. Crippen would have us believe that ALL unions are the Teamsters of Jimmy Hoffa's era... when even today's Teamsters is radically different from that union.

ONE THING THAT MR. CRIPPEN HAS STATED CORRECTLY: nurses have been savaged by 'corporate health care' because we were 'targets of opportunity' and were largely defenseless... those professional organizations that didn't collective bargain for us left us 'naked' to the predatory tactics of the new national health care corporate structure. But... Mr. Crippen offers no solutions... he rails against unions (... again, false generalizations... failing to offer facts...). If not collective bargaining... WHAT?? In an ideal world, we're all expert lawyers and can represent ourselves in the maze of labor law... until that foggy 'ideal' world arrives, I have to live in the real... and I'll take my place alongside the hardworking union men and women here in the 'real world'...

David Crippen reply:

OK, to this partisan diatribe, lets add some cold logic and common sense. It's the 90s and managed care has formulated a different playing field of medical economics. When the money crunch inevitably came, hospital administrators figured out who could be bullied to cut expenses and who couldn't. Nurses were an attractive target. Hospital employees, subject to hospital disciplinary actions for balking at capricious and arbitrary middle management edicts, dedicated to the proposition that the patient comes first. Environmental workers didn't make enough money to save much by cutting back. Physicians were immune since they brought patients to the hospital (and the hospital profited from them). Nurses took it on the chin because their chin was stuck out there the furthest.

First came the bewailing and the self flagellation. Hospitals figured out it was only talk and it would die down once they got used to it. Nurses were dedicated to patients first. They would squawk but, in the end, they would show up and take care of the patients. Then came the cold fury and the willingness to cut their own throats to get even. Unions started getting the nod. Once that happened, the National Labor Relations Board stacked the voting deck. All that is required for the union to be in is 50% plus one vote of those voting, not the entire population of nurses. So which population of nurses are most likely to show up for a union vote? The 30% that signed the petition to have a union. Those not voting (the apathetic majority) essentially opt for a Union Shop by not voting.

So what do you get with a Union Shop in a hospital? You get the triple agenda of all unions:

1. Union dues ($411.00 per nurse per year last time they tried it in Pittsburgh) toward the National political agenda of the Union, not necessarily the local agenda of the hospital. The best interest of the union always, repeat ALWAYS comes before the best interest of local individuals. The Union can if it chooses fine employees for any activity it considers not in the Union's best interest and can if it chooses force employees into work actions to promote solidarity with other striking union workers who may have absolutely no relation to your job. Nurses standing cheek by jowl with shaved apes and grizzled truckers on a Teamster Picket Line is perfectly legal and very compelling. Remember the famous line from the US Army, "The good of the service comes before the good of the individual". They have the legal right to force you to join other strikes if they think a greater good might be served. Not necessarily a greater good for nurses. That is a liability of aligning with a power group that has a heterogeneous agenda.

2. In order for a union to centralize their position of strength, they must ensure that their position of power is protected at all times. Unions always write into the contract many stipulations which tend to make it difficult, if not impossible to vote them out, should the workers desire at some later date. Once it's in, you can't get rid of it, like cat pee on an oriental rug. Union dues withdrawn from checks in advance. No one can work unless they are union, which applied to ALL the nurses, not just the ones that voted for it.

3. Strike action "as a last resort" when they don't get their way. The threat of some kind of work action disruption is integral to the central philosophy of the Union. Denials of this fact are contrary to massive evidence available to the most superficial perusal. A union without the threat of work action would have no more bargaining power with management than you alone. "Working with management to solve problems"? That will come as a surprise to UPS, Eastern Airlines, American Airlines, the Pittsburgh Post and many others. Let's not kid ourselves, the only real negotiating tool union's have is the threat of some kind of disruption. Expecting to use it in a discretionary fashion because they say they will is unrealistic. Nurses walking out of ICUs and leaving patients unprotected is a perfectly reasonable way to achieve their goals.

