A lot has changed since AFT Healthcare chartered its first healthcare local at the University of Connecticut in April 1979. Starting out as the Federation of Nurses and Health Professionals, the division in its early days counted about 300 members whose ranks grew swiftly to more than 65,000 members all across the country today.

“It’s hard to believe so much time has passed,” Candice Owley, chair of the program and policy council and president of the Wisconsin Federation of Nurses and Health Professionals, told participants at this year’s Professional Issues Conference in Washington, D.C., in the spring. Over the past 25 years, “we have managed to create a great foundation to fight for a better healthcare system,” she said.

Along with its size, the influence of the union has grown as well. Both the national union and the locals have played pivotal roles in lobbying for legislation to alleviate problems in the healthcare system, including worker shortages, unsafe staffing and mandatory overtime. The conference theme, “Looking Forward, Looking Back,” was fitting as activists celebrated their accomplishments while preparing for the fights ahead.

“It has been a challenge, but we continue to rise to the occasion,” said Owley, noting the many hard-fought battles and victories that shaped the division— from organizing new locals while fending off anti-union challenges to lobbying for legislation to improve working conditions and patient care.

Despite the challenges, the AFT never wavered, she said. The national union continued its commitment to its members and helped create strong leaders who are willing not only to take on employers but also to make the union the best it can be at the local, state and national levels, said Owley.  Many of the healthcare leaders recognized that the AFT was in a unique position: they understood the obstacles healthcare workers faced because many teachers had similar problems. A number of those leaders returned to join the celebration, including former members of the AFT Healthcare division’s program and policy council.

Along with celebrating, participants considered serious matters, such as the upcoming elections and healthcare reform. AFT secretary-treasurer Edward J. McElroy, the opening session’s keynote speaker, asked all members to turn their attention to the presidential race.

“From now until November, the union has got to be focused on politics because everything we care about—the survival of hospitals and nursing homes, Medicaid and Medicare—is at stake,” said McElroy.

National discussion on such issues as privatization, mandatory overtime and healthcare reform will remain stymied as long as the current administration is in place, he added. “We need to educate our members about these issues,” he said, encouraging participants to “go home and talk to members” about getting involved in electing Democratic Sen. John Kerry as the nation’s next president.

Guest speaker Ralph G. Neas, head of People for the American Way, a national advocacy group for civil rights and liberties, echoed McElroy’s call. “We’ve got to become part of the discussion, and we have to do a better job of articulating our issues,” Neas told participants.

Judith Feder, Georgetown University’s dean of policy studies, leveled with members, telling them that changing the healthcare system will be an uphill battle. Every effort to achieve national health insurance has been shot down so far, she noted. To win true reform, “we have to be willing to use our resources to make the system work for all of us.” 

Author Katherine Greider zeroed in on the pharmaceutical industry. Over the years, that industry has used marketing and lobbying to create “blockbuster” products that are vastly overpriced and exploit American consumers, said Greider, author of The Big Fix: How the Pharmaceutical Industry Rips Off American Consumers, a book detailing how the industry sells drugs by selling illnesses, and gouges desperate patients to reward itself handsomely for its research and development.

These so-called blockbuster drugs and medical devices drive profits for the industry, and “we pour our resources into these celebrity products almost blindly,” said Greider. “We complain about the industry, but when we buy these products, it sends a message to the industry to keep it up.”

Ergonomics in the workplace
Thousands of healthcare workers are injured on the job each year. Injuries are preventable if the right ergonomics program is in place, said Jamie Tessler, an occupational ergonomics consultant from the University of Massachusetts, Lowell.

“If work is safely designed, any person of any age can do it,” said Tessler, who headed up a workshop on creating an effective ergonomics plan in the workplace. Tessler and the participants identified some of the ergonomic hazards that injure workers on the job, including heavy lifting, repetitive tasks, awkward posturing and static positions.

“We have to make facilities safe enough to encourage people to come and stay on the job,” said Tessler. “There are solutions to prevent injuries to the back, shoulders and neck—injuries that plague healthcare workers.”

Unfortunately, a gap still exists between scientific evidence about safe practices and what actually happens on the job, Tessler said. Training alone is not enough. Research shows that merely learning lifting techniques doesn’t prevent job-related injuries. “We have to go beyond training workers to bend their knees and keep their backs straight,” said Tessler. Whether you are a registered nurse, a radiology technician, a school nurse or a dental hygienist, the concepts are the same. There are certain tasks that we can do and be fine, and there are tasks that exceed our physical limits, she said.

To launch an effective ergonomics program, healthcare professionals must win a commitment from both managers and employees to improve conditions, and then provide the appropriate training, evaluation and equipment. The commitment from management has to include the money to make everything work, and no one can tolerate such unprofessional behavior as apathy or underreporting of injuries.

