Gender, Race/Ethnicity, and Unionization in Direct Care Occupations.

Objectives. The goal of this study was to measure unionization in the direct care workforce and the relationship between unionization and earnings, looking closely at differences across race/ethnicity and gender. Methods. Using data from the Current Population Survey from 2010 to 2020, we first used logit analyses to predict the probability of unionization among direct care workers across race/ethnicity and gender. We then measured the relationship between unionization and weekly earnings. Results. We found that male (12%) and Black (14%) direct care workers were most likely to be unionized, followed by Hispanic and other direct care workers of color. Unionized direct care workers earn wages that are about 7.8% higher than nonunionized workers, but unionized workers of color earn lower rewards for unionization compared with White direct care workers. Conclusions. Unions are a mechanism for improving job quality in direct care work, and protecting workers' rights to unionize and participate in collective bargaining equitably may be a way to stabilize and grow the direct care workforce. (Am J Public Health. 2022;112(11):1676-1684. https://doi.org/10.2105/AJPH.2022.307022).

A bibliometric analysis of Health Promotion International content regarding unions, unionization and collective agreements.

A recent article brought together the health benefits of unionization and working under collective agreements. It was noted how Canadian health promotion texts, reports and statements made no mention of unionization and working under collective agreements as promoting health. This was seen as a significant omission and reasons for this were considered. In this article this analysis is extended to consider how contributors to the flagship health promotion journal Health Promotion International (HPI) conceptualize unions, unionization and working under collective agreements as promoting health. Of 2443 articles published in HPI since its inception, 87 or 3.6% make mention of unions, unionization, collective agreements or collective bargaining, with most saying little about their promoting health. Instead, 20 make cursory references to unions or merely see them as providing support and engagement opportunities for individuals. Forty-five depict unions or union members as involved in a health promotion programme or activity carried out by the authors or by government agencies. Only 33 articles explicitly mention unions, unionization or collective agreements as potentially health promoting, representing 1.3% of total HPI content since 1986. We conclude that the health promoting possibilities of unionization and working under collective agreements is a neglected area amongst HPI contributors. Reasons for this are explored and an Organisation for Economic Cooperation and Development report on the importance of collective bargaining is drawn upon to identify areas for health promotion research and action.

The health effects of wage setting institutions: How collective bargaining improves health but not because it reduces inequality.

Do wage-setting institutions, such as collective bargaining, improve health and, if so, is this because they reduce income inequality? Wage-setting institutions are often assumed to improve health because they increase earnings and reduce inequality and yet, while individual-level studies suggest higher earnings improve well being, the direct effects of these institutions on mortality remains unclear. This paper explores both the relationship between wage-setting institutions and mortality rates whether income inequality mediates this relationship. Using 50 years of data from 22 high-income countries (n ~ 825), I find mortality rates are lower in countries with collective bargaining compared to places with little or no wage protection. While wage-setting institutions may reduce economic inequality, these institutions do not appear to improve health because they reduce inequality. Instead, collective bargaining improves health, in part, because they increase average wage growth. The political and economic drivers of inequality may not, then, be correlated with health outcomes, and, as a result, health scholars need to develop more nuanced theories of the political economy of health that are separate from but in dialogue with the political economy of inequality.

An Exploratory, Descriptive Study of Nurse Leaders' Personal and Work Experiences During Union Negotiations and Strike Events.

OBJECTIVE: This study explored the experiences, perceptions and emotional state of nurse leaders during union activities to understand the impact on their personal and professional lives. BACKGROUND: Other than anecdotal stories shared during union negotiations and strike preparations, very little evidence exists in nursing and healthcare literature about nursing unions and their impact on nurse leaders and their organizational priorities. METHODS: This study used an exploratory, descriptive design with a convenience and snowball sample of Association of California Nurse Leaders members. RESULTS: The findings indicate nurse leaders experience a range of emotional states in response to union activities with perceptions of increased workload, job stress, and constrained and deliberate communications with their staff. CONCLUSION: This study adds to the body of knowledge about nurse leader experiences and feelings during union activities.

The role of collective labor contracts and individual characteristics on job satisfaction in Tuscan nursing homes.