All union dealings with management are adversarial. I have been around them and I have seen how they do things. I was around in New York City when striking hospital workers slashed tires, spray painted cars and beat up people as part of negotiating techniques. Any interest in getting them to do timely work is greeted with yawns. Any suggestion of getting rid of dead weight employees is, however, dealt with quickly. Those bringing that subject up are taken out to the parking lot by either shills or watchdogs and given a quick, impersonal lecture on the cost of dental work and the difficulties of trying to eat with two broken arms. They must justify their existence by continuing to demand more benefit increases for their members, usually with only passing regard for what resources might be available on the supply side. The key concept is that the union must "justify it's existence" by continued collective bargaining for more and more benefits. This concept works better in the usual business framework where is a more negotiable resource which can be redistributed. In the case of hospitals, managed care has caused a direct decline in hospital resources. This trend is easily seen on the most superficial examination of hospital policies around the city and the country. If nurses unions bail out their particular faction, it will be at the expense of some other faction less effectively shored up for battle. The end result will be the same.

To those who perceive that hospital management has treated them shabbily and feel powerless to deal with them effectively, the prospect of a powerful, centralized bargaining body seems hard to resist. A powerful bargaining agency with a National political agenda that may or may not address local aims and an equal amount of power to abuse employees from different angles.........History has shown that the upper echelon of many of these unions, especially the Teamsters, which pops up among nurses now and then in Pittsburgh are top heavy with characters so aggressively evil they glow in the dark. They make Nixon look like an amateur and Charles Manson a punk. But they are very interested in helping nurses do the right thing.?

Think critically about decisions to unionize. Listen to a lot of people. Have any legal paper proffered you explained in detail by a lawyer who has nothing to do with the process. Ask questions. Many questions. If opinions don't sound reasonable, don't believe them. If MY opinions don't sound reasonable, don't believe me. Believe what strikes you as logical and strikes a common sense chord somewhere in your gut.

XXXXXXXX Union organizer:

To all... Mr. Crippen is, again, generalizing and using false information to attempt to bolster his anti-union rhetoric. His support of predatory wage practices is part of his ideological prerogative... he can believe what he wants about what is 'fair practice'... even though he speaks from the arrogant perspective of being a physician and being advantaged (... at least he admits that "... PHYSICIANS ARE UNTOUCHABLE..." which accurately reflects physician 'exposure' during wage/staffing cuts...). We can 'agree to disagree' about political bend, economic theory, and whether the fundamentals of health care deserve to be eroded by cut-throat 'no-holds-barred' economic competition....

Nurses don't breathe the privileged atmosphere reserved for physicians and hospital management... we're stuck in the lower levels of fixed wages and benefits... and our desire to better our deteriorating conditions by banding together (... where, unlike physicians, our professional organizations have largely FAILED to protect our interests...) for collective action doesn't deserve the nasty ranting of someone who fails to understand our situation and obviously has no empathy for our plight. IF MR. CRIPPEN IS A CAPITALIST AND 'FREE-MARKET SUPPORTER'... then he can't make a philosophical argument that workers aren't entitled to attempt to better their condition through collective action... Worker empowerment through collective bargaining is inherent in free market principles ... and is NOT a socialist appendage.

But... I can't agree with his broad-brush, generalized attack on unions, because it isn't factual. He alleges that ALL unions fail to deliver on promises of better working conditions. Statistics refute this argument easily: unionized workers on national average make 20% to 30% more than same-skill/job non-unionized workers... union workers enjoy much better job security and protection from layoff... their contracts give them input on a wide range of workplace rules/policies.

Again... Mr. Crippen must get his dated opinion of labor from movies like FIST... modern organized labor is as sophisticated in its analysis of labor conditions as is management... Labor realizes that jobs are dependent on healthy, competitive industry... which has given rise to LABOR-MANAGEMENT PARTNERSHIPS in most major U.S. industries... where workers PARTICIPATE in the decision-making processes and rule-making. Industry management has realized that workers hold the knowledge for many process improvements which will improve efficiency... ultimately, industries mistreat their employees at their own peril... it's much more 'efficient' to pay a living wage and decent benefits.

