Trends in Labor Unionization Among US Health Care Workers, 2009-2021.

Importance: Labor unionization efforts have resurged in the US, and union membership has been shown to improve worker conditions in some industries. However, little is known about labor unionization membership and its economic effects across the health care workforce. Objectives: To examine the prevalence of labor unionization among health care workers and its associations with pay, noncash benefits, and work hours. Design, Setting, and Participants: This cross-sectional study was conducted using data from the Current Population Survey and Annual Social and Economic Supplement from 2009 through 2021. The US nationally representative, population-based household survey allowed for a sample of 14 298 self-identified health care workers (physicians and dentists, advanced practitioners, nurses, therapists, and technicians and support staff). Exposures: Self-reported membership status or coverage in a labor union. Main Outcomes and Measures: Prevalence and trend in labor unionization. Further comparisons included mean weekly pay, noncash benefits (pension or other retirement benefits; employer-sponsored, full premium-covered health insurance; and employer's contribution to the worker's health insurance plan), and work hours. Results: The 14 298 respondents (81.5% women; 7.1% Asian, 12.0% Black, 8.5% Hispanic, 70.4% White individuals; mean [SD] age, 41.6 [13.4] years) included 1072 physicians and dentists, 981 advanced practitioners, 4931 nurses, 964 therapists, and 6350 technicians and support staff. After weighting, 13.2% (95% CI, 12.5% to 13.8%) of respondents reported union membership or coverage, with no significant trend from 2009 through 2021 (P = .75). Among health care workers, those who were members of a racial or ethnic minority group (Asian, Black, or Hispanic individuals compared with White individuals) and those living in metropolitan areas were more likely to report being labor unionized. Reported unionization was associated with significantly higher reported weekly earnings ($1165 vs $1042; mean difference, $123 [95% CI, $88 to $157]; P < .001) and higher likelihood of having a pension or other retirement benefits at work (57.9% vs 43.4%; risk ratio [RR], 1.33 [95% CI, 1.26 to 1.41]; P < .001) and having employer-sponsored, full premium-covered health insurance (22.2% vs 16.5%; RR, 1.35 [95% CI, 1.17 to 1.53]; P < .001). Union members reported more work hours (37.4 vs 36.3; mean differences, 1.11 [95% CI, 0.46 to 1.75]; P < .001) per week. White workers reported mean weekly earnings that were significantly more than members of racial and ethnic minority groups among nonunionized workers ($1066 vs $1001; mean difference, $65 [95% CI, $40 to $91]; P < .001), but there was no significant difference between the 2 groups among unionized workers ($1157 vs $1170; mean difference, -$13 [95% CI, -$78 to $52]; P = .70). Conclusions and Relevance: From 2009 through 2021, labor unionization among US health care workers remained low. Reported union membership or coverage was significantly associated with higher weekly earnings and better noncash benefits but greater number of weekly work hours.

Do unions contribute to creative destruction?

We apply a shift-share approach and historical unionisation data from 1918 to study the impact of regional unionisation changes in Norway on regional wage and productivity growth, job-creation and -destruction and social security uptake during the period 2003-2012. As unionisation increases, wages grow. Lay-offs through plant closures and shrinking workplaces increase, causing higher retirement rates, while job creation, plant entry and other social security uptakes are unaffected. Productivity grows, partly by enhanced productivity among surviving and new firms and partly by less productive firms forced to close due to increased labour costs. Thus, unions promote creative destruction.

Not Part of the Job: An Analysis of Characterizations of Workplace Violence against Nurses in Canada by Unions and Professional Associations.

In the spring of 2019, Canada's House of Commons Standing Committee on Health reviewed the issue of workplace violence in healthcare and issued a report with nine recommendations. By summer that year, the Canadian Federation of Nurses Unions had two active campaigns on workplace violence characterized by a strong social media presence. In 2020, a private member's bill was sponsored to amend Canada's Criminal Code in cases of assault against a healthcare worker. In the face of these developments, we were interested in the framing of the problem of workplace violence by professional and labour organizations in Canada. We examined documents, websites and social media posts from selected nursing unions and professional associations, including both national and provincial organizations. We found that nursing unions and professional associations have distinctive views on workplace violence. We argue that these divergent understandings preclude the creation of consistent and successful political and organizational strategies that would help create safe workplaces for nurses.

Articulations of antimicrobial resistance in trade union financed journals for nurses in Scandinavia - A Foucauldian perspective.

