At a recent rally in Winston-Salem, Democratic primary front-runner Bernie Sanders weighed in on ongoing efforts at Mission Hospital to unionize nurses.

“Right now, some 2,000 nurses at Mission Health in Asheville are standing up for their patients and their profession,” the Vermont senator said to cheers at the Feb. 27 rally. “I applaud those courageous nurses, and I urge the Hospital Corporation of America that owns Mission Health to treat their nurses with respect and dignity and stop union-busting in that hospital.”

In his speech, Sanders said Mission nurses are organizing with National Nurses United, a union already representing nurses at HCA-affiliated hospitals in Florida, Missouri, Kansas, Texas, Nevada, and California.

"(Registered nurses) at Mission Health are seeking to form a union to have a collective voice to better advocate for the highest quality care for their patients and their community," said Bradley Van Waus, the southern regional director for National Nurses United.

These unionizing efforts come as staff, patients, and politicianslevy complaints at Mission Health and its management since HCA Healthcare purchased the hospital system in February 2019. Labor experts suggest union drives can be byproducts of dissatisfied workforces.

“This is not always true, but there's a line that an employer will get the union they deserve,” said Jeffrey Hirsch, professor at the UNC School of Law.

In an email to the Citizen Times, Mission Health spokeswoman Nancy Lindell said, “We believe a labor union comes between us and limits our ability to have trusting, collaborative relationships with our staff.

"We respect every colleague's right to make their own decision regarding joining a union," Lindell said. "However, we do not believe unions benefit our facilities, our colleagues, and most importantly our patients.”

What could a union do?

A union is an organization representing employees that collectively bargains with management on employees’ behalf to earn certain benefits and workplace conditions. One condition unions may negotiate is staffing levels, a concern for many at Mission.

"Every single department in the hospital that is designed to help the patient get out and toward wellness is critical and unethically and inhumanely understaffed," said Jennifer Kirby, a registered nurse at Mission Hospital, at a Feb. 10 public meeting on the state of Mission since HCA took over.

Unions are legal in North Carolina. While public employees (like teachers) can’t legally collectively bargain or strike in this state, private employees, like Mission nurses, do not face such restrictions. If a union and management cannot arrive at an agreement through the collective bargaining process, a union can opt to strike.

In certain states, employees in a unionized workplace must join the union because they receive all benefits the union earns. Yet, North Carolina is one of several “Right-to-work” states, which means employees do not legally have to join a union or pay union dues even if a union represents their workforce.

So, if Mission nurses do approve unionization, the union would represent every Mission nurse, but not every nurse would have to join the union or pay union dues.

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The status of Mission's potential union

Federal labor law lays out structured processes through which employees, the union, and management must adhere to before a union may form. At Mission, the first official step would be for nurses to indicate their desire to organize by filling out union authorization cards.

If 30% of nurses fill out cards in favor of unionizing, the union (in this case National Nurses United) can proceed and request an election through the National Labor Relations Board on nurses' behalf. According to the NLRB database, no petition to unionize Mission Health has yet been filed.

In the time between union cards and a potential election, both the union and management have the right to communicate with employees to discuss why they should or shouldn’t approve a union. Labor law limits both sides from making promises of special awards or threats of retribution.

At Mission, management has passed out a series of informational sheets to hospital leadership that provided details portraying unions in a negative light. Lindell confirmed the information in at least one of the sheets provided to the Citizen Times was from Mission.

One bullet-point said, “This union (UNN) has lost 35,000 members since 2014.” Another bullet-point stated, “Be careful what you sign, the union isn’t required to return your signed card if you change your mind.”

Before any election, management can also hold what are known as “captive audience meetings” mandatory for employees to attend, during which management may explain why it believes unionizing is not the best course of action.

“The law says retaliation and coercion is unlawful, but there is evidence that suggests one or more employees involved in union drives commonly ends up being fired or facing some other type of adverse consequences,” said Eric Fink, professor at Elon University School of Law.

A union is approved if a majority of employees vote in favor at the election. Mission employees are still determining, through the union authorization cards, whether a future election will take place.

Brian Gordon is the education and social issues reporter for The Asheville Citizen Times. He can be reached at bgordon@citizentimes.com, at 828-232-5851, or on Twitter at @briansamuel92.

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