Critical Care Nurse D:

"Lets consider market forces. Nurses are worth plenty as a group--just as GM workers are. We are worth little individually--unlike you. Therefore, we must act as a group to set our value--Steel can be produced elsewhere--patients can't travel for care."

David Crippen reply:

OK, lets do just that. There is a natural law of supply and demand somewhere that says that any employee worker is worth as much as his or her productivity adds to the amount of money a given product will bring. Any such group is worth only what Marx (Karl, not Harpo) said they were a long time ago. In the early 1900s, owners of industry determined what that worth was and got filthy rich exploiting it. Then the Union revolution came in the 30s and workers said what value was high school graduates with no skills got rich in Pittsburgh. A balance of power was achieved, with periodic swings of the pendulum each way. That balance of power was, and continues to be paid for by ADVERSARIAL dealings. A balance of terror. And if you believe the line of bullshit espoused by the organizer on the previous Internet discussion with the nurses group that unions are happy to "work with management" to create a nice warm, fuzzy family traipsing down the path hand in hand whistling happy tunes, they we don't have a discussion anymore. You are on your own to learn by doing, then come back and we'll talk again.

Lets just assume for the sake of argument that you are willing to admit that you hate managers and administrators as a species and you are willing to do whatever it takes to make the evil bastards do the right thing. The next question is.......what kind of evil bastards are we talking about here? Are they evil bastards that are intentionally stiffing you and your ilk so they can enrich themselves, or enrich some other group at your expense? Or do the evil bastards have their backs up against the wall with increasing cost and decreasing revenue, and you don't like the way they are tightening the belt. You want someone else to take more heat than you because your services are worth more than other peoples (probably true but unproven)?

Now, further, I will ask you to believe that the latter scenario is the case. I will ask you to believe that because I believe it and I happen to be VERY high up in the pecking order of people who have to be aware of what's going in in reimbursement, that I am considered to be a National expert and I have publications that say so. Or if you prefer, just accept it for argument sake, or accept it because if you REALLY believe the evil bastards are intentionally stiffing you so they can drive BMWs and maintain country homes in Florida with swimming pools and gold plated wet bars, then we don't have a conversation anymore because it would be pointless. You only have one realistic option in such a case and that is to order your life EXACTLY as those who go around shooting abortion doctors. It's a religious war and no one takes any prisoners. You have a righteous obligation to pound on them till you either win or die.

So here's the deal. The hospital has decreasing revenue and increasing costs and they start cutting back to save expenses. You and all the other people in harms way sit down to carve up your respective portions of the pie. Because there are no options to increase the size of the pie, the unalterable reality is if one faction gets a bigger piece, some other faction must necessarily get a smaller piece. That is physics that cannot be altered or creatively explained away. If you think it can, then we don't have a conversation anymore because you're not arguing on a functional level.

So, if you are still with me, you can negotiate a bigger piece or you can threaten to kill the pie slicer if you aren't happy with the size you are carved up. You can give thoughtful and logically compelling arguments that you are worth a reasonable size slice or you can tell the slicer you don't give a shit about any of that, you want YOUR FAIR SHARE....and By God, you intend to dictate exactly what that your share is.

OK, remember that the pie can be divided an infinite number of ways but can't be made bigger, any negotiation must be based on the reality that making one piece bigger will necessarily make another piece smaller. If EVERYONE negotiates in "good faith", that is in such a way to insure that the size of each portion respects the integrity of the whole, then the pie will remain edible at the end. Any form of prioritization must reflect the laws of diminishing returns.

But, your own admission, you don't want to play it that way, presumably because you don't think the pie cutter is impressed with your relative importance in the general scheme of things. So you're bringing in a ringer to bargain for you, not in order to negotiate in harmony with the needs and priorities of the other pieces, but to take a bigger piece for yourself and let the others worry about their share. Once the first negotiator does that, the others are mandated to follow suit in order to protect their pieces of the pie. Then all of the participants point weapons at each other and the one with the biggest, nastiest weapon gets the biggest piece, followed down the line by the second nastiest and so on. The happiest folks are the meanest. Survival of the fittest and might makes right. So everyone is happy in proportion to the amount of power they bring to the board.

