Kerri Wilson and Stephanie Jones, two registered nurses on medical cardiology units at Asheville’s Mission Hospital, don’t see eye-to-eye on unionization.
Wilson, who wears a “Vote Yes” button to work, believes a union will give her colleagues a collective voice to safeguard patient health, ensuring more equipment and higher staffing levels. Jones, who dons a “Vote No” button during shifts, would also like to see lower staff-to-patient ratios but doesn’t believe a union can deliver on its promises.
As the election nears — mail-in votes will be tallied on Sept. 16 — both nurses are aware this labor campaign has drawn attention from far outside their hospital’s walls.
“You definitely know that it’s bigger than just the hospital,” Jones said.
Politicians, labor experts, and advocates say the votes of 1,600 nurses in Western North Carolina have broader significant political and financial implications. HCA Healthcare, which owns 178 hospitals across the country, including Mission, stands to lose millions if the union succeeds. National Nurses United, the largest nurses’ union in the United States, stands to gain hundreds of dues-paying members in what would be the NNU’s largest union at an HCA-affiliated facility.
Pro- and anti-union advocates say a labor victory at Mission would open the door for more aggressive organizing efforts in North Carolina, one of the nation’s least unionized states.
Even presidential candidates have commented on Mission nurses’ efforts.
Democratic presidential candidate and former Vice President Joe Biden issued a statement Aug. 25 congratulating nurses at the Asheville hospital for seeking to form a union.
“I’m proud to stand by the Mission RNs in their collective bid for a better, safer, and more equitable workplace — an impressive show of solidarity not just for themselves, but for the health of their entire community,” he said.
Biden isn’t the first Democratic leader to back unionization at Mission Hospital. In late February, then-presidential hopeful Sen. Bernie Sanders, D-Vermont, applauded Mission nurses’ unionization efforts, a week before Mission nurses formally petitioned the National Labor Relations Board (NLRB) to join NNU.
The union campaign, “is definitely on people’s radar screen,” said Elon Law professor Eric Fink. “This is the biggest one I’ve been aware of recently, and it’s what people are talking about.”
On Twitter, Fink said fellow labor experts, both inside and outside North Carolina, have kept track of this sizeable organizing drive. According to the NLRB, a 1,600-person Mission nurses’ union would be the nation’s largest new union since June 2019.
After months of voicing concerns over hospital staffing levels and communicating with NNU representatives, Mission nurses formally petitioned to form a union in early March. Since the pandemic, their worries extended to their supply of personal protective equipment and COVID-19 testing procedures.
If more than half of the nurses who send in ballots vote yes, NNU will represent Mission nurses and bargain on their behalf for workplace conditions and benefits.
Mission Hospital management has argued unionizing would interfere with supervisor and staff communications and ultimately hurt the hospital’s quality of care.
Beyond workplace conditions and communication, the outcome of the election will have notable financial consequences.
NNU would collect union dues – one hour of pay every two weeks – from many of the 1,600 nurses. But because North Carolina is a right-to-work state, nurses are not compelled to pay dues and join the union, even though the union would be bargaining over their benefits and work conditions.
HCA has a financial incentive to fend off the union, too. In its annual financial report to the U.S. Securities and Exchange Commission, HCA stated, “If there is additional union organizing activity and to the extent a significant portion of our employee base unionizes, it is possible our labor costs could increase materially.”
Citing recent research from two economists, Elisabeth Kines, the national executive director for the nonprofit Americans for Fair Treatment, said a Mission union victory would equate to a 33% corporate income tax for HCA.
Both union supporters and detractors predict a union victory at Mission could reverberate to different regions and different professions.
Next to South Carolina, North Carolina has the nation’s lowest union workforce representation at 3.4%. Many say the upcoming Mission vote could begin to reverse that trend.
“What happens in Western North Carolina, with this National Nurses Union movement at Mission Hospital has huge implications for where they could spread across the states,” said Becki Gray, senior vice president at the Raleigh-based John Locke Foundation, a conservative-leaning think tank.
Gray, who has lived in North Carolina for 50 years, said the Mission campaign is the largest union effort in recent memory and believes it could inspire other hospital staff to organize. Aside from VA hospitals, nurses aren’t unionized in North Carolina.
Yet, David Zonderman, a labor history professor at N.C. State University, said nursing was one of the fastest growing sectors for organizing nationwide.
NNU Southern Regional Director Bradley Van Waus said, “There are no doubt other workers across the state who also desire to also form unions.”
Looking for a voice
Beyond health care, another profession watching the Mission union campaign closely is education.
Gray sees the efforts in Asheville’s hospital align with recent organizing efforts of the N.C. Association of Educators (NCAE), the state’s largest educator advocacy organization. She fears unionizing in both sectors are politically motivated and will drive up costs and inefficiencies.
In past years, the NCAE has held teacher walkouts. Last school year, the NCAE passed around surveys to gauge members’ willingness to strike for better pay and benefits. And NCAE’s leadership doesn’t shy away from referring to itself as a union, despite not having the right, as public sector employees, to collectively bargain.
While they disagree with Gray on the benefits of organizing, leaders of local-NCAE chapters also recognize a connection between the labor efforts of teachers and nurses.
“We’re also professions that when budgets get tight, are often asked to do more with less,” said Daniel Withrow, president of the Asheville City Association of Educators. “So, both in the case of public school staff and nurses, it’s going to be really important for those of us who are on the frontlines and doing the work every day to have a voice in the decisions.
In March, four days after Mission nurses petitioned to form a union, the ACAE and the Buncombe County Association of Educators publicly lent their support to their local hospital’s union push.
’All want the same thing’
While the scope of Mission nurses’ union efforts has resonated beyond the hospital, their motivation for voting either “yes” or “no” remains rooted in their daily work experiences.
“Ultimately, we all want the same thing, no matter which side of the vote you stand on, which is safety for patients,” Wilson said. “It’s just a matter of how we’re going to get there.”
As the final vote neared, the campaign to win over Mission nurses intensified. Mission had posted anti-union signs in the hospital hallways and hired a labor-relations firm to conduct voluntary information meetings to persuade nurses to vote “No”. A few weeks ago, the hospital changed its computer screensavers to show anti-union messages.
Pro-union nurses have countered by handing out flyers outside hospital grounds and signing petitions calling for better work conditions. The NNU also purchased a radio advertisement.
Jones said the six-month campaign has caused tension during work, as colleagues engage in less small-talk during shifts.
For her, the broader focus on this election has received left an impression.
“It makes you feel like there’s a little bit more pressure to vote one way versus the other,” Jones said.
Wilson notices the national and statewide attention, but emphasized she focused on her patients and coworkers when casting her vote.
Brian Gordon is the education and social issues reporter for the USA Today Network. Reach him at email@example.com or on Twitter @briansamuel92.
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