BACKGROUND: The role played by remuneration strategies in motivating health care professionals is one of the most studied factors. Some studies of nursing home (NH) services, while considering wages and labor market characteristics, do not explicitly account for the influence of the contract itself. PURPOSE: This study investigates the relationship between the labor contracts applied in 62 Tuscan NHs and NH aides' job satisfaction with two aims: to investigate the impact of European contracts on employee satisfaction in health care services and to determine possible limitations of research not incorporating these contracts. METHODOLOGY: We apply a multilevel model to data gathered from a staff survey administered in 2014 to all employees of 62 NHs to analyze two levels: individual and NH. Labor contracts were introduced into the model as a variable of NH. RESULTS: Findings show that the factors influencing nursing aides' satisfaction occur at both the individual and NH levels. Organizational characteristics explain 16% of the variation. For individual characteristics, foreign and temporary workers emerge as more satisfied than others. For NH variables, results indicate that the labor contract with the worst conditions is not associated with lower workers' satisfaction. CONCLUSION: Although working conditions play a relevant role in the job satisfaction of aides, labor contracts do not seem to affect it. Interestingly, aides of the NHs with the contract having the best conditions register a significantly lower level of satisfaction compared to the NHs with the worst contract conditions. This suggests that organizational factors such as culture, team work, and other characteristics, which were not explicitly considered in this study, may be more powerful sources of worker satisfaction than labor contracts. PRACTICE IMPLICATIONS: Our analysis has value as a management tool to consider alternative sources as well as the labor contract for employee incentives.

What is the Value of a National Football League Draft Pick? An Analysis Based on Changes Made in the Collective Bargaining Agreement.

Kraeutler, MJ, Carver, TJ, Belk, JW, and McCarty, EC. What is the value of a National Football League draft pick? An analysis based on changes made in the collective bargaining agreement. J Strength Cond Res 32(6): 1656-1661, 2018-The purpose of this study was to analyze and compare the value of players drafted in early rounds of the National Football League (NFL) Draft since the new collective bargaining agreement began in 2011. The NFL's player statistics database and database of player contract details were searched for players drafted in the first 3 rounds of the 2011 to 2013 NFL Drafts. Performance outcomes specific to each position were divided by each player's salary to calculate a value statistic. Various demographics, NFL Combine results, and total number of games missed because of injury were also recorded for each player. These statistics were compared within each position between players selected in the first round of the NFL Draft (group A) vs. those drafted in the second or third round (group B). A total of 147 players were included (group A 35, group B 112). Overall, players in group A were significantly taller (p ≤ 0.01) and heavier (p = 0.037) than players in group B. Group B demonstrated significantly greater value statistics than group A for quarterbacks (p = 0.028), wide receivers (p ≤ 0.001), defensive tackles (p = 0.019), and cornerbacks (p ≤ 0.001). No significant differences were found between groups with regard to number of games missed because of injury. Players drafted in the second or third rounds of the NFL Draft often carry more value than those drafted in the first round. NFL teams may wish to more frequently trade down in the Draft rather than trading up.

The Role of Labor Unions in Creating Working Conditions That Promote Public Health.

We sought to portray how collective bargaining contracts promote public health, beyond their known effect on individual, family, and community well-being. In November 2014, we created an abstraction tool to identify health-related elements in 16 union contracts from industries in the Pacific Northwest. After enumerating the contract-protected benefits and working conditions, we interviewed union organizers and members to learn how these promoted health. Labor union contracts create higher wage and benefit standards, working hours limits, workplace hazards protections, and other factors. Unions also promote well-being by encouraging democratic participation and a sense of community among workers. Labor union contracts are largely underutilized, but a potentially fertile ground for public health innovation. Public health practitioners and labor unions would benefit by partnering to create sophisticated contracts to address social determinants of health.

"Educate the Individual... to a Sane Appreciation of the Risk" A History of Industry's Responsibility to Warn of Job Dangers Before the Occupational Safety and Health Administration.

The Occupational Safety and Health Act of 1970 and the Workers Right to Know laws later in that decade were signature moments in the history of occupational safety and health. We have examined how and why industry leaders came to accept that it was the obligation of business to provide information about the dangers to health of the materials that workers encountered. Informing workers about the hazards of the job had plagued labor-management relations and fed labor disputes, strikes, and even pitched battles during the turn of the century decades. Industry's rhetorical embrace of the responsibility to inform was part of its argument that government regulation of the workplace was not necessary because private corporations were doing it.

Community Collectivization and Consistent Condom Use Among Female Sex Workers in Southern India: Evidence from Two Rounds of Behavioral Tracking Surveys.

Community collectivization is an integral part of condom use and HIV risk reduction interventions among key population. This study assesses community collectivization among female sex workers (FSWs), and explores its relationship with sex workers' consistent condom use (CCU) with different partners considering the interaction effect of time and collectivization. Data were drawn from two rounds of cross-sectional surveys collected during 2010 (N1 = 1986) and 2012 (N2 = 1973) among FSWs in Andhra Pradesh, India. Results of the multiple logistic regression analysis show that, CCU with regular and occasional clients increased over the inter-survey period among FSWs with a high collective efficacy (AOR 2.9 and 6.1) and collective agency (AOR 14.4 and 19.0) respectively. The association of high levels of collectivization with CCU and self-efficacy for condom use are central to improve the usefulness and sustainability of HIV prevention programs worldwide.