But what about the pie? The laws of physics cannot be transcended by weapons and threats. As slices for some get bigger out of proportion to the ability of other slices to commensurately diminish, a deficit is established. When that happens, another natural law of physics is induced, that of the conservation of mass. There cannot exist in nature more whole than the sum of the parts. So, if the pie slices are carved up in such a fashion, there is only one way to maintain conservation of mass. Some pieces of the pie must vanish in order to support other hyperinflated slices. So, when you (or anyone else) negotiate from a power position instead of a stewardly position, your portion of the pie has the potential to make extinct some other slice. Any benefits you get are maintained at the expense of making some other less powerful faction...... the owners of those slices get up, brush a tear and sadly shuffle off.

United Parcel Service workers found this out as their pay increases were neatly balanced in the ledger by layoffs. The Pittsburgh Post workers found this out vividly as did Eastern Airlines and even the impeccably loathsome NBA basketball players union, the most marginal member of which makes three times what I do with college majors in basket weaving and archery.

So, remember to tell those employees that you are organizing in our cafeteria that they will be part of a really big lottery that ultimately responds to the laws of physics. For every action there is an equal and opposite reaction. If you are going to play this game, be prepared. Some will win and some will lose and when that roulette spins, no negotiation will spell out the winners and losers. You pays your nickel and takes your choice. And in the end, ALL of us will heel to market forces. Any of these manipulations will simply put all that off for a variable time. That's the way it works........some will march on a road of bones and some will hang from telephone poles.

Critical Care Nurse F:

Having lurked with particular interest on this thread, I'd like to jump in with my $0.02, at my 120 bed hospital, which employs approx. 900 people recently went through a unionization process for the unskilled worker category, the organization was SEIU. We have a union for RN for a long time of which I am a dues paying member.

The process for unionizing the workers fell in with how FL described them in his web site post. There was much bluster, misinformation, and some flat out lying. There were buttons and stickers being passed around, wear these to show support. A "no thank-you" was met with, "oh, you don't think we deserve to have a cushy living wage like you." Or other such, rhetoric.

I believe there is a difference between bargaining units and unions. Bargaining units strike an agreement on the wage scale, disciple process, seniority scale and grievance process. Through a bargaining unit professionals retain autonomy, and the work relationship is professionally established.

Unions have become a political organization within the hospital. Increasingly, my union has been including a section on the perils of social security reform, education reform, health care reform, and how the Presdent's plan will make all things better. It includes political caricaturizations of national political figures. I do not pay dues to be told how to vote or which political figures to support. One thread was very interesting to watch in the SEIU newsletter was how the emotional thread was being played up. Where else can people with barely a high school level education start at a job for $8 an hour and climb the scale rather rapidly upon proving wroth to about $13-15/ hr range. My hospital is the 3rd largest employer in a county where agriculture is the main economic engine.

Coming back to this post, I realize it sounds like I am pro management. I am not I am just as critical of the "suits" as anyone else. What I am against is the agenda and tactics of the current evolution of unions. I am particularly against closed shop practices. At one employer, the burden was on me to take the process to a point where the union(SEIU) and I agreed on which charity my monthly dues would go to. What the hell business is it of theirs where my charitable contributions go??? Some of the choices were planned parenthood, UNICEF, UNESCO.

Critical Care Nurse G:

My comment will be short and on a very personal nature. I work in a hospital with a nurse's union. We belong to the INA and the ANA. Admittedly the union has little power over our continuous lack of staff and unsafe nurse- patient ratios. It has given us moderate power over other contract issues. With the simple threat of filing a grievance the management and hospital do back down on some issues. As a member of the ANA and INA I receive monthly nursing magazines and newsletters as part of my membership dues. A portion of the dues also goes to fund the national PAC, which of course is part of the ANA- giving me a national voice in NURSING issues.

