Add new comment

I've only worked in a few hospitals, but I have had the privilege of practicing in both union and non-union shops, so here's an example that I think simplifies one of the major issues I see in the health care industry. See if you can guess which of these is the union shop and which one is non-union (or, more accurately, anti-union - at least they were as of the time I practiced there).
One hospital I worked at had an RN-only policy for direct patient care. The only people who were allowed to lay hands on the patients, aside from drawing blood for lab tests, were RN's and MD's. There was significant literature and statistical support strewn throughout the hospital's mission statement, employee handbooks, the nurse's lounge, and even out in the halls in the form of posters suggesting (almost certainly accurately, in my opinion, for whatever that's worth) that patient outcomes improve when only an RN-or-higher professional interacts with the patients. We were assigned a maximum of six patients on the medical or surgical units, which can be a little taxing if the patients are more demanding (receiving active insulin drips, suffer from dementia, are in extreme pain, under the effects of hallucinogenic drugs, combative, threatening respiratory arrest, etc..) but usually the maximum six was pretty easy work. Compared to the nursing homes I've worked in, it was a cakewalk even WITH a load of six time-demanding patients, but the truth is that we probably averaged just a shade below five per RN.
Another place where I practiced had a little different outlook. They had RN's on staff, but they also had LPN's (Licensed Practical Nurse - legally can do just about everything an RN can outside of certain IV administrations) and CNA's (Certified Nurse Aides/Assistants. This is more of a manual labor, lower-skill* job designed to take pressure off the RN's/LPN's by fetching meals, refilling water pitchers, swapping out bedding, helping patients to the bathroom, etc..). In this alignment the RN had, usually, an LPN and a CNA assigned and they formed a team. The RN took care of the periodic assessments, coordinated with the doctors for order updates/changes, and administered any of the medications the LPN was unable to dispense while basically serving as the team leader. The LPN took care of the rest of the medications and helped out with the labor aspects when the CNA needed a hand. And the CNA did basically what I outlined in parenthesis above. This team was assigned a maximum 15 patient load, and they almost always had a minimum of 12. There was no literature in the nurse's lounge, or posters in the hallway of this facility, supporting their in-house system of direct health care delivery. It was simply the way they operated.
One of these hospitals was a union shop and the other was anti-union. One of these hospitals served as a major trauma center for a metropolitan area and the other was a small-town, rural-type hospital (although, to be fair, both hospitals were parts of larger networks which provided all manner of care spanning the entire spectrum).
Unfortunately, I applied for a job at the hospital I really wanted to work at but didn't get the post out of school. So I ended up working at the rural hospital instead.
*CNA's, in my experience working in a nursing home, are almost always the most important cog in the machine. They don't get paid much, they get too much asked of them, but they are the ones that the people who live there relate to and trust the most. I would 'go to war' with a much higher percentage of CNA's that I have had the pleasure of working with than I would RN's or LPN's who I have encountered professionally.