Partnership Negotiations: Innovation for Nurse Contract Negotiations During Turbulent Times.

Health care delivery is undergoing rapid change, with frontline nurses at the epicenter. A mind-set requiring innovative collaboration, creativity, flexibility, and openness to new care delivery models is necessary. This article describes an innovative approach to modern world contract negotiations in a 371-bed university-affiliated hospital. The nurses' contract negotiations were scheduled to begin 6 months after a layoff affected nurses and other caregivers. Concurrently, a strike was underway at a hospital in the state with the same union. Contentious negotiations were anticipated. Strategies employed to prepare for negotiations included consultation with a nurse expert, and an agreement between the chief nursing officer and chairman of the Shared Governance Committee to conduct negotiations that would allow for more dialogue between the staff nurse and nursing leadership teams. Sessions opened with a video address by a major health care nurse thought leader who provided an overview of the current health care landscape and future direction of nursing. Joint presentations by staff nurses and nurse leaders on topics of interest were conducted. "Nurses for Nurses" round table sessions took place each day, and valuable work was completed at breakout sessions. Ultimately, the partnership negotiations resulted in a successfully negotiated contract.

Protest of doctors: a basic human right or an ethical dilemma.

BACKGROUND: Peaceful protests and strikes are a basic human right as stated in the United Nations' universal declaration on human rights. But for doctors, their proximity to life and death and the social contract between a doctor and a patient are stated as the reasons why doctors are valued more than the ordinary beings. In Pakistan, strikes by doctors were carried out to protest against lack of service structure, security and low pay. This paper discusses the moral and ethical concerns pertaining to the strikes by medical doctors in the context of Pakistan. The author has carefully tried to balance the discussion about moral repercussions of strikes on patients versus the circumstances of doctors working in public sector hospitals of a developing country that may lead to strikes. DISCUSSION: Doctors are envisaged as highly respectable due to their direct link with human lives. Under Hippocrates oath, care of the patient is a contractual obligation for the doctors and is superior to all other responsibilities. From utilitarian perspective, doctors' strikes are justifiable only if there is evidence of long term benefits to the doctors, patients and an improvement in service delivery. Despite that, it is hard to justify such benefits against the risks to the patients. Harms that may incur to the patients include: prolongation of sufferings, irreversible damage to health, delay in treatment, death, loss of work and waste of financial resources.In a system of socialized medicine, government owing to greater control over resources and important managerial decisions should assume greater responsibility and do justice to all stakeholders including doctors as well as patients. If a doctor is underpaid, has limited options for career growth and is forced to work excessively, then not only quality of medical care and ability to act in the best interests of patients is adversely affected, it may also lead to brain drain. SUMMARY: There is no single best answer against or in favor of doctors' industrial action. The author calls for the debate and discussion to revitalize the understanding of the ethical predicaments of doctors' strikes with patient care as the priority.

Human research subjects as human research workers.

Biomedical research involving human subjects has traditionally been treated as a unique endeavor, presenting special risks and demanding special protections. But in several ways, the regulatory scheme governing human subjects research is counter-intuitively less protective than the labor and employment laws applicable to many workers. This Article relies on analogical and legal reasoning to demonstrate that this should not be the case; in a number of ways, human research subjects ought to be fundamentally recast as human research workers. Like other workers protected under worklaw, biomedical research subjects often have interests that diverge from those in positions of control but little bargaining power for change. Bearing these important similarities in mind, the question becomes whether there is any good reason to treat subjects and protected workers differently as a matter of law. With regard to unrestricted payment, eligibility for a minimum wage, compensation for injury, and rights to engage in concerted activity, the answer is no and human subjects regulations ought to be revised accordingly.

Community collectivization and its association with consistent condom use and STI treatment-seeking behaviors among female sex workers and high-risk men who have sex with men/transgenders in Andhra Pradesh, India.

