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Nursing Unions. The Pros and Cons


There are currently around 4.3 million registered nurses working in the health care system in the United States. Of those nurses, approximately 20% are currently members of nurses' unions, which is higher than the national average for union membership. A union is a coalition of workers in a given industry who band together to push for better working conditions and higher pay. Usually, union members pay a certain amount of money to the union each year. That money goes toward labor negotiations and organization. It is also used for strike pay when members of a union go on strike to demand changes to their work environment.

Nursing unions can be very helpful for many nurses and can make meaningful changes to the healthcare system's labor environment, but they also have some downsides. Having a guide to the pros and cons of nurses' unions is helpful for anyone who is currently working in nursing or is interested in becoming a nurse. Deciding whether or not to join a union is an important question that people in a wide range of industries need to be prepared to answer.


Unionization in Nursing

Many industries in the United States have unions, but unionization in nursing is more common than in most employment fields. Nursing unions are also growing faster than most labor unions across the country. Many nurses recognize the benefits that a union can bring to their employment opportunities and work environment. The prevalence of nursing unions actually goes against general labor trends across the United States. According to the Bureau of Labor Statistics, union membership is declining across the country. In 2020, union membership was at 10.8% of all workers; in 2021, membership had fallen to 10.3%, representing a difference of around 241,000 workers. In addition to nursing, industries with high union membership included education, library, and protective service occupations.


In the same report, the BLS noted that non-unionized workers made an average of 83% of the earnings of unionized workers, which is a significant difference. Union members were more likely to be older, with the youngest workers having the lowest rates of unionization in the country. Many theories seek to explain why nurses have such comparatively high unionization rates. One theory is that because there are more female than male nurses, unions have provided a way for women to maintain their position in the workforce, secure pay on par with men, and have their voices heard. Another theory is that unions are popular among nurses because nursing is a challenging job field that can put workers at higher risk of contracting illnesses at work. Nurses often have to work long shifts and may have limited opportunities to care for themselves while on the job. A union could support nurses to allow them to do their jobs effectively.


The Role of a Union

Unions can play many different roles in workers' lives. Their primary purpose is to advocate for workers' rights and give them a collective voice. An individual worker has relatively little power compared to their employers, but a union of workers has a great deal of collective power. Unions can help prevent worker exploitation and have had significant victories for workers' rights in the past. Having Saturday and Sunday as a weekend, a 40-hour work week, and the abolition of child labor are just a few of the things that have come about through the efforts of unions. Not everyone in the country currently works a 40-hour work week with weekends off, including nurses. For those workers, unions are even more important because there is room for improvement in the material conditions of workers. Nurses' unions can help protect the health and safety of nurses without compromising the efficiency of the healthcare system.


States with Nursing Unions

Prospective nurses may be interested in looking at states with nursing unions when considering where they would like to work. Looking at lists of unionized nurses by state can give a sense of how popular and powerful unions are in different parts of the country. The good news is that nursing unions exist in all fifty states and the District of Columbia. Participation in those unions varies from state to state, however. In some states, union membership is actually mandatory for nurses. In other states, membership is optional because of right to work laws. The current division between the states is as follows:

Right to Work

  • Alabama

  • Arkansas

  • Arizona

  • Florida

  • Georgia

  • Idaho

  • Iowa

  • Indiana

  • Kansas

  • Kentucky

  • Louisiana

  • Michigan

  • Missouri

  • Mississippi

  • Nebraska

  • Nevada

  • North Carolina

  • North Dakota

  • Oklahoma

  • Pennsylvania

  • SOuth Carolina

  • South Dakota

  • Tennessee

  • Texas

  • Utah

  • Virginia

  • Wisconsin

  • WEst Virginia

  • Wyoming

Mandatory Nursing Unions

  • Alaska

  • California

  • Colorado

  • Connecticut

  • District of Columbia

  • Delaware

  • Hawaii

  • Illinois

  • Maryland

  • Massachusetts

  • Maine

  • Minnesota

  • Montana

  • New Hampshire

  • New Jersey

  • New Mexico

  • New York

  • Ohio

  • Oregon

  • Rhode Island

  • Vermont

  • Washington


States that have right-to-work are much less likely to have strong nursing unions, although union options do exist in all of those states. In addition to these state options, there are also some national nursing unions that can help nurses organize their workplaces and provide strike pay no matter where nurses are in the country.


