Quiet on the Western Front? Behind the SEIU-CNA Alliance.

Days after SEIU stood with health insurance industry moguls in D.C. to declare their cooperation, members of the California Nurses Association were getting arrested to protest that same insurance industry for keeping single payer off the table. SEIU and CNA have feuded for years—but this time, the disagreement took place just weeks after the two unions signed a peace treaty. Photo: CNA.

When the Service Employees (SEIU) and California Nurses Association (CNA) called a truce in March, many union observers were confused—but breathed a sigh of relief. A years-long feud that pitted the unions against each other in hospital organizing drives across the country, increasingly rancorous in recent months, had finally flamed out.

But one controversial aspect of the deal concerned reform-minded union activists: CNA would cease its financial help to the new National Union of Healthcare Workers. NUHW emerged from the United Healthcare Workers-West (UHW), a 150,000-member SEIU local in California trusteed by the parent union in January following months of conflict over SEIU’s centralizing of control and sidelining of members.

What does the SEIU-CNA deal mean for health care unions in California and beyond? Labor Notes’ Mark Brenner interviewed Deborah Burger, a CNA co-president and a part-time nurse in gastroenterology at Kaiser-Santa Rosa hospital.

LN: How did the deal come about? When you look at things from the outside it seems like everything was ratcheting up, not calming down.

DB: We’ve been trying to come to some agreement with SEIU for years, because we realize that we would be stronger if SEIU were organizing health care workers and we were organizing RNs, and if we could come to some kind of truce over jurisdictions and how nurses were organized.

First, some history: We left ANA [the American Nurses Association] in 1993 because they were largely dominated by anti-union managers, supervisors, and administrators who happened to have a nursing license. We knew that we wanted to form a national nurses union, but it took many years of organizing in our own state to recapture facilities that we had once represented that the old CNA had given away, sort of recouping our territory. And we were trying to work with state nursing associations—Massachusetts, and Maine, and PASNAP [in Pennsylvania]—that also saw the value of getting out of the ANA.

So there has been this long history of trying to work with other unions to really form a nurses union. Once we started working together we realized that the next big chunk we needed to tackle was SEIU, because they were organizing wall-to-wall and they were taking the RNs with them.

We believe that there are enough issues in nursing that are specific to nursing practice that RNs really do deserve an RN union, just like the police, the teachers, firefighters. There are specific issues that we need to deal with that we can’t necessarily be constrained by other categories of health care workers.

LN: But you didn’t see yourself as antagonistic to those workers?

DB: No. In fact, at the facilities, despite the fact that we’ve had a longstanding love-hate relationship with United Healthcare Workers-West and SEIU, at the facility level we never really let that interfere with how we worked with those workers when we had to go up against management. We always knew which side we were on, no matter who, politically, we were feuding with outside. Much like in a family, there are issues that you deal with inside the family, and then there is the greater outside world that you have to deal with.

LN: How did you move so quickly to reach an accord?

DB: Because we understand what our bigger goal is. We could keep feuding forever, or we could come to an understanding about jurisdiction and say, that is the past, let’s move on. Especially when you look at the organizing opportunities with the Employee Free Choice Act and with the new administration not being as antagonistic. Nurses are very practical and they understand the bigger picture.

And I think it was mainly because Andy Stern also realized, “Look, I can either continue fighting with these nurses, or I can look at the bigger picture and see that I get two-thirds, they get a third, and we’re done.”

And it isn’t a small accomplishment for us. We have exclusive jurisdiction on all nursing issues in nursing practice.

LN: Why is that important?

DB: We won’t have anybody undermining, say, our ratios bill [that mandates specific nurse-patient ratios in California]. At one point SEIU was trying to water down the ratio bill, putting forward ratios for all health care workers. We’ll fight with the employers to make sure we have the support staff we need, but when it really comes down to scope of practice, doing the medications, doing the assessments, they need to be RN ratios.

LN: What are the key advantages for CNA in this new accord?