Our bargaining powers are not always very strong when it comes to staffing or monetary issues, those seem to be tied to the economics of supply and demand. But I feel confident that when patient care and patient lives are lost due to hospital policies the resulting law suits will in the end serve the just deserts to those who sit in the ivory towers. What surprises me though is the lack of physician involvement to stand up for the nursing staff in these issues-- those patient lives that we care for and are understaffed to provide safe and effective treatment to are YOUR patients. I really thought you cared more about them than what you have so far shown. This is simply not just a NURSING issue, it is a patient care issue.

Physicians want the nurses to provide the best care possible for their hospitalized clients-- how could you assume they could get that with the present staffing situations???= Why do we as nurses take the abuses? Primarily because we love what we do....it is a calling, not just a profession. We love the patients and put them first; not ourselves. Most of us are mothers, wives, and caretakers -- it is an innate part of our nature to put the good of others before our own. We unionize as a means to bring to light abuses of power. You have as yet to address the issue of the hospital reserve funds of millions of dollars in the original post....funds that were there during layoffs and even when the union representation provided the improved working standards...that hospital did NOT go under then or at any other point mentioned.

And by the way..excuse me...but I don't see this having any disastrous effects on only right and fair? Doesn't seem we were making any headway with other means.

Critical care nurse H:

Well Dr. Crippen, it is amazing to me that you are holding nurses, who you admit have no input into the running of the health care ship, responsible for keeping it afloat. I believe in one of our earlier correspondences, you stated that you were certainly unwilling to give up your Ferrari, private schools, and wife's penchant for shopping--

What's your part in maintaining the integrity of that pie?? I would imagine as Director of ICU, you are salaried by the hospital, as well as your private practice--at least our docs are. In fact, our pulmonologist just struck a lucrative deal with the hospital when he cried he wasn't making enough money from his private practice and would go elsewhere if the hospital didn't cough up big bucks (he also admitted he is a lousy business man who fills up his day whether he has one patient or 10).

You seem to ignore that I have IRS records showing the same old tired administrators who have been here for years are taking home raises of up to 48% over the past 3 years; while crying broke. Or that our hospital is indeed profitable with a increase in net worth of 38% over 3 years-- And I have yet to hear those nurses who are union crying that they wish they weren't. I called many hospitals before calling a union- random calls at 3 AM to= ICU, ER, Med/Surg and spoke randomly to nurses about their hospitals/jobs/unions. I am on several nurses ListServes--and it is the union nurses who can protest staffing conditions, etc.

I am 41 years old and our income has been fairly flat for at least 10 years--combined income of $75,000--but our cars are paid off; mortgage on our 4 bed/3 bath home will be done next year; and thanks to the stock market--we're fairly secure at present. I love small town life and hiking through the woods with the dog. It is not about money--although I agree, staffing, patient care, ultimately everything comes down to money--but for me, all I really want is to come home from work with enough energy to do more than hit the sofa with a heating pad and bottle of wine. (I am 5'6", 117 lb., hike and lift weights--during my stretches off--in fairly good shape, but I'm exhausted). I only work part time, 28 hours a week--I would be suicidal if I had to work full time.

David Crippen replies:

"This is simply not just a NURSING issue, it is a patient care issue. The problem seems to be that everyone has seen the iceberg. The nurses are frantically trying to organize to protect the pts and obtain some relief from the abuses of the cold dam water".

It is only a patient care issue at the end of the food chain. It becomes a patient care issue because of the chain of events that occur at higher levels. To treat it as a patient care issue necessarily obviates doing something about the fundamental causative issues. The fundamental issue is simply an economic situation where resources must be expended because of unlimited demand without any way of insuring they will be paid for, and the payers can ration by retrospective denial of payment. They deny payment after the money has been spent. Providers react by trying to nickel and dime over the entire population of consumers because they cannot prioritize.

