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Hospital Workers Unionization: Arguments Against Essay

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Updated: May 20th, 2020


Managing unionize employees is often a challenge for companies that operate in labor-intensive industries. The constitution of the US and those of most countries allow workers to join associations and take industrial action against their employers (Yates, 2009). This has led to the formation of numerous trade unions that focus on protecting the interests of their members. For instance, they negotiate for better remuneration schemes and improved work conditions on behalf of their members. However, the actions of trade unions can severely reduce the productivity of organizations that heavily depend on their employees to meet customers’ needs. This paper presents arguments against the unionization of workers in the context of a hospital with 1,000 nurses. It will also recommend a staff management plan as an alternative to participation in unions.

Arguments against Unionizing Nurses

Patient Outcomes

Unionization of nurses is undesirable because of its negative effects on patient outcomes. The Florence Nightingale Pledge states that “…devote myself to the welfare of those committed to my care” (Spetz & Herrera, 2011, pp. 60-67). The mandate of this pledge can only be “delivered by nurses who think, speak, and act independently rather than through a trade union” (Spetz & Herrera, 2011, pp. 60-67). Nurses are servants of their patients. Thus, their professional freedom should not be undermined by labor unions that make decisions on their behalf. Ethical nurses are expected to relinquish self-interest.

Moreover, they are expected to focus on high moral standards by acting in the interest of their patients. This requirement cannot be achieved through participation in unions that strive to achieve their objectives at the expense of patients. For instance, nurses have always been forced to abandon their patients to participate in strikes. This leads to unnecessary suffering and deaths among patients.

One of the popular arguments for unionizing nurses is that it helps in improving job satisfaction and motivation, which in turn leads to improved patient outcomes (Budd & Patton, 2004). Research indicates that this argument is not always true. Job satisfaction among nurses is not only achieved through salary increments or improving the nurse-to-patient ratio, which are the major concerns of unions. Nurses who work in hospitals with inadequate facilities will lack motivation even if they are highly paid. Thus, unionizing nurses does very little to improve patient outcomes.

Ineffectiveness of Unions

Labor unions are very ineffective in nearly all sectors of the economy (Yates, 2009). This can be illustrated by the sharp decline in the number of nurses who are members of labor unions. Most unions are led by people who are not medical professionals. Thus, they do not understand the dynamics of the healthcare industry and the needs of nurses. Oftentimes, labor unions fail to achieve their objectives through collective bargaining. Most negotiations usually end in compromises, where nurses have to accept less than what they demanded in terms of salary increments or improved work conditions (Spetz & Herrera, 2011). One of the factors that limit the effectiveness of labor unions is corruption and political interference. Corrupt union leaders usually betray their members by taking bribes to accept unfavorable offers. As a result, nurses continue to suffer.

Nurses have to pay for their membership in labor unions. However, the performance of the unions is never measured by nurses. The reality is that much of the periodic contributions made by nurses go to waste due to mismanagement (Yates, 2009). Nurses do not get value for their money since unions represent general/ group interests rather than the specific needs of individual nurses. Indeed, the needs of nurses are varied and unique to every hospital. This limits unions’ ability to act in the interest of nurses.

Financial Implications

Unionizing nurses will have a negative effect on financial management. Nurses account for nearly half of the hospitals’ workforce. In this regard, enforcing collective bargain agreements that focus on salary increments or increasing the number of nurses can be a serious challenge. For instance, increasing the salaries of 1,000 nurses by even 10% will require a substantial amount of financial capital, which might not be available. This will expose the hospital to the risk of being debt-ridden, especially if it has to borrow funds to implement unplanned salary increments or nurse recruitment programs (Yates, 2009). In addition, the profits of the hospital will reduce if the cost of enforcing collective bargain agreements cannot be passed to patients.

Empirical studies indicate that patients often bear the financial burden of implementing the demands of labor unions (Spetz & Herrera, 2011). For example, an unplanned increase in salaries might force the hospital to increase the cost of accessing its services. Moreover, the hospital might be forced to eliminate services that it cannot provide in a profitable manner in order to reduce costs. The overall effect will be poor patient outcomes (Budd & Patton, 2004). Specifically, access to medical services will reduce due to high prices. In addition, the quality of care will be compromised due to financial constraints.

Motivation and Incentive Programs

Motivation among nurses is an important determinant of the quality of healthcare in every hospital. Nurses have to be motivated through appropriate incentive programs so that they can deliver high-quality services. However, participation in labor unions is an impediment to the implementation of an effective reward or incentive system. Undoubtedly, productivity in the hospital is determined by the natural leaders who provide valuable inspirations and align the work environment to the needs of nurses. These leaders have to be recognized and rewarded so that they can keep improving productivity among nurses (Yates, 2009).

