A lifeline for Massachusetts nurses
Beth Wilson began research for a master's thesis her primary
objective was to discern if "in the wake of health
care and hospital restructuring, the MNA [Massachusetts
Nurses Association] was a lifeline for Massachusetts nurses."
Through surveys, interviews and focus groups Wilson, currently
a Program Coordinator/Economic Analyst in the Nutrition
Division of the Massachusetts Department of Public Health
ultimately came to the conclusion in her thesis titled "A
Lifeline? Is the Massachusetts Nurses Association Able to
Shield Massachusetts RNs from Healthcare Industry Restructuring?"
that indeed membership in the MNA serves as strong support,
but more non-union nurses and in particular, nursing students,
must be educated about the advantages of organizing.
Wilson, who presented her thesis at UMass-Lowell in April
of 2004, points to a hospital and health care system "in
flux" resulting from the past 30-year period when efforts
were made to control costs through deregulatory measures.
Cost-cutting changes translated into restructuring methods
borrowed from industry—shakeups that effected hospital
mergers, consolidations, integrations and downsizing and
generated increasingly unsafe and overworked conditions
for nurses. And so the domino effect began. Nurses left
the hospital setting, creating a shortage and further straining
As a result, more nurses were mobilized to unionize, primarily
through MNA. In 1994, at the behest of its members, MNA
initiated its Safe Care Campaign, a drive that propelled
its status to one of national leader on the issue of nurses
staffing and patient care and brought the issue of nurses
unionizing into the forefront. Now, years and many bargaining
units later, MNA has continued to strengthen its membership.
But even as more nurses have become aware of the advantages
of belonging to a union, the bottom line question to Wilson's
thesis generated a contradiction in response.
Through analysis of working conditions, facility reorganization,
patient care and job satisfaction of unionized and non-unionized
RNs, Wilson attempted to determine whether unionized RNs
maintained more positive conditions. As it turned out, her
survey said one thing and one-on-one interviews with nurses
survey (65 delivered over a four-week period with 49 returned,
30 completed by union nurses and 19 by non-union nurses)
indicated that non-union nurses had "more positive
working conditions, patient care, and job satisfaction,
with less facility reorganization than union nurses."
But, according to Wilson, the broad format of the survey
allowed nurses to answer "without much reflection on
Those nurses interviewed, however, had a better opportunity
to reflect on their experiences, both good and bad. Interviews
allowed Wilson to "go beneath the surface and discover
that the seemingly better conditions of non-union nurses
were a misconception."
What Wilson discovered was that without a basic understanding
of the political, economic, historical and ideological structure
framing the hospital and healthcare systems, non-union nurses
did not have a clear understanding as to why they were facing
higher patient loads and increased work assignments. They
chalked the decline of their working conditions up to patient-related
factors, such as poor diet, lack of exercise, an aging population
and low access to insurance. What these non-union nurses
were not familiar with was the growth of managed care, changes
in insurer reimbursements and the ramifications of years
worth of cost containment measures.
The union nurses interviewed, however, were well educated
on the political economy of health care. They were aware
of the big business hospitals had become and were not fearful
of telling the public and the Legislature the affects that
undermining conditions had on them and ultimately their
according to Wilson, therein lay the contradiction between
her survey and personal interviews. While the survey indicated
non-union nurses saw diminished conditions as their fault,
union nurses were aware of what was really going on. While
four out of five non-union nurses interviewed did not see
the benefit of joining the MNA, these same nurses were also
not aware of pro-nurse legislation MNA has passed or is
in the process of making law. A false consciousness prevailed,
according to Wilson's thesis, bringing her to the conclusion
that "new ways" are needed to disseminate information
about joining the union and the positive actions such a
measure will engender.
But, according to Wilson, the MNA "can not do it all."
She concludes that nursing education must be expanded. Currently
students are taught how to care for patients, but when it
comes to providing critical information about the political
economy of health care, instruction stops short.
addition to "giving non-union nurses the tools to be
self-aware," Wilson points to the need for national
health care reform and calls for the adoption of universal
"Hospitals should focus on patient care standards,
not reimbursements and market share," she writes. "The
insurer oligarchy must be dissembled, and the free-market
mentality so pervasive in today's society must be removed
from health care."