DB: The obvious one is the end of this ongoing war with SEIU. Then we’ve agreed that when it comes to facing the employer, we will present a united front on key principles and not undermine each other’s positions on working conditions, benefits, all those kinds of things.

It frees up a huge amount of time that would be used on internal fighting amongst ourselves to go out and organize and fight the employer. Of course, with Andy, he has a unique way of dealing with the employer, but it is to his advantage to have us as an ally because we’re not afraid of speaking out against an employer.

LN: Is this going to change CNA’s approach to striking deals with employers?

DB: No, because in the agreement they don’t interfere with our internal structure, programs, and campaigns, and we don’t interfere with theirs. So the employer knows that when they’re dealing with CNA, nothing has changed in that respect.

We’re not changing our approach to the employer, our approach to politicians, to single payer. That’s the beauty of the deal. We did not have to compromise our core principles in order to have this treaty.

LN: From the rank-and-file level how did people react? One month you have a cover story on your magazine with an SEIU label on a purple poison bottle, and now there is this deal. Was it confusing?

DB: Nurses are very practical. But they understand that when there is a core principle that we need to fight for, we’ll take on anyone. We’ll take on our own employers, which is not a comfortable position to be in. If you’re a nurse in some of these communities you can get blackballed. So nurses understand taking a stand and being in a very uncomfortable position.

We’ve kept them informed on all the issues. Our nurses that are our elected leaders are also working nurses. I work at Kaiser 20 hours a week. So we have a unique position, relating to nurses in our facilities. So when we say we’re at war with SEIU because they’re going to Ohio and they’ve cut this sweetheart deal where they’re going to get the nurses, our nurses say, “Wait a minute.”

So when we said we struck a treaty with Andy, they go, “OK, that’s good. But is there an escape clause? Can you trust him?” They are saying, “Let’s move forward with our eyes wide open.” And they trust us as leaders because we have not come back and said, “Oops, we messed up and you’re all having massive takeaways and massive layoffs as a result of the deal we cut.”

LN: When you are at work in your hospital what’s been the reaction on the job?

DB: On the ground, nothing much changes because we’ve always worked with our co-workers. Whether we’re at war, whether we’re at peace, whether we’re just having skirmishes, you still end up working with the people at your facility. It’s sort of like kids in a family. Despite the fact that the parents are feuding, the kids still get fed, they still go to school, they still get taken to their basketball games. You still have to take care of business.

So nurses, what they want to know is: I’ll still have contact with my labor rep when I need it, our contract is being enforced, I’m still being represented properly. Those are the things they look at. So we’ve got labor peace with these folks and we’re going forward. They see the value in organizing nurses nationally. The biggest thing for nurses is to expand the nursing ratios nationally. As long as California is the only state that has them they are under constant threat. We have to make it a community standard nationwide.

Nurses travel. They get the fact that they leave this state and their family member is injured in another state and they could have one nurse for 20 patients, one nurse for 15 patients. They get it. And they work with nurses who are travelers from other states who reinforce the whole “You don’t know what it’s like out there” [idea]. And nurses here in California remember what it was like 10 years ago and how things changed when the ratios were put into law.

LN: You have always made the case that you can’t be an island in California. This is a national industry, and these need to be national standards, and that is why CNA needs to organize nationally. But you’ve also made the case that your vision of how to do that is what puts you at odds with SEIU. Are your co-workers who see the national picture raising concerns about this deal?

DB: No, because we do have a national campaign. We’ve worked with Massachusetts, Pennsylvania, Maine, and Texas to put ratios legislation in the states, and we have promised nurses that we’re going to redouble our efforts to get a national bill.



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We’ve also done a lot of education with nurses outside the state. We’ve gone to other states like Florida, Texas, Louisiana, and Kentucky to talk about ratios, unlike the ANA, whose position is that you don’t need ratios, you need the ability for RNs to use their independent judgment. Well, we’ve had that for the last 200 years and it’s never worked, because we don’t control the budget, we don’t control how management enforces any kind of acuity system [which judges the severity of a patient’s illness]. In California our ratio bill does include using acuity, so that ratios are the floor and not the ceiling.