We examine community collectivization among female sex workers (FSWs) and high-risk men who have sex with men and transgenders (HR-MSM) following several years of HIV prevention programming with these populations, and its association with selected outcome indicators measuring individual behaviors (condom use with different partners and sexually transmitted infection [STI] treatment-seeking from government health facilities). Data for this study were collected from a large-scale cross-sectional survey conducted in 2010-2011 among FSWs (sample size: 3557) and HR-MSM (sample size: 2399) in Andhra Pradesh, India. We measured collectivization among FSWs in terms of three binary (low, high) indices of collective efficacy, collective agency, and collective action. Collectivization among HR-MSM was measured by participation in a public event (no, yes), and a binary (low, high) index of collective efficacy. Adjusted odds ratios (adjusted OR) and their 95% confidence intervals (CI) were computed to assess the relationships between collectivization and outcome indicators directly and through mediation of variables such as self-efficacy for condom use and utilization of government health facilities. Results show that among FSWs, high levels of collective efficacy (adjusted OR: 1.3, 95% CI: 1.1-1.7) and collective action (adjusted OR:1.3, 95% CI: 1.1-1.8) were associated with consistent condom use (CCU) with regular clients. Among HR-MSM, participation in a public event (adjusted OR: 2.7, 95% CI: 2.0-3.6) and collective efficacy (adjusted OR: 1.9, 95% CI: 1.5-2.3) were correlated with condom use with paying partners. The association between collectivization and outcome indicators continued to be significant in most cases even after adjusting for the potential mediators. Indicators of collectivization exhibited significant positive association with self-efficacy for condom use and service utilization from government health facilities among both FSWs and HR-MSM. The association of high levels of collectivization with CCU, STI treatment-seeking from government health facilities, ability to negotiate for condom use, and self-efficacy in utilizing government health facilities is relevant to effort to improve the effectiveness and sustainability of HIV prevention programs in India and beyond.

Opportunities and constraints to improving milk quality in Ireland: enabling change through collective action.

Ireland plays a key role in contributing to the global supply of dairy produce, and increasing international demand, as well as the abolition of milk quotas in the European Union in 2015, present opportunities for the Irish milk industry. Improving milk quality is required to maximize these opportunities. National action on milk quality is spearheaded by Animal Health Ireland, yet the potential for collective action at an industry level is undermined by the inability of individual stakeholders to accept responsibility for action. In-depth qualitative interviews were conducted with n=12 stakeholder representatives. The theoretical concepts of collective action (i.e., when a group of people with a shared interest undertake some kind of voluntary common action in pursuit of that shared interest) is applied to understanding the results and identifying a collective way forward. Though consensus is apparent on the need to improve milk quality, differences exist about individual responsibility and the best way to achieve higher quality standards. The propensity for collective action is undermined by shifting responsibility to other stakeholders, stakeholder positions, trust concerns, and concerns over the commitment of other stakeholders to cooperate. Understanding how collective action works provides Animal Health Ireland with a knowledge framework in which to build stakeholder consensus. The paper concludes with practical examples of how Animal Health Ireland continues to apply this understanding by bringing individual stakeholders together to achieve milk quality improvement.

The golden goose in the crosshairs: the transition to defined contribution pension plans in the public sector: unintended consequences.

State, county, and local governments are currently facing a myriad of economic issues, based on shrinking tax revenues combined with increased expenditures. Of these, the costs related to defined benefit pension plans are one of the most serious issues facing many public employers. Through a comprehensive review of the existing literature, this article examines how the shift from the defined benefit (DB) to defined contribution (DC) pension plan has the potential to enhance levels of labor unrest due to changes in union militancy, bargaining skills deficits, intra-organizational conflict, and issues related to economic trade-offs. Besides the capacity for immediate and deleterious ramifications in the collective bargaining process, the transition to the DC pension also presents some potentially negative consequences related to human resource management, including changes in the psychological contract, recruitment strategies, employee turnover, and changes in retirement patterns. Recommendations to improve labor relations and human resource management practices in the DC pension environment are also explored.

A review of the opportunities and challenges facing the nursing associations in Iran.

BACKGROUND: Nursing associations and organizations are deemed to be effective tools in promoting the profession. Professional nursing associations are an essential part of the nursing culture. Examining the challenges and opportunities confronting the associations would pave the way for the identification of their limitations and also would lead to more interactions among the members and the associations. METHODS: Following an extensive review of the literature and also examining the professional nursing associations in Iran, the common challenges facing the nursing associations are identified and their shared challenges with other associations in other countries have been explored. Lack of members and insufficient support from the associations, financial problems, non-professional activities of associations and lack of interactions among associations are among the important challenges that the nursing associations confront within Iran. The possibility for establishing specialized nursing associations for increasing teamwork activities can be pointed out as one of the available opportunities. CONCLUSION: Professional associations follow important priorities with regard to their objectives, which distinguishes each from the other. The clear introduction of objectives and pinpointing the convergences that might bring about clashes between them will lead to building confidence among nurses, and hopefully, increasing membership. Members' dynamic participation, and support and interactions between associations are among the measures for increasing the professional power. Researchers hope that this article could provide both nurses and professional associations with insights to support each other for the purpose of promoting professional development. Considering the insufficient research in the field, more studies are also suggested.