North Carolina has the second lowest percentage of union members among its workers of all the states in the country. So the fact that 1,600 nurses working at Mission Hospital in Asheville, NC, voted on September 17 to join the National Nurses Union is good news for all North Carolina workers. The nurses won with a majority of 70 percent, but their fight is hardly over.
Mission Hospital was bought early in 2019 by Hospital Corporation of America (HCA), a notoriously anti- union chain of 184 hospitals and other health care facilities, mostly in the southeast United States. Last year, HCA paid stockholders $600 million in dividends while its CEO raked in $27 million. When the purchase was completed, HCA immediately started cutting staffing to bolster its bottom line.
Wait times in the emergency room increased substantially. Intensive care unit nurses reported that HCA made them each responsible for three patients when previously the normal ratio was one-to-one. Under the pressure of increased workloads, highly experienced older staff began to retire and weren’t replaced. Families immediately noticed that patient outcomes were deteriorating at what is the only major hospital serving the far west region of the state. When it bought Mission, HCA had made commitments to maintain or improve the quality of service at the hospital. Hundreds of Asheville residents protested worsening care at public hearings investigating how well HCA was following through on those commitments. Nurses say that they won the election partly thanks to support from the community which recognized that the union nurses were fighting for higher standards of patient care.
After it took over, HCA contracted with lower-cost, lower-quality suppliers of day to day supplies while cutting back on stockpiles. When COVID hit, management refused to make personal protective equipment (PPE), including masks, available throughout the hospital. In response, pro-union nurses campaigned successfully to force management to supply masks and other PPE for all those involved in patient care. COVID heightened nurses’ perceptions of how HCA’s profit-maximizing, cost-cutting efforts hurt their ability to serve the sick. This experience helped build support for unionizing even as HCA used COVID as an excuse to delay the union election by months.
HCA has announced it’s aiming to appeal the result of the vote certifying the National Nurses Union, a move that would delay the beginning of contract negotiations for months. HCA hopes that delays will wear down workers’ confidence that anything will ever change, and with it, wear down support for the union. Mission nurses only got this far because they organized themselves to pressure management on immediate issues like PPE even before there was a union vote. Keeping up pressure on management to respond to the workers’ everyday issues is one good way to counter the delaying and other tactics HCA will try in an effort to frustrate Mission nurses’ organizing.