Pros and Cons of Nursing Unions

When it comes to unions, the pros and cons are crucial to consider. There are many pros and cons to nursing unions, and in the end, the decision of whether or not to join a union comes down to personal choice and circumstances. Some unions run efficiently and make the work environment better for everyone, while other unions need better management and may not be as good at protecting their members' rights and interests. There are many good reasons for joining a union, and there are some good reasons for opting not to join as well. One thing that nurses could do if they are unsure of whether or not to join a local union is to speak to fellow nurses who have made either decision. What pushed them to join or not join? How do they feel about their choice? What advice would they give? Hearing the lived experiences of others in the field can be invaluable.


Benefits of Nursing Unions

Unions exist because they can bring many potential benefits to workers. Some of the most important benefits of nursing unions include the following:

Safer working conditions

Nursing can be a challenging field of work. Nurses work long hours in emotionally and often physically grueling conditions. They are likely to be at heightened risk of contracting infectious diseases and may experience deleterious effects from sleep deprivation. Unions can push for better safety regulations to protect nurses, which can also help keep patients safer. Exhausted nurses are more likely to make mistakes that could be dangerous to patients.

Better pay

One of the most important roles of a union is to secure fair wages for workers. According to the BLS, the median wage for registered nurses is $77,600 per year, but the lowest-paid 10% of nurses only make $59,450 per year. A strong union could help raise wages for those making less than others in the field.

Due process for discipline

Unions can help support workers who are fired or subject to other disciplinary action at work. They can help ensure that there is a process for employers to follow when disciplining employees and can follow up on that process to ensure that it is implemented correctly. This can help workers know where they stand and can improve communication across the board.

Recourse and assistance if something goes wrong

Employees may struggle to get help if they are mistreated at work. A unionized employee will have dedicated support channels to reach out for help if they feel that something at work is not functioning the way that it should. This assistance can be invaluable for nurses with busy schedules and high levels of responsibility.

Strike pay and support

When workers reach a point where their work environments are untenable, they may choose to go on strike. A union can provide strike pay and can negotiate improvements to the workplace. This is one of the most significant ways unions can support their members.

Consistent hiring standards

Unions may be able to point out inconsistencies in employers' hiring standards and can push for changes to the policy. This is particularly important for nurses who are members of marginalized or under-represented groups and feel their odds of being hired may be hurt by poorly written or poorly enforced hiring practices.

A protected working schedule

Nurses work long shifts because of the nature of hospital schedules. That is not necessarily a bad thing, but it is something that unions can help regulate. They can help ensure that nurses are paid what they are owed for overtime work, work the number of hours they have in their contracts, and their work schedules cannot change without due notice.

Enhanced job security

Unions can help establish the circumstances under which nurses can be fired or let go from their jobs. They can also help nurses get hired at new positions if needed. This job security can help nurses have a secure financial situation and can help them plan for the future.

Legal representation

If nurses need legal representation related to a work matter, unions can provide trained lawyers who can defend union members and protect their interests. With the high cost of legal representation, this is an important benefit of unions.

Improved benefits

Many unions either offer or help their members secure good benefits like health care, a retirement plan, parental leave, sick leave, and more. Without union assistance, employees either have to rely on employers for these benefits or pay them out of pocket.

Lack of favoritism

Unionized workers are less likely to experience favoritism at work. Their treatment is standardized, which creates a more equitable work environment where everyone is entitled to the same treatment.

The potential for free education

Some unions can help nurses pay for their nursing education if they agree to become members. Since nursing unions are often large, they are more likely to have the resources to provide this kind of help to members.

These benefits will vary from one union to another, but they are all reasonably common and are important things to consider for those debating whether or not to join a union.


Drawbacks of Nursing Unions

Of course, no system is perfect. There are drawbacks to nursing unions that can discourage some people from joining them. As with the benefits of unions, none of these drawbacks are universal, and many will depend on a union's structure and management.


