At a press conference last week, nurses at the University of Wisconsin Hospital and Clinics formally demanded that the UW Health board voluntarily recognize their newly formed union. The nurses, who had lost union representation after former Governor Scott Walker unleashed a package of anti-labor legislation in 2011, fought—and lost—the battle to retain their union-won contracts in the years since.
The Wisconsin nurses join the ranks of health care professionals across the United States organizing for improved staffing ratios and safer work conditions at hospitals and clinics. The nurses, who have organized in response to chronic understaffing in the UW health care system, say that patient safety lies at the heart of their campaign—which was launched a year ago, and grew out of the public eye in the months since.
In 2019 alone, nurses in Michigan, Montana, and Oregon have campaigned for union representation; in each drive, nurses placed patient outcomes squarely at the center of their campaign platforms. And months of strikes and unionization campaigns around the United States have demonstrated the power of organized nurses to fight for working conditions on their own terms.
Months of strikes and unionization campaigns around the United States have demonstrated the power of organized nurses to fight for working conditions on their own terms.
Nurses in New York who threatened to walk off the job in protest of understaffing won minimum ratios of nurses to patients in the hospitals, with the hospitals agreeing to hire over 1,400 new nurses in the hospitals. Most recently, Chicago nurses went on strike over unsafe working conditions and excessive overtime. California remains the only state that mandates staffing minimums in hospitals and clinics, and nurses’ unions have backed similar legislation at the federal level.
Kate Walton, a registered nurse in the emergency department at the UW Hospital, says that the nurses are fighting for appropriate staffing ratios, and that securing union recognition would be critical for a broader guarantee of safety for patients. Unionization, Walton says, would preserve “the ability to speak up on behalf of our patients without fear of retaliation or concern that we’ll be punished.” By negotiating with the hospital as a collective—rather than through individual channels within the UW’s human resources department—the nurses hope to avoid having to self-report safety concerns within the departments.
“We feel like without a voice we have lost some of the tools that we need to care for patients, especially with regard to our staffing ratios,” says Shari Signer, a UW nurse of over a decade.
Nurse unionists and advocates around the United States have charged that practices by their employers—like cutting budgets for support staff—are the product of an administrative attitude that prioritizes profit over safety. But the factors underlying the union push in Wisconsin provide a rare, and grim, illustration of the genesis of such labor practices.
From 2017 to 2018, the hospital—with the guidance of the consulting firm Prism—implemented a budgetary program wherein hospital supervisors tracked workers’ hours and other labor-related data to set “productivity” and budget targets. In a webinar, Prism and UW Health issue an eerily straightforward mandate to define and quantify the productivity of nurses on the job, comparing work in the health system to sandwich making at Subway.
“Let’s say . . . for every lunch shift that I worked, I needed to make at least five sandwiches,” says the UW Health panelist. “In productivity terms, that would mean that I needed to make one sandwich every thirty minutes, or .5 worked hours per unit of service.”
The most highly-sought health care consulting firms (among which Prism does not, in fact, rank) deploy a similar logic with respect to the workforce: McKinsey & Company, the top consulting firm for health care, also attempts to address patient care as a formulaic economic model. One McKinsey publication asserts bluntly that in healthcare systems in general, “inputs” (workers) were not achieving appropriate levels of “outputs” (health services).
The effect of the labor program at UW Health was rapid. “It’s been a very dramatic experience for the nurses,” says Chuck Linsenmeyer, a UW nurse of over twenty years. “Those changes involve a shift in the top priority of our institution, going from being delivering outstanding patient care, considering ourselves the best hospital in the state for direct patient care, and the shift is toward maximizing corporate profits,” he adds.
The Wisconsin campaign constitutes a rebuke to the Walker-era legislation that denied nurses at the university the legal right to collectively bargain with the hospital board. It has also occasioned reflection on the effect of a unionized workforce by nurses who worked in the UW Health system before and during the Walker administration.
Before the passage of Act 10, says Linsenmeyer, UW Hospital “was filled with empowered nurses who felt like they had created this hospital, that they were an integral part of what this hospital was and that they had the power to do right by their patients and do right by themselves.”
The hospital has not yet responded to the nurses’ demand for union recognition except to say that “state statute eliminated collective bargaining at the University of Wisconsin Hospitals and Clinics Authority,” and that the Hospital “has successfully implemented many processes to obtain direct employee feedback, such as forums, the Employee Advisory Council and employee surveys.”