Nursing as a Profession — Why Do Nurses Still Unionize?
Submitted by Arturo (ART) Garza, RN, BA, BSN, MBA
Tags: clinical labor nurses nursing patient patients profession safety staffing
Nursing is widely recognized as a profession requiring specialized education, ethical standards, and clinical expertise. However, many nurses continue to organize into labor unions to advocate for working conditions, compensation, and patient safety. This apparent contradiction raises an important question: If nursing functions as a profession, why do nurses feel the need to unionize? This article explores the structural, economic, and workplace factors that drive unionization in nursing and argues that nurses often operate simultaneously as professionals and as members of a workforce. Understanding this dual identity is essential for healthcare leaders, policymakers, and the profession itself.
Introduction
Traditionally, professions such as medicine, law, and engineering are associated with autonomy, authority over practice, and self-governance. Nursing meets many of these criteria. Registered nurses undergo formal education, licensure, continuing competency requirements, and adhere to a professional code of ethics.
Despite this, large numbers of nurses in the United States and globally belong to labor unions. Union activity among nurses has increased in recent years, especially in response to staffing shortages, burnout, and workplace safety concerns.
This situation creates tension between two views of nursing:
- Nursing as a profession
- Nursing as a workforce or labor group
In reality, both views may be true.
Nursing as a Profession
Sociologists typically define a profession by several characteristics:
- Specialized knowledge and education
- Formal credentialing or licensure
- Ethical standards
- Service to society
- Professional autonomy
Nursing satisfies these criteria.
Nurses make complex clinical judgments, coordinate care, educate patients, and serve as patient advocates. Professional organizations such as the American Nurses Association (ANA) emphasize nursing's autonomy and ethical obligations.
However, professional status does not automatically grant control over workplace conditions.
Why Nurses Unionize
Limited Control Over Working Conditions
Unlike many traditional professions, most nurses are employees of large healthcare organizations. They often have little control over staffing levels, scheduling, workflow, or resource allocation.
Unsafe staffing ratios, excessive workloads, and mandatory overtime are frequently cited concerns. Research shows that inadequate staffing is associated with worse patient outcomes, higher mortality, and nurse burnout (Aiken et al., 2002).
Unions provide a mechanism for collective bargaining when individual nurses have limited negotiating power.
Protection Against Organizational Pressures
Healthcare systems operate under financial constraints and productivity demands. Nurses may face pressure to discharge patients quickly, manage more patients than is safe, or complete non-clinical tasks.
Union contracts can establish safeguards such as:
- Staffing guidelines
- Overtime limits
- Break protections
- Due process for discipline
These protections can support both nurse well-being and patient safety.
Compensation and Equity
Professional status does not guarantee fair pay. Wage disparities, limited salary growth, and inconsistent benefits contribute to dissatisfaction.
Collective bargaining has been shown to improve wages and benefits for nurses (Sojourner et al., 2010). For many nurses, unionization is less about identity and more about economic security.
Voice in Decision-Making
Nurses are often closest to patient care but may be excluded from organizational decision-making. This disconnect can lead to frustration when policies are developed without frontline input.
Unions can amplify nurses' voices and provide formal channels for participation in workplace governance.
Workplace Safety
Nurses face significant occupational risks, including workplace violence, infectious diseases, and musculoskeletal injuries.
Union advocacy has played a role in advancing safety policies, including violence prevention programs and safe patient handling standards.
The Dual Identity: Professional and Workforce
Nursing occupies a unique position. Nurses function as autonomous clinicians at the bedside but as employees within large bureaucratic systems.
This dual role creates tension:
- As professionals, nurses prioritize patient welfare and ethical practice.
- As workers, they must navigate organizational constraints and labor conditions.
Unionization can be understood not as a rejection of professionalism but as a strategy to protect the conditions necessary for professional practice.
Implications for Healthcare Leadership
Rather than viewing unionization as adversarial, leaders may benefit from addressing the underlying causes:
- Chronic understaffing
- Burnout and turnover
- Lack of frontline input
- Perceived lack of respect or recognition
Improving these factors may reduce the perceived need for union intervention while strengthening professional engagement.
Conclusion
The presence of unions in nursing does not negate nursing's status as a profession. Instead, it reflects the realities of modern healthcare systems, where highly educated professionals often work within large organizations with limited individual bargaining power.
Nurses unionize not because they are less professional, but because they seek to protect their ability to practice safely, ethically, and sustainably.
Recognizing nursing's dual identity — as both a profession and a workforce — offers a more accurate framework for understanding the future of the field.
References
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288(16), 1987–1993.
American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: ANA.
Sojourner, A., Grabowski, D. C., Chen, M. M., Town, R. J., & Konetzka, R. T. (2010). Trends in nurse unionization in U.S. nursing homes. The Gerontologist, 50(2), 164–175.
Budd, J. W., & Bhave, D. P. (2008). Values, ideologies, and frames of reference in employment relations. Industrial Relations, 47(1), 92–120.
Clark, P. F. (2011). Nurse unionization and patient care: Evidence and implications. Labor Studies Journal, 36(1), 86–104.