A contractual agreement between a labor union and the hospital’s management will limit the extent to which excellent performers can be rewarded. For instance, increasing the salary of the best performing nurse or using bonus pay to reward committed nurses can result in a dispute concerning wage disparities. Since the best performers will be earning more than the marginal performers, the union is likely to organize a strike to compel the hospital to increase the salaries of every nurse. This limits the freedom of supervisors to reward excellence in their departments.

Maintaining the highest quality standards among nurses is not negotiable. Thus, underperforming nurses should not be rewarded. In addition, consistent underperformance should lead to dismissal, especially if the management has taken all available measures to improve the underperformers’ productivity. The union will prevent the hospital from acting in the interest of the patients by retaining only the best nurses (Spetz & Herrera, 2011). This perspective is supported by the fact that labor unions use legally binding agreements to protect their members from being fired. This constraint will lead to misallocation of resources by rewarding underperformers. Moreover, patient outcomes will decline since nurses will not have the incentive to do their best.

Productivity and Innovation

Innovative patient care can only be provided through effective interactions between experienced nurses and fresh graduates who possess new perspectives and high enthusiasm. Combining experienced nurses with fresh graduates is an effective technique for catalyzing change in the workplace. Achieving this combination is often difficult when nurses belong to a labor union. Most unions resist the employment of fresh graduates on short-term contracts since temporary employees are difficult to unionize (Yates, 2009).

Nurses who enjoy the protection of their unions do not consider fresh graduates as a threat to their employment. Specifically, they have no incentive to improve their productivity to avoid being replaced by fresh graduates. Similarly, they will not be interested in going the extra mile to achieve innovation. The resulting reduction in ideation and creation of new knowledge will reduce the competitiveness of the hospital in terms of its ability to satisfy patients’ needs (Yates, 2009).

Work Schedules

The union will limit the hospitals’ ability to implement flexible work schedules. Financial constraints might prevent the hospital from replacing nurses who are on training or annual leave. This can lead to long shifts in order to avoid interrupting the provision of medical services. Although the long shifts might be disadvantageous to some nurses, they will facilitate the implementation of training programs at a low cost. Eventually, they will lead to a win-win outcome since all nurses will get training opportunities, the hospital will reduce costs, and patients will access improved services. However, this outcome cannot be achieved if labor unions resist long work shifts.


The attempt to unionize the nurses can be prevented through the following plan. First, the hospital should focus on addressing the needs that are likely to motivate nurses to join a union. To begin with, the hospital should provide an improved reward system that enables nurses to earn a decent salary (Sims, 2007). It should also enable the hospital to motivate nurses to increase their productivity and to focus on innovation. The work environment should be improved to enhance satisfaction among nurses. This can be achieved by providing flexible work schedules, training programs, staff support programs, and opportunities for career advancement (Sims, 2007). Nurses should have adequate facilities or equipment to perform their duties effectively in order to achieve their work targets.

Second, a staff management committee should be established to handle the welfare of nurses and other employees. Nurses should dominate the committee since they are the majority in the workforce. The main responsibility of the committee will be to articulate the concerns raised by nurses. It will also collaborate with the management to find and implement appropriate solutions. Nurses should also be represented effectively in all management committees. This will improve the participation of nurses in all decision-making processes. The resulting improvement in the relationship between nurses and the management will negate the need to join a union (Sims, 2007).


Nurses should not be allowed to join a union in order to avoid deterioration of the quality of healthcare and the competitiveness of the hospital. If nurses are allowed to join a union, the hospital might be forced to incur costs that are not sustainable in the long-term. Besides, productivity among nurses is likely to decline due to the protection that they will enjoy by participating in the union. This will have adverse effects on service quality. In this regard, the attempt to unionize the nurses should be thwarted by addressing nurses’ needs internally.


Budd, K., & Patton, M. (2004). Traditional and non-traditional collective bargaining: Strategies to implement the patient care environment. Journal of the American Nurses Association, 9(1), 1-23. Web.

Sims, R. (2007). Human resource management. New York, NY: John Wiley and Sons. Web.

Spetz, J., & Herrera, C. (2011). The effect of unions on the distribution of wages of hospital-employed registered nurses in the United States. Journal of Clinical Nursing, 20(2), 60-67. Web.

Yates, M. (2009). Why unions matter. New York, NY: McGraw-Hill. Web.

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