Nurses aren’t just taking orders anymore.

From intensive care wards to the halls of Congress, they’re exerting growing influence over hospital practices and patient treatment. With the clout they’ve gained through unionization, they’ve raised their incomes and their profession’s profile.

Now they’re lobbying for a radical change to the country’s healthcare system, starting in California.

On Monday, hundreds of members of the California Nurses Assn. marched on the Capitol in Sacramento and pledged to continue to campaign for universal healthcare coverage.


Gov. Arnold Schwarzenegger said he would call a special session of the Legislature to write a law to significantly expand coverage in the state -- though not by nearly enough to satisfy the nurses union.

For Rose Ann DeMoro, the union’s executive director, the goal is to end what she called the “pay-or-die system” once and for all.

“We are a very, very strong and, some say, militant organization,” said DeMoro, an AFL-CIO vice president. “And, honestly, in this environment it takes a militant organization. It’s very hard for a registered nurse to go home at the end of a shift and feel good about the care she’s able to give.”

Emboldened by the nation’s huge need for their skills, bulked up through unionization, and energized by their last dust-up with Schwarzenegger, organized nurses have become a bona fide political force.


“They have a very strong hand,” said Darry Sragow, a Los Angeles lawyer and political strategist.

That’s due in part to organized labor’s big gains among nurses in recent years. In strongholds like California, Florence Nightingale is almost as likely to carry a union card, and a picket sign, as she is to wear clogs.

For Irene Gamboa, an operating-room nurse at USC/University Hospital in Los Angeles, the decision to join the California Nurses Assn. last year was about having a say in how the hospital operates.

Last month, the union won raises of about 25% over four years for Gamboa and 6,500 other nurses who worked for Tenet Healthcare hospitals. The new contract also sets minimum staffing levels and seeks to ensure that a nurse’s judgment is not usurped by new medical technology.


“It’s not only about the money,” Gamboa said. “It’s about quality patient care, which is very important to nurses.”

Organized nurses’ agenda includes changes that can’t be won at bargaining tables, such as universal healthcare coverage. So nurses also are taking their demands to statehouses and to Congress.

“By coming together, they can really influence public policy,” said AFL-CIO President John Sweeney.

Nurses have come a long way since the late 1980s, when hospitals were laying them off in droves to cut costs amid the managed-care revolution. Factions of frustrated, change-seeking nurses broke away from professional associations in California and elsewhere to form collective bargaining units.


Their unions continue to grow even as organized labor is in critical care. In labor’s heyday, more than one-third of all U.S. workers, almost all of them blue collar and male, belonged to unions. Today, about one in eight workers carries a union card.

Among the largely female ranks of nurses, however, the figure is closer to one in five.

About 325,000 nurses belong to 11 AFL-CIO affiliates, including the United American Nurses, the nation’s largest nursing union. The California Nurses Assn., which claims 75,000 members, joined the giant labor federation this year, and the various unions recently formed a coalition called RNs Working Together.

Another 85,000 nurses belong to the Service Employees International Union, which touts itself as the nation’s fastest growing union and is focused on organizing the nation’s 10 million non-union healthcare workers, from home health aides to hospital nurses.


United American Nurses, which represents 115,000 nurses in 25 states, recently formed an alliance with the SEIU, and is boosting its organizing efforts with $8 million for membership expansion this year alone.

In the mid-1990s, when the California Nurses Assn. made organizing hospitals a priority, it had about 17,000 members. Both it and the SEIU gained ground as staffing shortages emerged, and skirmishes over hours, wages and staffing levels were fought hospital to hospital.

Then, in 1999, Gov. Gray Davis signed the nation’s first nurse-patient ratio mandate into law, requiring that nurses on typical wards be assigned to care for no more than five patients each.

Hospitals complained that they couldn’t hire enough nurses to comply with the ratio.


Schwarzenegger attempted to delay the law’s full implementation -- touching off a firestorm of protest that is now widely viewed as a watershed in the politicization of the profession.

The association bought attack ads and rallied nurses who heckled him at public appearances around the state. The nurses’ version of the Boston Tea Party came when the union hired a banner-toting blimp to fly over a Super Bowl party Schwarzenegger was hosting. The mandates eventually took effect.

Publicity over the flap catapulted the California union onto the national stage. The union launched an effort to organize nurses across the country. It now bargains for nurses in Maine and Illinois and has its sights set on several Texas hospitals.

Nurses’ newfound power owes a lot to an aging population and a workforce miscalculation of gargantuan proportions.


As baby boomers grow older, their medical needs increase the demand for nurses. But the supply isn’t keeping up.

Like the boomers she cares for, the average working nurse is also nearing retirement age. Half are older than 50. And the nation’s nursing schools -- many of which closed down when hospitals were laying off nurses two decades ago -- don’t have the capacity to replace them at the rate they are leaving.

Unlike many jobs, however, nursing can’t be shipped offshore. “Workers in other nations cannot do it like they can produce flat-screen televisions,” said Robert Reich, a public policy professor at UC Berkeley who was secretary of Labor under President Clinton.

Looming physician shortages and efforts to cut costs are likely to push even more of the patient-care workload onto nurses, further stoking demand, as is ever-changing medical technology, which requires skilled workers, often nurses, to operate.


As a result, Reich said, “we’re going to see more and more pressure put on hospital systems that are not yet unionized.”

Not everyone believes the growing bargaining power and political influence of nurses is the best medicine.

When nurses win pay raises and lower staffing ratios, costs rise, said Steve Malanga, a senior fellow at the Manhattan Institute, a conservative think tank based in New York.

“So it’s a little bit naive to expect that their victories are going to also be complete victories for the patient,” he said.


And not every nurse believes joining a union is the best way to improve patient care or their own lot.

“I think unions are taking advantage of the crisis in healthcare today,” said Suzanne Geimer, an emergency room nurse at Cedars Sinai Medical Center in Los Angeles.

Geimer launched a website for nurses who opposed the unionization efforts at that hospital a few years ago. The California Nurses Assn. won the right to represent the Cedars nurses in an election in 2002, but the National Labor Relations Board overturned the election in a setback the union characterizes as an example of the Bush administration’s efforts to undermine labor.

Geimer’s website remains a forum for anti-union sentiment among nurses. She said many believed organized labor was merely interested in pumping up its numbers -- and collecting union dues.


“They see healthcare as a fertile field,” Geimer said.

Union activists don’t disagree.

“Everybody’s looking at nurses,” said United American Nurses President Cheryl Johnson, a nurse in Michigan.

“Everybody wants to have a say in how to fix” the problems with healthcare, she said. “There are big stakes in this game.”


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lisa.girion@latimes.com