Do unions belong in the hospitals? Do they belong in nursing? The answers vary considerably among nurses.

What are the pros of a nursing union? If it’s a good union, nurses who are unfairly accused of an act will have the backing of the qualified people to help prove his or her case; they give nurses a voice and representation. Unions often have minimum staffing clauses in the contracts, ensuring that nurses cannot work with less than a minimum number of nurses on the floor or unit, how often they can be asked to work overtime and limits the amount of floating that nurses may have to do.

Unions outline how much nurses are to be paid, how many breaks they may have and how often they may take them. Another important issue is seniority. Nurses who have worked long and hard at certain jobs are given priority over newer, less experienced nurses for coveted jobs.

However, there are cons to the situation as well. Because unions can be so strong, nurses who should not be working any longer cannot be fired without a considerable amount of proof and hard work on behalf of the superiors. And, even with enough documentation, if the union fights hard enough, the nurse may not have to leave.

The minimum number of staffing is, on paper, a great idea. However, there can be situations where it was really “any RN is good enough” for the numbers. This means that if you need an RN instead of an LPN, who may actually have more experience in that particular situation, you may get an RN without the right amount of experience.

Another important issue about unions is that many people don’t want to join them and forced union membership can create hard feelings and resentment. These nurses enjoy the perks of the unions but don’t want to join because they don’t believe in them or they are afraid of striking. Others have had bad experiences with unions beyond nursing and believe them to be too confrontational and not ready to help for the little things, only the big headline grabbing issues. The Canadian Federation of Nurses Unions, mentions this issue in their article, Nursing Health Human Resources in Canada: The Time for Action was Yesterday!. Linda O'Brien-Pallas, RN, PhD, wrote, “With respect to union support, nurses spoke of the adversarial nature of labor relations, the increasing numbers of grievances, the lengthy processing time, the budget constraints and the need to educate nurses about union matters.”

Other nurses report that they would prefer performance-based pay rather than union-mandated pay – it is patently unfair to some to see some nurses who are undeserving of pay raises but they get them any way because they are mandated by the union.

But, all that aside, are unions good for the patients – the ones who are the receiving end of care? According to the Massachusetts Nurses Association, unions help improve patient care. A study was done in California, looking at the impact of unions and the mortality rate for patients with acute myocardial infarction (AMI). The author wrote, “"Thirty-five percent of hospitals in California have RN unions. The significant finding in this study is that hospitals in California with RN unions have 5.7% lower mortality rates for AMI after accounting for patient age, gender, type of MI, chronic diseases and several organizational characteristics. This result includes controls for number of beds, AMI-related discharges, cardiac services, staff hours and wages.”

This theme is echoed in the Canadian report that states there were, “Positive statements about the role of nursing unions included providing support to patients and nurses, advocating for worker rights.” In their opinion, unions help nurses give better patient care.

So, we’re back to the original question – are unions good for nursing? What do you think?