VIII. ASSOCIATIONS, UNIONS, AND THE CHANGING NATURE OF PROFESSIONAL WORK

Professional Associations and Collective Bargaining:
Motivations and Difficulties

MATTHEW M. BODAH
University of Rhode Island

M. CATHERINE LUNDY
Michigan State University

PATRICK P. MCHUGH
George Washington University

Abstract

      This paper addresses two questions: what motivates a professional association to move toward collective bargaining, and what problems does a professional association face once it becomes a bargaining agent? Two case studies were conducted. The first involves the American Pharmaceutical Association, which recently amended its policy that discouraged unionization. The second concerns the American Nurses Association, which recently underwent restructuring with the disaffiliation of several state branches and the creation of a new bargaining wing. The findings are that the protection of “professionalism” is a key reason an association moves toward bargaining, while the balancing of interests between bargaining and nonbargaining members, particularly if many of the latter are supervisors, managers, or executives is difficult and can lead to organizational schisms.

Introduction

      In this paper we ask two related questions: what motivates a professional association to move toward collective bargaining as a means of advancing its members interests, and what problems does a professional association face after becoming a bargaining agent? For answers we bring together two research projects. The first began several years ago when one of the authors was commissioned by the American Pharmaceutical Association (APhA) to study workplace issues among pharmacists. A national survey was conducted with a questionnaire that included an item concerning pharmacists’ views toward unionization. That research was supplemented with interviews with several high-level APhA officials. The second research project began in the summer of 2001 and is continuing. This latter research examines the reordering of representational forms in the nursing profession. Specifically, we explain some of the dynamics that have surrounded the American Nurses’ Association (ANA) within the past few years--several of its state branches have disaffiliated and may form a new national union, while ANA’s national office has established United American Nurses (UAN), an AFL-CIO affiliate, as its collective bargaining wing.¹

      The key findings are: First, while some argue about the appropriateness of unionization for professionals (Rabban 1991), in fact perceived threats to “professionalism” are important factors in the move toward collective bargaining by professionals and their associations. Second, there is a delicate balance between the interests of collective bargaining and non–collective bargaining members, which can threaten the solidarity and stability of a professional association, particularly when a significant number of non– collective bargaining members are executives, managers, or supervisors.

Case Study 1: Pharmacists

      One motivation for the study of the work lives of pharmacists was the increasing tension within the APhA regarding the potential role that collective bargaining could play in improving the practice environment. In turn, the dissemination of survey results coincided with a change in the APhA’s position concerning unionization. Although there is an interesting history of labor militancy among pharmacists (Bectel 1970; Fink and Greenberg 1989; McHugh and Bodah in press), the APhA had been skittish about the unionization of pharmacists. In 1948 it called for pharmacists to work out “codes of employer-employee relations” as substitutes for collective bargaining (Bectel 1970:2) and eventually, in 1971, adopted a policy stating that “membership in a trade union is the antithesis of professional status for pharmacists” (American Pharmaceutical Association 1999:3–4).

      However, there have been major changes in pharmacy practice during the past several decades. Employment has shifted from small owner–operator pharmacies to large chain stores. There has been an increased dependence on third party payers. At the same time, prescription volume has increased, while pharmaceutical care and drug treatments have become more sophisticated. In short, pharmacists have become increasingly stressed while dealing increasingly with institutions whose interest is financial not medical. As one of interviewees stated: “New practitioners had stars in their eyes . . . [they] had been told that you are going to do some really great things providing patient care. [But then] they were working seven, twelve-hour days with the associated pressure and problems.”

      As a response to these pressures, some pharmacists and even independent pharmacy owners have reached out to unions. Largely due to the efforts of APhA members who belonged to unions despite the association’s policy, in 1999 APhA rescinded its former policy and created a new policy on unionization. Its new policy provides implicit support for unionization by stating that APhA “supports pharmacists’ participation in organizations which promote the discretion or professional prerogatives exercised by pharmacists in their practice” and “supports the rights of pharmacists to negotiate with their respective employers for working conditions that will foster compliance with standards of pharmaceutical care as established by the profession” (American Pharmaceutical Association 2000).

      We find that at both the individual and organizational levels, the change in policy is linked to a belief that collective bargaining can protect or restore professional standards in the workplace. We base our beliefs on evidence from survey data and interviews with APhA officials.

      The national survey (n = 718) found that '.9 percent of respondents would “definitely vote against a union”; 29.5 percent “would probably vote against a union”; 28.3 percent “would probably vote for a union”; and 14.3 percent “would definitely vote for a union”. In seeking to explain the probability of a respondent favoring unionization, we subjected a number of variables and factors to ordered probit analysis. (See McHugh and Bodah in press.) We find that union support is strongest among male nonwhites, those with prior union experience, those with a union member in the household, and those whose job satisfaction is low. We also find that union support is most likely among those who believe that a union would improve compensation. But we believe the more noteworthy findings are that union support is negatively associated with the current level of “professionalism” in the workplace² and positively and strongly associated with a belief that a union would be instrumental in restoring or protecting professionalism.³ With these latter findings, we conclude that the belief that a union could enhance the professional practice environment is a key reason why individuals within APhA sought the move toward a more favorable position concerning unionization and collective bargaining within their association.

