United We Stand

Gwendylon Johnson, RNC, MA, has been a registered nurse for 30 years—and for nearly 20 of those years, she has also been a union activist within the District of Columbia Nurses’ Association.

To Johnson, the two roles are perfectly in sync. Being part of a nurses’ union, she feels, is as important to her struggle to be recognized as an African American as her activism during the civil rights movement in the 1960s, when she marched with Dr. Martin Luther King.

“Back in 1961, he delivered a speech to the AFL-CIO at its Fourth Constitutional Convention. Basically, the focus of the speech was that if black people win, labor wins,” recalls Johnson, a staff nurse in women’s health at Howard University Hospital in Washington, D.C.

Dr. King’s words resonated with Johnson. “He talked about the duality of purpose between what I as a minority was looking for and what labor was looking for,” she says. “He talked about things like decent wages, fair working conditions, health and welfare, respect and dignity.”
It’s no surprise, then, that Johnson recently assumed a key role at the negotiating table representing the United Association of Nurses (UAN), the collective bargaining arm of the American Nurses Association, during a bitter nurses’ strike at the Washington Hospital Center. The six-week walkout centered on issues such as understaffing and mandatory overtime.

“I think I’ve always had a different respect and association with the union than a lot of other nurses because I felt that [unions] have been an avenue for achieving [equity]–in the same way Dr. King felt that if the civil rights movement worked together with labor, both blacks and the unions would win,” she says.

Minority Membership Gaining Strength

At a critical time in health care history when union representation among nurses is climbing–due largely to concern over staffing shortages and the declining number of nurses entering the profession—a growing number of minority nurses are gaining a collective voice.


Overall, about 19% of the 2.7 million registered nurses nationwide were covered by collective bargaining agreements in 2000, according to U.S. Census Department figures. That’s up from less than 17% just two years earlier.


Several unions represent RNs, including the UAN, the Service Employees International Union (SEIU), the American Federation of Teachers, the United Food and Commercial Workers Union, the American Federation of State, County and Municipal Employees (AFSCME) and the American Federation of Government Employees (AFGE), plus local and regional independents, such as the California Nurses Association.
Unionization among nurses was revved up a notch this spring as the UAN–the largest union representing exclusively registered nurses, with 100,000 members–voted to affiliate with the AFL-CIO, a move organizers hope will strengthen the voice of nurses and their patients on a national level.

While none of these unions track minority membership, union leaders say that nurses of color like Johnson appear to make up approximately the same proportion in unions as they do in the nursing workforce—i.e., about 12%.

Wearing the Union Label From Top to Bottom

Some activists say that greater diversity within nurses’ unions is needed to better reflect the U.S. population at large, particularly in urban areas where significant numbers of nurses are African-American, Hispanic, Asian or from other non-Caucasian ancestry.

“I believe very strongly that the union should reflect [diversity in its membership],” says Sonia Moseley, RNP, executive vice president of the United Nurses Association of California, which represents about 11,000 RNs and is affiliated with AFSCME.

While Moseley says her union’s membership adequately reflects the 20-30% of California RNs who are nurses of color, she feels the percentage of minority members in leadership roles is still too low, at about 1%. “[Minority union members] don’t always show an interest in moving into leadership positions, and we don’t necessarily reach out to them, so I think we’re lacking in that area,” she admits

Moseley thinks it’s important that the mix of negotiators and union leaders reflects a diversity of races and cultures. She explains, “If the nurses you are representing aren’t all lily white, you have to have people at the bargaining table who reflect the true face of your membership”–not just because some issues may affect minority members directly, but also to build credibility and trust.

Nurses’ Unions Go to School

Sylvia Barial, RN, MS, can personally attest to the impact a minority nurse can have within a union. She is the chapter chair for school nurses in the United Teachers of New Orleans, which is affiliated with the American Federation of Teachers. The AFT’s health care division represents about 60,000 RNs nationwide.

For the first 10 or 15 years of her 30-year tenure with the union, Barial was the only African American–and the only school nurse–serving on the health care committee. Over the years, she’s seen first-hand the power and professional recognition that school nurses have gained from having a stronger collective voice within the teacher’s union.

“People would say, ‘Oh, you’re only a school nurse,’” Barial remembers. But since those early years when they were paid much less than teachers, school nurses now receive the same salaries as teachers (commensurate with their level of college education and other factors).
Today, school nurses manage students with a variety of illnesses and conditions that impact their ability to learn. Says Barial, “The union has increased schools’ awareness that there are federal rules and regulations that must be followed and that it’s important for them to have school nurses who can perform these services.”

Union Ties That Bind

For the most part, leaders of nursing unions say the issues they address collectively are the same for all members, regardless of their racial or ethnic background. “The same issues that affect any nurses affect minority nurses,” says UAN chair Cheryl Johnson, RN, BSN.
Heading the list of issues are those relating to working conditions and short staffing.



“Hospitals in particular, but nursing homes as well, do not have enough nurses and other bedside caregivers, so each nurse has too many patients and is vulnerable to unsafe care and medical errors,” says Gay Hayward, nurse alliance coordinator for the SEIU, which represents 70,000 RNs and 40,000 LPNs. “It really impacts the quality of the care that’s being given.”


