Texas professional nurses don’t need unions

Fort Worth Star Telegram, November 13, 2008

Continuing a campaign to unionize Texas nurses, today the California Nurses Association is holding a rally on the Capitol steps in Austin. This out-of-state union’s rallying cry will be a) how miserable and overworked we nurses are, b) how they can improve patient safety by mandating nurse-to-patient staffing ratios, and c) how they can speak for us.

I guess those Californians don’t realize that we professional Texas women — like former governor Ann Richards, syndicated columnist Molly Ivins and former Congresswoman Barbara Jordan — are perfectly capable of speaking for ourselves.

I’m a staff nurse, an hourly wage-earner, an employee of the same hospital since graduating from nursing school in 1979. I’ve kept my career promise to stay in direct patient care. Fresh out of school, I chose to work in a near century-old hospital with a Catholic mission dating back to the 1600s to serve the sick and the poor. Sisters, many of whom were nurses, controlled the hospital, and a sister currently chairs the Board of Trustees. These aren’t the kind of folks nurses need a union to negotiate with.

Nurses where I work organized 15 years ago — but not in unions. Together, we designed a shared governance structure wherein frontline staff nurses like myself have a strong voice in decision-making. We have standardized patient-care policies into research-based best practice. We have collaboratively established the work environment we want, and it’s paid off in positive patient outcomes (lower rates of morbidity, mortality, birth trauma injury, etc.) and patient/nurse/physician satisfaction.

Our Central Texas hospital system has a dynamic chief nursing officer, and each of the nine hospitals has its own executive nurse, most of whom began as staff nurses in their hospitals. That’s power. What we don’t have is a third-party intermediary, picket lines and strikes that leave patients in jeopardy.

In the 15 years since we organized from within, the level of respect and professionalism for nursing has elevated to a very high level both within the organization and nationally. Staff nurses publish, are doing research and present all over the country. Four of our hospitals have earned the American Nurses Credentialing Center’s coveted Magnet nursing status, and three the ANCC Pathway to Excellence designation.

If nurses unionize, we will no longer be able to communicate with management about workplace issues; our collective bargainer will do that for us. Gains in nursing professionalism in my organization earned over 15 years would be lost, replaced with a “we/they,” victim mentality, unhappy atmosphere.

No one disputes that adequate nurse staffing is essential for safe patient care, but how to achieve that? The National Nurses Organizing Committee (the California Nurses Association free-standing union, not affiliated with the American Nurses Association) wants Texas to go the California route, which passed a formulaic nurse-to-patient staffing ratio law in 1999, implemented in 2004. The law was challenged in court, resulted in a high-profile battle between union nurses and California’s “Terminator” governor and drove up already obscenely inflated healthcare costs. I call that the “hatchet” approach.

In contrast, six states — Texas was the first — have used the “scalpel” approach of mandating staffing plans. For each legislative session, the Texas Nurses Association collaborates with stakeholders — staff nurses like myself, the Texas Hospital Association and nurse executives — to achieve incremental improvements. In 2002, this effort resulted in the Texas Department of State Health Services adopting nurse staffing rules requiring each hospital to have a staffing plan that meets set standards, a staffing committee composed of direct-care nurses and measurable, positive patient outcomes.

For the 2009 session, organized nursing (TNA) and hospitals (THA) are discussing enhancements to better ensure adequate nurse staffing, prohibiting mandatory overtime and the right of government-employed nurses to advocate for their patients without fear of retaliation.

It’s intuitively obvious that hospital staffing is far too complex and volatile for states to legislatively mandate ratios — the ultimate in micro-management. California is the only state to have done so.

In 29 years, I’ve been given an assignment that I thought was unsafe fewer than a half dozen times. The fix was as simple as informing the charge nurse, who immediately rearranged assignments. We help each other out here.

My TNA dues are about half what union fees are, and a real bargain. Texas has negotiated some of the toughest whistle-blower and patient advocacy protections for nurses in the nation — without unions.

We don’t butt heads in Texas; we work together. Nurses want to be part of the solution, and we can speak for ourselves collectively without third-party intermediaries.

Toni Inglis, MSN, RN CNS (retired), FAAN, a lifelong Austin resident and retired neonatal intensive care nurse and editor of NursingNews, writes a monthly opinion column for the Austin American-Statesman editorial page.