Antimicrobial resistance (AMR) in bacterial infections is a growing threat to humanity and a challenge to healthcare systems worldwide. Healthcare professionals have an important role in preventing AMR and the spreading of infections. This article focuses on trade union financed journals for nurses in Scandinavia studying how the journals articulate AMR to its readership. A systematic literature search over an eleven-year period was conducted, using web-based national trade union financed journals, searching for 'bacteria' and 'resistance'. A thematic analysis, inspired by Foucault's concepts of power and governmentality, was made of 131 texts to understand, which kind of practices, strategies and policies the journals frame regarding AMR. The time period studied resulted in the recognition of four separate themes: the horror scenario, the 'dangerous' other, healthcare professionals as a source of resistance development and AMR as a field of research and producer of research qualifications. The study concludes that the journals tend: to present AMR in apocalyptic terms with more research and pharmaceutical industries needed for avoidance; to point out problems in other countries, populations, and sometimes nurses' working conditions, but primarily with other professionals' behaviour; and lastly, to present the nurse as a good fairy and disciplinator of doctors.

Discursive archaeology: constituting knowledge of militant nurses in trade associations.

OBJECTIVE: To analyze the constituting knowledge of militant nurses in trade associations. METHOD: Historical research, based on the oral history method, with a qualitative approach carried out with 11 nurses who are/were militants for professional issues since the 1980s in the state of Bahia. The data collected through semi-structured interviews were organized in the software n-vivo 10 and analyzed based on dialectical hermeneutics. RESULTS: We identified pedagogical, administrative, public health, sociological, and trade union background knowledge as constituent of militant individuals. Final considerations: The constituting knowledge of militant nurses are inscribed in the Social Sciences, distanced from biomedical knowledge and power, pointing at ways for structuring nursing curricula. We identified the Brazilian Association of Nursing as a space for political formation.

Discursive archaeology: constituting knowledge of militant nurses in trade associations / Arqueología del discurso: los saberes constitutivos de enfermeras militantes en entidades de clase / Arqueologia discursiva: os saberes constitutivos de enfermeiras militantes em entidades de classe

ABSTRACT Objective: To analyze the constituting knowledge of militant nurses in trade associations. Method: Historical research, based on the oral history method, with a qualitative approach carried out with 11 nurses who are/were militants for professional issues since the 1980s in the state of Bahia. The data collected through semi-structured interviews were organized in the software n-vivo 10 and analyzed based on dialectical hermeneutics. Results: We identified pedagogical, administrative, public health, sociological, and trade union background knowledge as constituent of militant individuals. Final considerations: The constituting knowledge of militant nurses are inscribed in the Social Sciences, distanced from biomedical knowledge and power, pointing at ways for structuring nursing curricula. We identified the Brazilian Association of Nursing as a space for political formation.

RESUMEN Objetivo: Analizar los saberes constitutivos de enfermeras militantes en entidades de clase. Método: Investigación histórica, basada en el método de historia oral, de enfoque cualitativo realizada con 11 enfermeras que militaron o militan por las cuestiones profesionales desde la década de 1980 en el estado de Bahía. Los datos recogidos mediante entrevistas semiestructuradas se organizaron en el programa informático n-vivo 10 y se analizaron con base en la hermenéutica dialéctica. Resultados: Se identificaron los saberes pedagógicos, administrativos, de salud colectiva, sociológicos y de formación sindical como saberes constitutivos de sujetos militantes. Consideraciones finales: Los saberes constitutivos de enfermeras militantes están inscritos en las Ciencias Sociales, alejados del saber y del poder biomédico, señalando caminos para la estructuración de los currículos de enfermería. Se identificó a la Asociación Brasileña de Enfermería como un espacio de formación política.

RESUMO Objetivo: Analisar os saberes constitutivos de enfermeiras militantes em entidades de classe. Método: Pesquisa histórica, baseada no método de história oral, de abordagem qualitativa realizada com 11 enfermeiras que militaram/militam pelas questões profissionais desde a década de 1980 no estado da Bahia. Os dados coletados por meio de entrevistas semiestruturadas foram organizados no software n-vivo 10 e analisados com base na hermenêutica dialética. Resultados: Identificados os saberes pedagógico, administrativo, saúde coletiva, sociológico e de formação sindical como saberes constitutivos de sujeitos militantes. Considerações finais: Os saberes constitutivos de enfermeiras militantes estão inscritos nas Ciências Sociais, distanciados do saber e do poder biomédico, apontando caminhos para estruturação dos currículos de enfermagem. Identificou-se a Associação Brasileira de Enfermagem como um espaço de formação política.