Therefore, your perception that patient care suffers is a correct one, but your proposed cure will offer only short term relief at the expense of long term repair because it forces prioritization in a system where it is not possible. What you want to do is force administrators to slice up the pie differently so that you benefit more. Yes...YOU, because the resources available for direct patient care are irrevocably tied to nurses salaries and benefits. In order to provide better patient care, it will be necessary to pay nurses more and hire more of them. But nurses do not bring in revenue to the system. They are an expense the hospital must bear and to increase the benefits for one, they must also increase the benefits for the rest. And small amounts of increase in benefits are phenomenally costly but largely unsatisfying for individual nurses.

"As a member of the ANA and INA I receive monthly nursing magazines and newsletters as part of my membership dues. A portion of the dues also goes to fund the national PAC, which of course is part of the ANA- giving me a national voice in NURSING issues."

Your voice in nursing issues does not significantly impact the fundamental issues that are making and breaking how health care is delivered in this county. Nurses are hospital employees and, as such, do not make or alter rules made by those having the power to make them. Rank and file physicians have little say either. That is not to say that your voice wouldn't be a better one than those currently empowered, but that's the reality and we will all live by it.

When a union tells you your voice can be heard, what they mean that the union's voice can be heard, not because it's more logically compelling but because they can cause wasted resources and inconvenience if someone doesn't listen. When a union stiffs American Airlines or United parcel Service, they recoup by simply passing the cost of strikes along to the consumer, and don't think for a minute they don't do exactly that. The hospital is different, When you strike, and you will because you're running on a head of anger steam and not pure reason, the hospital has no way to pass on the cost. They will recoup the damages from your strike anywhere they can within the existing system because they cannot pass along the damage to the consumer or the insurers. Someone else in the hospital will pay for your increases until the deficits exceed the revenue, then the hospital will go under, or more likely merge with a larger and infinitely more vicious entity that will play much harder ball with the unions.

"What surprises me though is the lack of physician involvement to stand up for the nursing staff in these issues-- those patient lives that we care for and are understaffed to provide safe and effective treatment to are YOUR patients. I really thought you cared more about them than what you have so far shown."

Your perception that I am anti-nurse stems from the fact that I disagree with your passionate belief. It is possible for you to be passionately wrong. In fact, you know nothing about my advocacy of nurses or anything else other than your filtered perceptions. You're angry at the situation and you're taking it out on anyone that doesn't see it the way you and the unions have it figured. In fact, physicians "standing up for the nursing staff" is not as easy as it appears at first blush. First of all, we have different problems with the administration than you. Secondly, we have virtually nothing to do with the nursing staff administration and we are frequently reminded of that fact in meetings.

You are hospital employees and we are independent contractors. We bring "business" to the hospital and you expend hospital resources in the face of decreasing reimbursement. We cannot be treated the same by the hospital administration. Even if we did stand up and shout, we would and we have been ignored because we are completely out of the hospital employee-relations loop. I can recall bitterly complaining in the recent past that the ED nurses were getting dumped on. Not enough and overworked. I was told curtly by the "Service line manager" that it was none of my business and to butt out. That was the end of the discussion.

"The doctors are sitting in the deck chairs, pontificating on the size of it, resting assured that the brandy is damn good and the cigars had best be smoked and it may as well be them smoking 'em. And by the way..excuse me...but I don't see this having any disastrous effects on YOUR financial situation, so how can you condemn us for wanting what is only right and fair? Doesn't seem we were making any headway with other means."

A traditional thread of all union diatribe is blaming those with more resources for the fact that some have less. The stark reality is that there is a pecking order of people who have more than others for a variety of reasons, some of which are reasonable. When you point a finger at me and say I have too much and therefore I should get down to the level of those who have less, turn around and you will notice there's someone off your other shoulder pointing the finger at you. It is their nature of the beast to want a classless society until you see how one works in real life. I can't comment on this kind of stuff further. It has gone on in every society from time immemorial and it is unlikely to change.