      Findings at the individual level do not necessarily translate into changes at the organizational level. However, our interviews confirm that the same belief that collective bargaining could advance professionalism was a factor in APhA’s change of policy. APhA officials told us “they [the union members] were the earliest barometer. People who were in unions and carried that banner believed that if only more of their brethren were represented in those kind of collective bargaining units then we could in fact mobilize more activity to set right the practice environment problems.” Another added, “It was a vocal group of pharmacists that were union members or had leadership positions within their union. . . . They believed that unionization was the way to go to solve workplace issues.” One APhA official noted that “APhA does strongly support the professional autonomy of the pharmacist so if you are in a position where you are being asked to do something that you are not comfortable with you get out. If the union helps you do that--great.” Another APhA official highlighted the role that professionalism played regarding changes to the association’s collective bargaining policy, “We established and calibrated the policy and had an opportunity to reaffirm our strong feelings about pharmacists’ professionalism and the fact that they need to work in an environment that allows them to deliver professional services.” Hence, we believe that concerns over professionalism were a key reason for APhA’s change in policy at the organizational level.

Case Study 2: Nurses

      While APhA only recently moved toward a position more favorable to collective bargaining, the largest professional association for nurses endorsed bargaining many years ago and, soon after, through its state affiliates, became the largest bargaining agent for nurses in the United States. By studying pharmacists, we were able to explore why a professional association moves toward collective bargaining; the nurses’ case allows us to see the difficulties faced at a more advanced stage.

      Like APhA, the American Nurses’ Association was at first reluctant to embrace collective bargaining. When union membership surged in the 1930s, ANA’s first response was to urge against unionization by nurses. Instead, it proposed that its state nurses’ associations (SNAs) develop programs of public education to raise the economic standing of the profession. Such programs alone were insufficient to raise nurses’ wages and with pressure from its own ranks and competition from labor unions that were organizing nurses, ANA decided to become directly involved in bargaining through its SNAs (Alexander 1978; Kruger 1981).

      Although the ANA became a bargaining agent, it remained a professional association and continued to enroll non–collective bargaining members, including those who held supervisory, managerial, and executive positions. Balancing the interests of all of its members has proven difficult for ANA. In 1976, nurses at a hospital in Midland, Michigan decertified the Michigan Nurses Association as their representative. A scholar who studied the case wrote: “The Midland nurses saw the MNA’s role as primarily concerned with advancing the professionalism of nursing practice rather than with the furthering of nurses’ collective economic interests. Many other professional nurses view their state associations in a similar light” (Kruger 1982:'5). A former ANA official was quoted more recently as saying that the existence of bargaining and nonbargaining members produced a “palpable weirdness” within the ANA (Moore 1997:24).

      In addition to balancing the interests of bargaining and nonbargaining members, another, and perhaps more significant, challenge is in reconciling the interests of staff and supervisory nurses. An organization called the Boston Nurses Group (1978:7) noted that a state director of nursing, who had been responsible for laying-off nurses at a public hospital, was the secretary-treasurer of her SNA.

      Interviews we conducted in the summer and fall of 2001 indicate that the tensions caused by ANA’s dual role led to the disaffiliations of several SNAs during the 1990s and early 2000s. Since 1995, the California, Massachusetts, and Maine state nurses associations have disaffiliated from the ANA. There is also no longer an ANA-affiliated state collective bargaining organization in Pennsylvania, although that resulted primarily from the decision of the nurses’ association to relinquish bargaining activity.⁴ Interviewees in the disaffiliated states rooted their discontent in the divisions that surfaced during the difficult economic times of the early 1980s.

It started with the acquisitions and mergers and the downsizing and all of this. And it just became crystal clear that the only people who were standing up and fighting this were the staff nurses at the bedside. . . . Those who were in charge looked at it and told us . . .
“This is an opportunity. If you get laid off it is good for you because you will expand and you will grow”.

Dissatisfied with the response of ANA leadership, which was dominated by managers, to the financial pressures of the time, labor representatives encouraged staff nurses to become more active in the association.

I was always pushing grassroots organizing within the organization. If you’re the majority of the membership, you have the majority of the voting power, but you have to lead it, you have to take it, you have to elect people, you have to get involved.

      In California, this activism was met with stiff resistance from the association’s executive board, which terminated the labor relations director and much of her staff. The terminations (which were followed by successful actions for reinstatement) provided a further rally point for the labor activists, who went on to win a one-vote majority on the executive board. In 1995, at a state convention, and following the speech of the president of ANA critical of the labor activists, the California nurses voted to disaffiliate.

