With nurses in Oregon and Washington continuing to press their hospital employers for better wages and working conditions, the unions representing them are worried that a proposed update to the national nurses’ ethics code could hamper their clout by undermining the right to strike.
Unions in both states urged their members to submit comments opposing proposed changes to the American Nurses Association’s Code of Ethics, arguing that the revisions would upend longstanding obligations hospitals and other employers have to patients during strikes.
The American Nurses Association’s ethics code guides nurses’ interactions with patients and handling of workplace dilemmas, and state nursing boards look to it as well. The proposed update to the national ethics code comes as health care unions in the Pacific Northwest and across the country have become increasingly assertive, frequently using strike threats and limited-duration strikes as a bargaining tactic. The unions worry the changes could shift the patient-safety obligation during strikes from employers to nurses.
“The wording of the proposed revision is vague and could be misinterpreted to suggest that nurses could be responsible for finding their own replacements in preparation for a strike,” Scott Palmer, chief of staff for the Oregon Nurses Association, told The Lund Report in an email. “We are asking ANA to clarify this language to avoid any confusion or misunderstandings about the proper role of nursing staff.”
The debate is more than abstract. After a three-day strike called earlier this year, the Oregon association continues to negotiate with Providence Health over working conditions at six hospitals.
The ethical implications for health care workers going on strike have long been a matter of significant debate, effectively placing the bar higher for them than other workers due to their work with patients.
In the past some health care unions have been willing to compromise during strikes, letting a small number of workers cross the picket line to ensure minimum staffing is maintained, a Cornell University organizing expert, Kate Bronfenbrenner, told The Lund Report earlier this year. However, of late, public attitudes toward corporate employers and health care strikes have changed, experts say.
Nurses strikes are difficult logistical operations for hospitals, which have to find replacement workers and scale down services, and can affect patient care. But union officials argue that over the long term strikes benefit patients by causing employers to, for instance, increase staffing and pay, leading to better-qualified nurses
The American Nurses Association updates its ethics code every 10 years to reflect the views of its members and the changing circumstances of the profession. The proposed revision that is sparking concern? “When a strike is deemed the most viable option, nurse organizers ought to examine the structure of the systems in place at their organization or within their state and ensure there is a process in place to care for patients.”
The Washington State Nurses Association issued a statement last week calling the revision “very problematic,” saying it has “the effect of placing responsibility for patient care during a strike on the union, not on the employer, where it belongs.” Another state's union, the Montana Nurses Association, has taken a similar stance.
The current ethics code directs nurses to advocate for improved patient care and working conditions. According to the code, nurses should push for changes through professional associations and “collective efforts.” Yet the code does not explicitly address striking.
The national group, which dropped its no-strike policy in 1968, has been accused of being slow to support minimum staffing laws in the past. The proposed ethics update has sparked renewed criticism from several nurses online, including some accusing the national association of being in bed with hospitals and calling on people to not join the group.
Kara Curry, senior policy and ethics advisor for the American Nurses Association, told The Lund Report in an email that “as nurses continue to navigate institutional and structural issues” a committee working on revisions to the code “agreed that the language around striking should be more explicit than what is articulated in the current Code of Ethics for Nurses.”
Striking burdens
The association serves as the national professional organization for more than 5 million registered nurses, lobbying Congress on nursing issues and providing other services. While the Oregon Nurses Association and the Washington State Nurses Association are affiliated with the national group, they also operate as labor unions under the umbrella of the American Federation of Teachers.
The Oregon Nurses Association has counseled its members in advance of potential strikes that the American Nurses Association ethics code not only justified a strike but might require it, citing provisions that direct nurses to seek improvements to the “ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.” The code also states that, “The needs of patients may never be used to obligate nurses to remain in persistently morally unacceptable work environments.”
The federal law allowing health care workers to go on strike requires their unions to give 10 days’ notice so that hospitals have time to hire temporary workers and take other measures to care for patients.
The Oregon Nurses Association in a Facebook post last week called the national association’s draft revision to its ethics code a “misplacement of responsibility” that “ignores the existing labor law.”
They continued, “Employers are ethically and legally obligated to ensure safe working conditions, reduce patient census upon receiving strike notice, and refrain from using strikebreakers unfamiliar with the hospital or their assigned units.”
Curry, of the national association, said that the revision regarding the obligations of nurse organizers during strikes “has generated a lot of feedback.”
“This is exactly the reason we seek public feedback and extended this public comment period,” she wrote. “It is a critical part of the revision process to gain more insight and understanding of nursing practice and ethical issues.”
The group plans to consider the comments received and potential revisions so the new code can take effect in January 2025.