But all these obstacles can be overcome, said Tessler. Your union can work with other unions to come up with a plan to educate members as well as management about ergonomics research and the benefits of having a program, including reduced employee injuries and fewer lost work days, Tessler suggested.

In addition, to help keep ergonomics improvements coming along at a steady clip, data about injuries can be compiled and monitored using OSHA logs as well as incident reports and workers’ compensation data. Watching for patterns of problems, your union and management leaders can figure out solutions.

“Talk to members and encourage them to report their injuries,” urged Tessler.

State legislative issues
Each year, states consider an average of 32 bills involving healthcare. And while the scope of the legislation ranges from nurse-specific measures like patient safety to more general healthcare concerns like funding, the hottest issues—staffing and mandatory overtime—are beginning to get more attention.

“Mandatory overtime legislation is passing. The tide is turning on this issue,” Ed Muir of the AFT research and information services department told participants in a workshop on legislative issues. To date, mandatory overtime laws have passed in Maine, Maryland, New Jersey, Oregon and West Virginia, and measures are pending in Connecticut, New York, Rhode Island, Vermont and Wisconsin.

Meanwhile, a push for safe staffing legislation is happening all over the country, but it’s slow going, said Muir: “States say they can’t afford it; nurses say we can’t afford not to.”

California is the only state to pass legislation mandating staffing ratios. However, lawmakers are considering similar legislation in Missouri, New Jersey, New York, Oregon and Rhode Island.

Union members can move their legislative agenda by communicating with elected officials, involving members and building membership, said workshop co-presenter Stephanie Bloomingdale, director of policy for the Wisconsin Federation of Nurses and Health Professionals.

Her members are lobbying lawmakers to ban mandatory overtime in their state this year. Their efforts have been buoyed by a bipartisan coalition the union created with politicians and others.

Working together has proved mutually beneficial so far, Bloomingdale pointed out. But everyone still faces challenges—the first being apathy, she said. “Our job is to get those members who say they aren’t interested in politics involved in the political process. It’s about connecting those issues to their daily lives, like we do in organizing.”

Relationships matter, and you can build them by meeting with state representatives to discuss your issues, by writing letters, e-mails and postcards, and by following up on your efforts, Bloomingdale said. In addition, being politically active can help you organize and bargain. The victories at Christ Hospital in New Jersey and Fletcher Allen Health Care in Vermont are perfect examples.

Better nurse staffing
Healthcare workers know that safe staffing is the key to quality patient care, which is why staffing has become a major topic at the bargaining table. During a workshop on achieving better staffing, members from Fletcher Allen Health Care in Burlington, Vt., and Kaiser Sunnyside Medical Center in Portland, Ore., shared how they were able to overcome the obstacles and get staffing ratios included in their contracts. 

“Staffing ratios are no different than anything else we want in our contracts,” said Andrew Tripp, lead organizer with the United Professions of Vermont, who worked with the nurses at Fletcher Allen to get their first contract.

To achieve safe staffing language in your contract, “the magnitude of the problem has to be equal to what you’re willing to do to get it,” Tripp said. “From the beginning at Fletcher Allen, we knew it was going to be tough to get nurse-to-patient ratios. We were willing to strike.”

During negotiations at Fletcher Allen, the union worked a plan to build the organization internally, get the community involved and push for legislation—on mandatory overtime and whistleblower protection as well as on staffing.

If the hospital hadn’t given the union what it wanted at the bargaining table, members would have gotten it through state legislation, said Tripp. The plan “created a crisis for the hospital. If they didn’t back the proposal, the state would step in and solve the problem by passing a law.”

Now that the ratios are in the contract, the union works to enforce them.

“We always have to hold their feet to the fire,” said RN Betsy Dunn of the hospital administration. “They fight us daily [on staffing], so we fight back.”

“The floors with strong union members are getting what they want because they speak out,” added Lee Phelan, also an RN at Fletcher Allen.

At Kaiser Sunnyside, the healthcare workers represented by the Oregon Federation of Nurses and Health Professionals (OFNHP) are part of a labor-management partnership between Kaiser Permanente and the Coalition of Kaiser Permanente Unions. Recently, the partnership piloted a joint staffing project at Kaiser Sunnyside focused on safe staffing in three areas: emergency, medical-surgical and the step-down unit. The staffing changes the partnership brought about are improving both the quality of care and the hospital’s bottom line.

“Before ratios, I didn’t have time to engage patients,” said Susan Wells, an emergency room nurse at Kaiser Sunnyside. “It’s exciting to see the evolution. It’s refreshing because [at first] we think it’s not possible.”

“The transformation is amazing, but it didn’t happen overnight,” said Kathy Geroux, OFNHP president. “One union, one unit can’t do it alone.”