Nearly 18 months of pandemic hardships have raised tensions between the healthcare workforce and their employers.
Not only have longer hours, mounting stress and a litany of safety concerns fueled industrywide labor shortages, they’ve also been the rallying cry for numerous protests, demonstrations and organization efforts that have cropped up across the country.
“When the pandemic came, you had a major shortage of [personal protective equipment (PPE)]. The unions looked at that as a perfect time to try to start a lot of these organizing drives at these ununionized hospitals,” Ivan D. Smith, an attorney at Buchanan Ingersoll and Rooney specializing in labor and employment law, told Fierce Healthcare. “You saw huge organizing campaigns—[Service Employees International Union (SEIU)] in particular—going after different organizations to do that, and that has spurned into other industries also because these are worker protection issues. That has definitely been on the uptick and continues to be.”
The 2 million-member SEIU and other healthcare worker unions have frequently highlighted staffing shortages and other safety issues as the impetus behind recent demonstrations, one of the most notable of which is a nearly five-month strike at Tenet Healthcare-owned St. Vincent Hospital in Massachusetts that’s backed by the Massachusetts Nurses Association.
National Nurses United (NNU), a 170,000-strong national union, was also among the most vocal advocates for federal masking guidance and headlines its COVID-19 campaigns with calls for increased PPE and infection control policies in healthcare facilities.
However, the conversation on healthcare workplace safety has become more nuanced as the focus shifts to COVID-19 vaccination.
Nursing and healthcare worker unions largely say they support the vaccination as a complement to other infection control and safety measures. However, while policies requiring COVID-19 vaccination as a condition for employment have been widely embraced by dozens of multidisciplinary industry and professional organizations, responses from labor groups have been much less uniform.
NNU recently voiced its support for employer and public officials’ vaccine mandates, telling Fierce Healthcare in an email statement that the organization “strongly believe[s] all eligible people should be vaccinated, while respecting the need for medical and religious accommodations.”
A few weeks back, the National Union of Healthcare Workers, a 15,000-strong union based in California, applauded Gov. Gavin Newsom’s decision to require all healthcare employers to verify the vaccination status of their employees and to ensure masking and testing among those who are unvaccinated.
In contrast, healthcare labor groups such as the Ohio Nurses Association and New Jersey-based Health Professionals and Allied Employees said they generally support vaccination but could not get behind compulsory policies that remove their right to bargain.
SEIU did not respond to a request regarding its position on vaccine requirements. While educational resources available on the union’s website encourage members to receive the vaccine and outline when an employer may require them, the group’s local affiliates have previously backed demonstrations against policies mandating vaccination as an employment requirement.
"We believe that our members are best equipped to make the healthcare decisions that are right for their bodies and for their families," 1199SEIU Communications Director Cara Noel told an ABC affiliate in late July. "We have been promoting vaccination, but to make vaccination a condition of employment is absolutely wrong."
Increased union activity and ramifications beyond COVID-19
The disparate responses from healthcare unions are not surprising, Smith said.
Support for vaccination is “unfortunately” geographic, he said, with state or local unions in regions with lower population coverage generally more willing to voice concerns of workers’ rights protections over physical safety.
Further, any facilities with a union already in place are required to negotiate changes to the terms and conditions of employment, he said.
Unions with a large number of members who don’t want the vaccines have an obligation to their members and will use the opportunity to hash out the policies and procedures to protect workers in lieu of the shots, Smith said. Others will come to the table with future negotiations front of mind.
“They don’t want to give up ground [or] to say ‘Okay, I’m going to allow you to do this mandate for other types of vaccines or other types of things when they’ve only been deemed for emergency use,’” Smith said. “So, they look to the future about certain other things people might have problems with—[for instance] there’s a lot of hospitals that don’t require their workers to have flu shots.”
Advocacy around the COVID-19 vaccines and, to a much larger extent, PPE and staffing safety issues is also a potential selling point for un-unionized workplaces, Smith noted.
Unions from every industry have commanded a prominent position in nationwide conversations on COVID-19, and safety demonstrations to date have garnered plenty of public awareness, he said. Combining these gains with workforce shortages and a more labor-friendly White House gives the organizations little reason to slow down as new cases and issues arise.
“I expect to see more union activity and unionizing campaigns, absolutely,” Smith said. “The unions realize it will take a little while to get back to the norm, and what they’ll also realize is … they will be better prepared to deal with those issues very quickly. Ultimately, I think this [pandemic] has been an opportunity for the unions to campaign and to organize effectively.”
Vaccine controversies may settle, but engaged employees are a long-term boon
Experts said they expect labor unions and their memberships will warm up to the vaccination mandates over the coming months.
Ezekiel J. Emanuel, M.D., vice provost for global initiatives at the University of Pennsylvania, former White House health policy adviser and the organizing force behind the industry’s pro-mandate joint statement, said more and more organizations representing nurses and other healthcare professionals have been reaching out to add their signatures and support.
He hesitated to characterize the unions as uniformly opposed, noting that several he had talked to prioritized individuals’ safety and, as such, leaned toward backing the mandates. With time, he said growing pressure from supportive patient groups, the public and employers will bring holdout employees into the fold.
“I think when it becomes more general in the population and among employers—and you’ve seen a big, big tidal wave this past week—it just becomes the norm,” Emanuel said during a recent press Q&A. “To go into work requires the vaccine, and that’s just going to become standard practice and move into the background.”
Smith’s conversations with labor unions have instead hinged on the full regulatory clearance of the vaccines as the turning point many groups are waiting for.
“As long as they have that emergency use [authorization], they’re not going to take on that fight with their members,” he said. “What I’ve seen is they’ve been trying to do more education about the vaccines and their reluctance … but emergency use has been the concern.”
Some healthcare employers including Spectrum Health have similarly looked to regulators as a lifeline, announcing mandatory vaccination policies that will only go into effect once a full clearance is secured. Others, like Ballad Health, have been cautious in the face of workforce shortages, worrying a mandatory requirement could drive too many of their employees out the door and impact their ability to provide care.
Emanuel pushed back against these organizations’ concerns as “more theoretical than actual.”
“If you look at healthcare systems that have actually mandated this, they’ve retained over 99% of their workforce,” he said. “Their workforce does go along when the employer requires it.”
Conversely, Smith warned against compulsory policies that don’t begin with a conversation.
Whether it’s COVID-19 vaccines or any other terms and conditions of employment, his advice to hospitals worried about labor blowback was to engage employees about their needs well before a union sees the need to step in.
“They’re human beings, right? When you’re dealing with these kinds of issues, their lives are at stake and their professions are at stake,” he said. “There are things you can do to help them—make sure they have mental health training or [employee assistance programs]. Small things like that where you say, ‘we understand what you’re going through, we appreciate what you’re going through and we want your input to make it easier and better,’ can go thousands of ways of making your facility better.”
Specifically for facilities in which unions are already in place, Smith said employers would be best served to think of the labor groups as partners tackling a shared challenge.
Walkouts notwithstanding, adversarial relationships between management and labor can rob organizations of a crucial bargaining chip when it comes to seeking out external support.
“If you have a union, go in there and say, ‘We are partners here, we have to work this out. How can you help in dealing with what we’re going through? How can you help in recruiting nurses or whatever staff we need? How can you help us get the equipment we need from government or states?’” Smith said. “The unions do have resources and power. I think sometimes employers don’t ask unions to do what they need to do to help [employers] be able to do their jobs and move effectively in their space.”