While many U.S. unions appear to be waiting on the outcome of the Employee Free Choice Act debate to ramp up their organizing activities that has certainly not been the case for those unions targeting health care workers. Rather, those unions have for some time been engaged in often intense levels of national organizing, albeit typically in a non-coordinated (and, at times competitive) fashion. A few recent developments suggest more coordination and cooperation by the major unions involved.

For example, in February of this year, three significant unions targeting nurses announced plans to merge. With approximately 80,000, 45,000 and 23,000 members respectively, this merger will bring together the California Nurses Association (CNA), the United American Nurses (UAN) and the Massachusetts Nurses Association (MNA). While only UAN can make an arguable claim to a national presence, CNA is one of the most aggressive unions in the United States and the moving force behind much of the unionization which has occurred in California hospitals over the last 10 years. Likewise, while likely more a product of unique environmental conditions in California than union representation (e.g., cost of living, complexity of the health care system, Governor Gray Davis), the wages, benefits and working conditions contained in many CNA collective bargaining agreements can be attractive to nurses in other parts of the country if left unexplained. CNA also claims credit for California’s state law which mandates the nurse-to-patient staffing ratio in every acute care hospital in the state. These are the types of issues CNA touts in mailings regularly sent to health care workers across the United States.

This merger comes at an interesting time for both UAN and CNA. Last year, the American Nurses Association (ANA) (the well respected national professional association for nurses nationwide) severed ties with UAN – which was a long-time affiliate of ANA – taking away a major source of structure and funding. It was out of that separation that UAN and CNA began to discuss affiliation. CNA, on the other hand, has since 2004 been engaged in an effort to become an independent national nurses union through an organization they named the National Nurses Organizing Committee. They have opened offices in many states and mailed thousands of flyers to registered nurses (RNs) nationwide. Yet, they have had very little organizing success outside of California and remain a union whose membership is based largely in that state. Indeed, CNA has invested significant resources in Arizona (where they lost a couple of elections), Illinois (won one, lost one), Nevada (same) and perhaps most significantly, Texas. That included the resources needed to extract neutrality organizing concessions from a major Texas-based hospital company. Despite those concessions, this year CNA has been unable to organize two of this company’s Houston facilities, lost a related neutrality election in a Pennsylvania facility and is now fighting to retain the one Houston hospital (Cypress Fairbanks) where they won (by a slim margin) a neutrality election but where a little over a year later the nurses filed a decertification petition.

Obviously, these unions hope this merger will bring them more success on a national level. While this merger is currently only moving to the next stage in the planning discussion, a founding convention has been scheduled for December 7-8 in Scottsdale, Arizona. Likewise, last week they announced that the name of the merged union will be the National Nurses Union (NNU) and that their driving goal will be “to organize nurses across the country.”

While interesting in itself, that development becomes more interesting given an agreement reached earlier this year between the CNA and the Service Employees International Union (SEIU). The SEIU is one of the largest, wealthiest and most aggressive unions in the United States with nearly 2 million members and what they claim as 1 million health care members and 400,000 nurses. While SEIU and CNA have long been at best competitors and at worst bitter enemies, in March 2009 they “buried the hatchet” entering into a cooperative organizing agreement. Under this new pact, the two said they will “work together to bring union representation to all health care employees.” While neither side spelled out in detail how these two will coordinate organizing, the indication is that CNA will focus on RNs while the SEIU will target employees working in other job categories. In Florida, however, which was described by CNA Executive Director Rose Ann DeMoro as “ground zero,” this joint effort is likely to function like a merger with CNA and SEIU targeting RNs jointly.

Obviously, all of this occurs against a backdrop of change in Washington, D.C. with a National Labor Relations Board that will soon be much more open to labor’s perspective and the prospect for dramatic change through EFCA and the RESPECT Act. As a consequence, the atmosphere will necessarily be more accommodating for union organizing.

All of this suggests the need for continuing vigilance for health care employers. Your employees will continue to receive impressive brochures from these unions with enticing promises about issues that matter to your employees. More and more we are seeing these unions attempt to exploit fear and insecurity associated with emerging conditions (such as staffing, quality, job security and safety – e.g., the H1N1 virus). You need to make sure your leadership has the awareness, skills and information to respond to these communications and the questions they will undoubtedly generate.