Adds UAN’s Johnson, “You could be anywhere in the country right now and you’d see about the same thing. There’s not enough nursing support, and we are expected to do more work with less people. It’s scary to go to work sometimes because you don’t know the positions you’re going to be put into.”

Indeed, union membership has gathered steam in the last 10 to 15 years as cost-cutting measures at medical facilities drove many RNs into other health care jobs that offered higher pay and better working conditions–or drove them out of nursing entirely. The Bureau of Health Professions reports that 494,000 licensed nurses were not practicing in 2000.

In addition, the prospect of low pay and stressful working conditions appears to be influencing prospective nurses’ career choices. The American Association of Colleges of Nursing recently reported that enrollment of students in BSN degree programs fell 2.1% in the fall of 2000, marking the sixth straight year of declines.

Negotiating for Equality

But not all union concerns are colorblind, other union insiders say. Some labor issues, such as racial discrimination in the workplace, are particularly relevant to minorities. Most nursing unions have a system in place, through their grievance procedures, to handle allegations that arise.

“[Unions’] grievance and arbitration procedures are much more in the hands of the individual workers than, for instance, an EEOC claim or private suit would be,” according to Hayward. “The outcomes can be much more satisfying, and more timely, [when you] have the union and contract language to pursue as a venue of recourse.”

Educational opportunities for career advancement, such as tuition reimbursement, are another issue that may have special significance to nurses of color, particularly at a time when more minorities are being encouraged to enter the profession. Such issues can be addressed by unions, activists say.

“I work in a hospital that is a predominantly black institution,” says Gwendylon Johnson, “and we’ve been able to achieve strong contract language that focuses on providing the opportunity for nurses to get educational opportunities, both within and outside the workplace.”

To Join or Not to Join

While union organizers are quick to say that collective bargaining isn’t the only way to make strides in improving nurses’ working conditions, they insist that unions can be an effective tool in getting management to listen. In many cases, unions have been instrumental in boosting wages and other benefits, such as retirement compensation, innovative bonus systems and increases in differential pay.


UAN leader Johnson tells her ANA colleagues who aren’t union sympathizers: “If you can sit with your employer and come to some kind of agreement where you have decent working conditions and you can compensate nurses so they’ll stay there, then good for you. But what we’re finding more and more, even in states that don’t have nursing unions, is that nurses are thinking about starting them.”


While nursing union organizers admit it can be difficult to get anyone–regardless of background–to get involved in unions, cultural differences can make the task of attracting minority members even harder. For instance, Philippine nurses, particularly recent immigrants, come from a culture where it is considered inappropriate to buck authority or the mainstream, and may therefore be difficult to recruit, says Hayward.

Pete-Reuben Calixto, RN, BSN, CNN, president of the Philippine Nurses Association of America, agrees with that assessment. In fact, he says, those cultural norms prevented him from joining a union when he came to the University of California at San Francisco on a work visa in the 1970s.

Although he paid the mandatory dues, Calixto didn’t officially join the California Nurses Association until a year and a half ago, when he had become more assimilated to U.S. culture and finally felt he could stand up to the changes sweeping through the health care industry.
“When you are sponsored by a certain U.S. employer, you feel that loyalty has to be paid back,” he explains, adding that other Filipino nurses may fear repercussions regarding their immigration status.

But today’s nursing unions have become more prepared to deal with these issues. They’re typically staffed with immigration lawyers and other experts to consult and defend members, if necessary. Union organizers also try to address cultural concerns one-on-one with prospective members by connecting them with current members from the same ethnic background, adds Moseley.

“It helps to tell your own story, how you became involved, how you stood up [for the right to organize] and how you didn’t get fired or have anything bad happen just because you decided you wanted to vote for a union,” she says.

Where do professional organizations for minority nurses stand on the issue of union membership? The National Black Nurses Association, for example, does not currently have a labor entity for its members but is planning to discuss union representation for the first time in the wake of UAN’s affiliation with the AFL-CIO, according to NBNA executive director Millicent Gorham.

On the other hand, Sandra Haldane, RN, BSN, president of the National Alaska Native American Indian Nurses Association, believes the decision to unionize is a local issue. “Unions have their place in some instances when staff cannot seem to work out situations with management or when they’re just taking an incredibly long time [to resolve nurses’ concerns],” she argues. “But with a very forward-thinking leadership group, you can correct situations and improve the working environment so that employees don’t feel like they have to unionize.”

A Voice for Patients, Too

Ultimately, the decision to join a union is up to each individual nurse. But many nurses of color who have taken that step feel union representation does more than just help ensure that the concerns of minority nurses are heard—it also translates to better care for their patients, which they say has always been a key concern.

“My association with the union has allowed me the ability to speak out on issues like patient advocacy without the fear of retaliation,” Gwendylon Johnson asserts, adding that the black nursing sorority to which she belongs, Chi Eta Phi, also promotes union membership.