      Their move was closely watched by labor officials from the Massachusetts Nurses Association, who were growing increasingly dissatisfied with the positions of ANA. However, Massachusetts remained with the national association until the final establishment of UAN. Although the Massachusetts officials had been active in the formation of the UAN, they did not approve of several aspects of UAN’s proposed structure and operation. For example, they did not believe that there was sufficient insulation between ANA and UAN with respect to budgeting and staffing; they were concerned that AFLCIO membership would make organizing more difficult, since they would be unable to compete with other AFL-CIO unions for members; and they did not approve of the mandatory nature of UAN membership, preferring instead to have membership determined on a state-by-state basis.

      Hence, with their general discontent with ANA and several disagreements concerning UAN, Massachusetts chose to disaffiliate. The first attempt at breaking away came at a state convention in 2000. Although 62 percent of delegates supported disaffiliation, 66 percent were needed for the motion to pass. Comments on the vote by a Massachusetts official further reveal the tensions within ANA:

You could look in the audience and almost tell who was going to vote which way. Because by age and by the person arriving in scrubs you could see that they had just gotten off a shift trying to get there for the vote. And the group that was either totally elderly or clearly coming from a work environment in which they wore suits or had freedom over their schedule or . . . it was just a very different . . . when you looked at it you really saw a class struggle.

While initial attempts at disaffiliation failed, during the same time frame elections were held that put the Massachusetts executive board firmly in the hands of those who favored disaffiliation. After the election, the executive director was terminated; the director of labor relations was elevated to executive director; and in the spring of 2001 the Massachusetts Nurses Association disaffiliated from ANA.

Conclusions

      The pharmacists’ case provides evidence of why a professional association moves toward unionization. We believe that survey and interview data demonstrate the importance of the link between professionalism and collective bargaining. At both the individual and organizational level, unionization and collective bargaining are viewed more favorably if they are perceived as means toward restoring or protecting professional standards.

      The nurses’ case shows that professional associations that become bargaining agents, but continue to enroll nonbargaining and management-level members, can face difficulties in balancing the interests of all groups. If not handled properly, such conflicts of interest can lead to instability and eventually the fragmentation of an organization.

Endnotes

1. The authors thank the following interviewees and respondents for their help: James Bailke, Teri Evans, Cheryl Johnson, Lucinda Maine, Kay McVay, Theresa Peaphon, Pat Philbrook, Julie Pinkham, April Shaugnessy, and Susan Winkler.

2. Professionalism was measured with the following 6-item scale (alpha = 76): (1) My employer provides me with feedback regarding the quality of patient care; (2) my work environment is conducive to patient care; (3) I am rewarded for the quality of work I do; (4) I am encouraged by my employer to attend educational seminars or professional association meetings for professional development purposes; (5) I have time to keep up with the clinical knowledge and practice issues; and (6) I feel pressure from my employer to make unethical/illegal decisions (reversed coded). In responding to these items, participants were asked: “Consider your current primary work locale, to what extent do you agree or disagree with each statement?”

3. Union instrumentality-professionalism was measured with the following 6-item scale (alpha = .88): (1) The amount of training available for staff . . . ; (2) the demands my work organization puts on pharmacists . . .; (3) the workload (number of prescriptions filled per hour) . . .; (4) the quality of patient care . . .; (5) the amount of time spent on patient assessment and counseling . . .; (6) my dispensing error rate. . . . Participants were asked to complete the preceding sentences with statements ranging from 1 = would get much worse, to 5 = would get much better, after they were instructed to “Assume that your present employment site becomes unionized. Indicate how you would complete the following sentences. . .”

4. However, an organization called the Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP) is composed of units that disaffiliated, on a unit-by-unit basis, from the ANA in the early 1990s.

References

Alexander, E.L. 1978. Nursing Administration in the Hospital Health Care System. St. Louis, MO: C.V. Mosby.

American Pharmaceutical Association. 1999. House of Delegates Report of the Policy Committee, Annual Meeting of the APhA, San Antonio, TX.

American Pharmaceutical Association. 2000. “APhA Policy Statements on Employer/Employee Relations.” American Pharmaceutical Association Policy Report.

Bectel, Maurice Q. 1970. “The Problem of Employer-Employee Relations in Historical Perspective.” Journal of the American Pharmaceutical Association, Vol. 10 (February), p. 91ff.

Fink, Leon, and Brian Greenberg. 1989. Upheaval in the Quiet Zone: A History of Hospital Workers’ Union Local 1199. Urbana: University of Illinois Press.

Kruger, Daniel H. 1982. “Labor Relations and the Nurses.” In J. Lancaster and W. Lancaster, eds., Concepts for Advanced Nursing Practice. St. Louis, MO: C.V. Mosby, pp. '0– 93.

McHugh, Patrick P., and Matthew M. Bodah. Forthcoming. “Challenges to Professionalism and Union Voting Intentions: The Case of Pharmacists.” Journal of Labor Research.

Moore, J. Duncan. 1997. “Breaking Apart.” Modern Healthcare, November 3, pp. 24–25.

Rabban, David M. 1991. “Is Unionization Compatible With Professionalism?” Industrial and Labor Relations Review, Vol. 45 (October), pp. 97–112.