Six stormy years and the audacity to confront a challenging future: taking stock of the Kenyan Doctors' Union.

The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) was formed in August 2011. Within the last six years, this union has galvanized the Kenyan doctors together, agitated for healthcare policy reforms and successfully negotiated and registered a Collective Bargaining Agreement (CBA). Though political will and the national citizens' psyche on matters pertaining to public healthcare remain a challenge, this union has made its foot prints on the Kenyan conversation space. KMPDU looks forward to engaging local, regional and international health stake holders to improve the state of the country's health care, key among these being to have a national commission handling all the human resources for health.

Managing and sustaining an ageing nursing workforce: identifying opportunities and best practices within collective agreements in Canada.

AIM: This paper seeks to identify gaps within nursing collective agreements for opportunities to implement practices to sustain the nursing workforce. BACKGROUND: Since the majority of nurses in Canada are unionised, some of the strategies recommended in the literature to cope with nursing shortage may not apply to unionised nurses, making collective agreements a potential source for designing practices that can mitigate the impact of ageing nurses. METHOD: Nine major collective agreements for registered nurses in each province governing the nursing employment relationship were analysed to see if different practices were already addressed in the collective agreements. RESULTS: Five such practices were identified, including: providing more mentorship opportunities; encouraging nurses who are eligible to retire to remain in the nursing workforce; attracting internationally trained nurses; implementing operational changes that include process improvements or new technologies; and empowering nurses through flexibility in work schedules. CONCLUSION: If collective agreements are silent in any of the strategies identified in the literature, health-care organisations can adopt these practices without violating the collective agreements. IMPLICATIONS FOR NURSING MANAGEMENT: Non-unionised health-care organisations can also benefit from learning about these policies and practices to assist in managing and sustaining an ageing nursing workforce.

A Quasi-experimental Evaluation of Performance Improvement Teams in the Safety-Net: A Labor-Management Partnership Model for Engaging Frontline Staff.

BACKGROUND: Unit-based teams (UBTs), initially developed by Kaiser Permanente and affiliated unions, are natural work groups of clinicians, managers, and frontline staff who work collaboratively to identify areas for improvement and implement solutions. OBJECTIVE: We evaluated the UBT model implemented by the Los Angeles County Department of Health Services in partnership with its union to engage frontline staff in improving patient care. DESIGN: We conducted a quasi-experimental study, comparing surveys at baseline and 6 months, among personnel in 10 clinics who received UBT training to personnel in 5 control clinics. We also interviewed staff from 5 clinics that received UBT training and 3 control clinics. PARTICIPANTS: We conducted 330 surveys and 38 individual, semi-structured interviews with staff at an outpatient facility in South Los Angeles. INTERVENTIONS: Each UBT leader received an 8-hour training in basic performance improvement methods, and each UBT was assigned a team "coach." MAIN MEASURES: Our outcome measure was 6-month change in the "adaptive reserve" score, the units' self-reported ability to make and sustain change. We analyzed transcripts of the interviews to find common themes regarding the UBT intervention. KEY RESULTS: The survey response rate was 63% (158/252) at baseline and 75% (172/231) at 6 months. There was a significant difference-in-change in adaptive reserve between UBTs and non-UBTs at 6 months (+0.11 vs -0.13; P = .02). Nine of the 10 UBTs reported increases in adaptive reserve and 8 UBTs reported decreased no-show rates or patient length of stay in clinic. Staff overwhelmingly felt the UBTs were a positive intervention because it allowed all levels of staff to have a voice in improvement. CONCLUSIONS: Our results indicate that partnership between management and unions to engage frontline staff in teams may be a useful tool to improve delivery of health care in a safety-net setting.

Thousands of NHS staff to walk out over pay.

Unions have vowed to press ahead with a 12-hour strike this week after talks to resolve the pay dispute with health secretary Jeremy Hunt failed.

Social confidence in unions: a U.S.-Canada comparison.

This article examines changes in levels of social confidence in unions in Canada and the United States between 1982 and 2006 based on an analysis of the World Value Survey (WVS) data set. It considers why confidence rates are similar in the two countries, applying a logistic regression model to the two most recent WVS waves (i.e., 2000 and 2006) so as to bring out the effects of political and social differences on the propensity of individuals to trust unions in each national context. The results show similarities between the two countries (e.g., more progressive and younger citizens generally have greater confidence in unions), but also important distinctions (e.g., only in Canada do individuals with a working class profile appear to have greater confidence in unions).