An increasingly important labor-management issue in the nursing profession is that of unionization. Today's hospitals are under intense pressure to contain costs. This translates into the need to reduce labor-related expenses, since staffing costs are a hospital's largest budgetary expenditure, and nurses comprise a significant percentage of hospital staff. More and more nurses, experiencing widespread anxiety over job security, are turning to unions to address their grievances.
Nurses in private and nonprofit hospitals and nursing homes have the right to organize for purposes of collective bargaining subject to the terms outlined in the National Labor Relations Act (NLRA). Despite their legal right to do so, many nurses have not chosen to unionize. Estimates are that approximately 18 percent of nurse and service workers in acute care hospitals are union members; however, 90 percent of the nation's approximately 6 million healthcare workers are not unionized (Flarey, Yoder, and Barabas, 1992, p. 15). The American Nursing Association (ANA) has established policies to accelerate unionizing efforts and the number of union members in the nursing profession is expected to increase dramatically in the coming decades.
One of the problems with unions is that they favor the traditional approach to healthcare and are resistant to change. Unions are based on a pre-World War II factory model of employment characterized by a rigid labor-management hierarchy. Such a structure creates an "us" against "them" approach to bargaining. This industrial relations model is ingrained in most American institutions. As the healthcare industry moves forward, however, medical professionals have begun to acknowledge the need for a reassessment of traditional, centralized roles.
The trend in modern nursing is toward decentralization of authority. As Rhoades (1987) puts it, "The trend in hospitals is away from centralized nursing administratio...