Union fees

Unions are not free, and some may have steep membership fees. Some unions also do not differentiate union dues based on individual salaries, making membership more costly for lower-paid members

Unpaid strikes

Strikes should be paid, but it depends on how a union is run, how much money they have, and how long the strike goes on. There is always a risk that striking workers will lose out on pay, which can be a major challenge.

Internal union politics

Some unions may prioritize seniority over expertise or may have complex internal politics that end up hurting some of their members. This is more common in unions that are poorly managed, but it can be a problem for ordinary members. 

Disadvantages for patients

Some people worry that nursing unions will harm patients by putting nurses' needs first; if nurses' hours are limited, hospitals could be understaffed, and so on. On the other hand, there is also the argument that if nurses' needs are not met, they will not be able to provide high-quality care.

Harm to healthcare industry stakeholders

Many stakeholders in the healthcare industry worry about union membership hurting their finances. Primarily, this is because unions are intended to prioritize workers' needs over profits.

Less control over work schedules

Since union negotiations impact everyone in it, some nurses may be frustrated by their own lack of control over individual work schedules. Everyone's scheduling needs are different, and what works for the majority may not work for everyone.

Loss of individual opinion

Particularly in large unions, some nurses worry about having their own opinion and voice lost. One solution to this problem is to get more involved in union politics and to vote on issues as they arise, but that solution does not necessarily work for those lacking spare time.


These drawbacks should be given due consideration when looking into union membership. It may be worth looking into how a given union handles the above issues and speaking to members about how they feel about these drawbacks, and seeing how they actually play out.


Are Nursing Unions Worth It?

Nursing unions can and do provide many benefits to workers and to patients. There is some research suggesting that labor standards pushed by unions can help hospitals run more efficiently. Proper safety procedures, work hours that allow nurses to function at a high level, and adequate staffing are all issues that nursing unions advocate for, and all of those changes benefit patients as well as nurses. Nurses in unions are paid better than non-union nurses on average and receive other benefits as well. The long history of unions improving labor conditions for workers should not be ignored in this debate either, particularly when nurses face such high rates of burnout and are very much in need of support on the job. Unions are not perfect, however, and there can be some drawbacks, particularly when they are not managed well.


The decision to join or not join a union is a personal one. There is no right answer to that, and all nurses need to consider their own situation, their priorities, and the union options in their state before coming to a conclusion. Nursing is a challenging profession full of difficult questions and decisions, and union membership is just one of those questions. Of course, nurses in many states are required to be unionized, so the decision of whether or not to join also depends on geography. Some nurses may choose to relocate to a state that either requires or does not require union membership based on their own convictions and the union offerings in their state of residence.


Becoming a Nurse: NCLEX Exam

Before the time comes to make a decision about whether or not to join a union, prospective nurses need to pass the NCLEX exam. The NCLEX test is usually administered online and uses an adaptive computer system to test candidates' abilities over the course of the exam. Getting a passing score on the NCLEX is one of the most important prerequisites for becoming a nurse in the United States, and the exam is challenging for many applicants. Fortunately, the NCLEX website does provide practice tests so that prospective nurses can get familiar with the structure and difficulty level of the exam.


In addition to completing the NCLEX, prospective nurses will need to attend nursing school and complete registration and licensure requirements in their state. Each state has a different process for training and registering nurses, so it is best for those interested in becoming nurses to explore the most common educational pathways used in their state of residence. Most training programs for nurses require candidates to spend time working in hospitals and clinics to get hands-on experience before they can complete their nursing education.


Frequently Asked Questions


Are Nurses' Unions worth it?

The question of whether membership in a nursing union is worth it is subjective. Unions have many benefits, but they are not perfect; each person will have to weigh the pros and cons when it comes to them.


What is nurse unionization?

Nurse unionization is the process of creating and maintaining labor unions for nurses. Nurses are unionized at a higher rate than most other industries in the United States.


What are the benefits of the Nurses' Union?

Nurses' unions can provide better pay, job security, strike pay, legal representation, a fairer workplace, and consistency. They can improve nurses working conditions and benefit patients by pushing for better safety regulations.


What is the purpose of a Nursing Union?

Nursing unions exist to protect the rights of nurses. They help nurses advocate for their own needs at the workplace and improve working conditions.


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