"You have as yet to address the issue of the hospital reserve funds of millions of dollars in the original post....funds that were there during layoffs and even when the union representation provided the improved working standards...that hospital did NOT go under then or at any other point mentioned."

The reality is that these funds are not available for the purposes you might desire. Every hospital must float bonds to pay for new equipment and physical plants to maintain their competitiveness, such as it might be. In order to get a good interest rate, the bond regulating agency looks at how much asset the hospital has. That means how much cash they have that could be used to pay off investors if things go sour. Once they float bonds, the hospital is placed in a double bind. They can't use any of their cash reserve because it is used to guarantee a good bond rating. If they must use cash reserves, the bond rating goes down commensurately and they have to pay more interest. That interest can end up costing more than their ability to guarantee and so on.

"My comment will be short and on a very personal nature."

It's very obvious. You're mad as Hell and you're not gonna take it anymore, which is OK because it is clearly not a desirable situation. You perceive a wrong and you propose to right it by identifying those responsible and bludgeoning them over the head until they fix it. Because it is a personal issue, you will feel better after you show the evil bastards you damned well do have some power to tell them how to run things the way you want them. But your perception of the problem is constructed on a layer that shows you effects rather than cause. You aren't privy to upper levels where the real problems are made. You see how they trickle down. But because you are hospital employees, you have no power to affect change on the top levels......unless you align yourselves with a stronger power to speak for you. Enter unions with a patter that falls gently on your ear. Nothing to powerful as an idea you choose to believe. They have a lot of experience in helping you believe what to desire to.

But remember just two things as you skip down the road with your newfound friends Collective bargaining doesn't work in a closed system of increasing costs and decreasing reimbursements. Unions have only one weapon more than your local nursing association and that is the strike. You have the very REAL potential to be standing in a picket line while patients languish to force better patient care, kind of like killing to stop wars. And there is no way to pass on the damage to a bigger pocket so they can be a death knell for hospitals. But the "death" of a hospital will not mean the death of it's ability to rise again as part of a bigger conglomerate with the ability to learn from it's mistakes. Big doesn't not necessarily mean better, only more effective in dealing with threats such as unions.

I have little doubt that you will succeed in unionizing nursing and altering the layer of the system at which you function. Those changes will immediately be met with reactionary changes to match yours. In the end, inevitable strikes will definitely affect the upper reaches of policy, but not in the way union leaders have led you to believe.

Attorney X:

Dave C.--Why the cynical blather? Sorry to say--your comments are unconstructive, uninformed and do not reflect reality as most of us know it. Like many Boomers and younger, Dr. Crippen does not understand or appreciate the historic value and success that unions have brought to leveling the field between workers and employers, nor the role and value of the NLRB. Yes, a number of people actually DIED for creation of unions. Yes, they are flawed, as is every human institution. At present, though, unions are what stand between the worker and (even worse) overt exploitation by employers.

It is essential to remember that unions are the reason that widespread employee benefits exist at all. Unionization is the primary, if not the only, reason why most full-time employees in this country have health care insurance. Unions got workers decent, living wages, prompted the concept of minimum wages, safer working conditions, pensions, etc. The political influence of unions gave rise to minimum wage laws, child labor laws, the 8-hour workday, worker's compensation, worker safety laws, and other institutionalized protections for workers. Pre-unionized U.S. workers had a horrible time. Remember the song, "I Owe My Soul to the Company Store?" That song reflects the reality of many pre-union workers who could never get out of debt and had to buy everything from the company store, including housing rentals, dying in debt. (Read The Dollmaker, for a taste of factory-workers' lives when rural people migrated to big northern factory cities around turn of the century.)

Dave and others who scoff at unions should read up on the Wobblies, coal mining and factory conditions for workers pre-unions, the Triangle shirtwaist factory fire incident and other such historical stuff. I, for one, would much prefer to live in the post-unionization environment. Look what we have to still deal with from employers, despite labor laws! History shows most employers to be greedy bastards who won't give employees much of anything unless forced to by law. How do you think the mansions in Newport, R.I., and elsewhere in the U.S. were financed anyway? It wasn't from paying workers good wages and benefits, that's for sure. Just about any story of huge financial success in the U.S. is a story of unconscionable oppression and exploitation of workers, from Chinese slave labor on railroads, coal miners, steel workers, child laborers, you name it.

