The president of the union of service workers at Big City Medical Center calls you to complain ofthe firing of one of the union’s shop stewards.

 The president of the union of service workers at Big City Medical Center calls you to complain ofthe firing of one of the union’s shop stewards. The union president claims that the firing was because the shop steward was an effective advocate for the members. You tell the union president that you will look into the matter and get back to her. Your labor relations director tells you that she approved the discharge because the shop steward was a chronic absentee. She also says that the steward was a constant thorn in her side. What do you say when you call back the union president?

  • Chapter10OrganizedLabor100918.pptx

    Chapter 10 Organized Labor

    Overview of unionization

    The labor relations process

    A review of legislative and judicial rulings

    Developments in organizing healthcare workers

    Management guidelines


    A union is an organization formed by employees for the purpose of acting as a single unit when dealing with management.

    The labor relations process is the process by which management and union jointly decide on and administer terms and conditions of employment.

    Union Membership in the United States

    From the 1950s to the 1970s, union membership represented 25 to 30 percent of the US workforce.

    During the 1980s and 1990s, union membership decreased.

    Proportion of wage and salary workers in unions: 11.1 percent (2015)

    Total number of union members: 14.8 million (2015)

    Of the 8.4 million people working in healthcare as practitioners or in technical occupations, 12.4 percent were members of unions (2016).

    Among the 3.4 million people employed in healthcare support positions, 6.9 percent were union members (2016).

    Labor Relations Process

    National Labor Relations Act (NLRA) is the legal framework for labor relations (1935).

    The National Labor Relations Board oversees the implementation of the NLRA.

    Participants in the labor relations process:

    Management officials

    Union officials


    Third-party neutrals, such as arbitrators

    The labor relations process includes three phases:




    Recognition Phase

    In this phase, unions attempt to organize employees.

    Management strategies have become more aggressive in recent years in trying to prevent unionization, but the NLRA identifies unfair labor practices, which are disallowed.

    Unions solicit authorization cards that designate the union as the employee representative.

    If successful, groups of employees are designated as a bargaining unit under the NLRA.

    Processes are also included in the NLRA for union decertification.

    Negotiation Phase

    Once certified, unions negotiate on behalf of employees; this is known as collective bargaining.

    Collective bargaining includes both mandatory and voluntary issues.

    Mandatory bargaining issues are issues that must be bargained.

    Voluntary issues can be bargained only if both sides decide to discuss them.

    Collective bargaining may take several forms:

    Concessionary bargaining, in which the employer may ask the union to accept reductions in wages or other commitments in light of financial constraints

    Integrative bargaining, in which both sides attempt to arrive at win–win solutions

    Distributive bargaining, in which negotiation ends with a winner and loser

    An impasse may result if agreement is not reached.

    This could result in a strike or lockout, where the employer shuts down its workplace in an effort to pressure workers into accepting management’s contract proposals.

    Administration Phase

    Once an agreement is signed, the contract must be administered.

    The agreement includes information about grievances and processes of employment, such as discharges and discipline.

    A grievance may be filed by an employee if the employee feels that the terms of the contract were violated by management.

    Due process is followed during a grievance.

    In some cases, an arbitrator decides the outcome of a grievance.

    Legislation and Judicial Rulings

    In addition to the NLRA, various other federal laws and court rulings have changed certain aspects of the labor relations process.

    The Labor Management Reporting and Disclosure Act of 1959 defines procedures for regulating the internal affairs of labor unions.

    Managers cannot be members of a labor unions, but in healthcare there are not always clear distinctions between who is a manager and who is not (most commonly among nurses who have supervisory responsibilities).

    A number of courts have ruled on who is eligible to be in a union.

    Most notably, NLRB v. Kentucky River Community Care, Inc., and subsequent Supreme Court decisions clarified the definition of an employee.

    The Taft-Hartley Act (1947) defined rights of management during the labor relations process.

    The Taft-Hartley Act

    A union shop is an arrangement whereby an employee must join a union after being hired.

    This act gave states the right to enact right-to-work laws, which prohibit union shops.

    21 states have such laws

    An open shop is a provision whereby no employee is required to join or contribute money to a union as a condition of employment.

    A closed shop is an arrangement whereby an employer is permitted to hire only union members.

    This action is illegal under the Taft-Hartley Act.

    Key National Labor Relations Board Rulings

    2011: Allowed for much small groups to unionize

    2011–2013: Permitted bargaining units that consist of one department or one classification rather than “wall-to-wall” units (not applicable to acute care hospitals)

    2014–2015: Ruling on expedited elections shortening the time between filing a petition and holding an election

    Healthcare Employees

    The 1975 Health Care Amendments allowed for unionization among healthcare workers, with special provisions for conflict resolution and strikes.

    In 1989, the NLRB established eight bargaining units that could be organized in acute care hospitals:

    Physicians, nurses, all other professionals, technical employees, business office clerical employees, skilled maintenance employees, guards, and all other nonprofessional employees

    Developments in Organizing Healthcare Workers

    The Service Employees International Union is the largest healthcare union.

    Physicians are a special case in healthcare labor issues because only employed physicians may be eligible for union membership.

    In 1999, the NLRB ruled that house staff at Boston Medical Center were employees and not students and therefore were covered under the NLRA.

    Nursing unions have addressed a number of issues including increased workload, working hours, and staffing issues.

    About 18 percent of registered nurses are unionized.

    National Nurses United is the largest union representing nurses.

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