Our national (federal) labor laws are enforced by the NLRB, which brings legal actions against employers for alleged violations. If the NLRB is biased, its bias is toward favoring workers, since it represents the government/workers (against employers) in lawsuits and other actions to enforce existing labor laws. Should some of our labor laws be revised to reflect reality as we now know it? Sure. Are labor laws and NLRB effective in remedying any and all injustices perpetrated by employers? Of course not. But--why do you suppose the NLRB exists at all?

Similar to the EEOC, it provides free legal support to workers whose legal rights have been violated. NLRB is one of the few powerful legal instruments available free to the public. It is unclear where Dr. C gets the notion that the NLRB claims to do one thing while doing the opposite. What in the world are you talking about? I know attorneys who work there, representing workers in cases against employers and enforcing labor laws--that is exactly what NLRB is mandated to do and is doing.

For those unhappy with existing labor laws, unions lobby constantly for laws more favorable to their constituent membership. Of course maintaining all this costs some money. However, the modest dues exacted by unions generally is offset considerably by the greater salary and benefits unionized workers in the same field get, compared with non-union workers. Just ask around, if you don't go by me.

You also see an indirect influence of unions. In companies where numerous competitors are unionized--the non-union companies raise salaries to be close enough to those in unionized companies, simply to reduce worker motivation to unionize. (Check out the newspaper biz, for example.) Why do you think non-union companies go to such great lengths to prevent unionization? (Remember the recent strike at the Detroit Press, where they brought in scabs and paid them much more than their usual salaries to break the strike?) Why do you think we have such heavy penalties for violations of laws allowing workers to start and continue unions? Because unions work and get workers higher pay and more benefits, that's why. Every time you read about unions negotiating contracts with employers, it is about wages, salaries, benefits, etc. that the union is pressing to be greater and employers want to be lower or stay status quo.

Sure, there are some governmental restrictions on union strikes, when the public may be extremely adversely affected, i.e., with air traffic controllers and possibly healthcare workers under certain conditions. Well--that is called balancing public welfare against other interests and is done all the time in government. We only don't like it when we are on the end affecting us badly, but cheer when we benefit.

Unlike what Dr. C says, unions operate at the local level, hence Local ... being the name of unions and national levels. Local unions bring local companies to the bargaining table and there are also unions operating more nationally doing the same. Then there are the local and national lobbying efforts.

What history does show us is that it is essential for workers to group together in some form to gain protections, whether from unions, filing class-action suits or just working "to-the-rule." For those unfamiliar with the term, it suggests a Ghandi-like approach to resisting exploitation by quietly subverting unreasonable pressures to work more hours, more jobs, etc. than required by one's job description, contract, etc.

One of the premier employer exploitations operating today is to cut staff, then foist more jobs/responsibilities onto salaried workers. This effectively makes them feel they should work overtime to get the work done, while they are precluded from overtime pay by virtue of being placed into a management/salaried category. Health care organizations have been doing this for some time, of course. As long as people continue to perpetuate the illusion/delusion that they are 1) indispensable because of their great individual contributions or 2) will be rewarded for merit of their work alone, employers win.

History is a great teacher, if we pay attention. Unionization of health care workers is more essential than ever in a climate of huge, vertically and horizontally integrated mega-HMOs. How can this not be obvious?

Wrapup by David Crippen:

There you have it.....the entire massacree....in five part harmony, and to insure I do not have an "end of thread" bias, I allowed an attorney the last word! This has been a discussion worthy of note and I sincerely hope everyone having an interest will read it and gain some perspective from each of the discussants' viewpoints. Go forth and be better informed becasue of it, whichever view you choose to give credence.