So we have done a huge member mobilization on getting ratios implemented in other states. At chains like HCA, Tenet, and Catholic Healthcare West that have facilities in other states, we’re working to negotiate language for ratios in other states.

LN: How is the agreement going to work logistically in terms of coordinating with SEIU nurses?

DB: It’s complex trying to meld organizations because of the culture and the leadership and making sure everybody has a voice at the table. There are, I’m sure, nurses in SEIU that feel that they’re well represented. They’re trying to see how they fit into that structure. It’s like two separate families with kids getting married. It’s like you aren’t the youngest any more, you have to give up certain privileges and rights you had in one family structure to move into a new family.

The thing that will help us work together is that we have a common language that we use when we’re taking care of patients, when we’re fighting the employer for patient protections. In some states the protections for nurses and other health care workers in calling out patient abuses or unsafe hospital conditions are not as strong as they are in California as a result of our work. Being able to work on the ratio campaign, being able to work on comparable worth and whistleblower protections--there will be those projects that we’ll be able to bring them in on, so that they won’t feel like they are outsiders anymore. It’s more the formal structures that we have to figure out.

LN: I imagine there is some work to do on the SEIU side. At the SEIU convention last summer, SEIU nurses had plenty to say about the CNA.

DB: You are at war and you say things at war that you can’t really say when you’ve worked out a treaty.

LN: Lots of folks in the labor movement saw conditions over the last year pushing CNA and UHW, now NUHW, closer. There was lots of speculation about what this could mean nationally. What are the implications of your deal with SEIU for the efforts of NUHW activists to leave SEIU?

DB: We’ve had a long-term relationship with UHW. Part of it goes way back to the Summit Hospital strike, where we were striking to make sure that workers could honor picket lines. We’ve worked with them extremely closely. We’ve developed personal relationships with lots of leaders there. When we were going through our own struggle to take control of our union, and when the old CNA leadership fired our labor staff—they virtually gutted our collective bargaining program—Local 250 (UHW's predecessor) supported us. They provided us office space and and support. This allowed us to play it out in the courts with a lawyer that did brilliant pro bono work for us. So there is a loyalty there that we can’t sever because we made this deal with Andy Stern.

We are constrained by the agreement not to provide any financial assistance to NUHW and we’re honoring that commitment. But by the same token, at the facilities nurses are supporting their co-workers and their ability to get the representation of their choice. We’re making sure we don’t interfere with that. And we’re not obligated by the terms of our agreement with SEIU to interfere with that, so we are keeping hands off. Nurses who choose to help NUHW at the facility level can continue to do so. We’re not saying, “you can’t do that.”

We certainly do hope that somehow they do come to some agreement. It certainly looks like there is a lot of testosterone flying around right now. I have to think that both sides have what they perceive as principled stands.

LN: Do you see this as a missed opportunity for you to form a national alliance with a health care union that has more in common with your vision of health care organizing than SEIU does?

DB: I haven’t seen it as a missed opportunity yet. Because I don’t see that we’ve totally blocked us working with NUHW. If NUHW and SEIU could eventually bury the hatchet, then we’d be able to work with both groups.

LN: But if you think of your fight with ANA in the 1990s, it was impossible for you to reconcile with them.

DB: It was, so we left. But in the past we’ve worked with groups like NYSNA [New York State Nurses Association], where NYSNA is still affiliated with the ANA. We don’t support the ANA, but we don’t cut off avenues of working together with NYSNA or Washington or Oregon because of their relationship with the ANA.

The older you get the more you see things in grays instead of blacks and whites.

The NUHW and SEIU are really out of our control. We do have control over how we make the best of an opportunity to organize a national nurses union.

LN: The reason people raise this is because, as you know when you left the ANA yourselves, there is a window in which things take time to sort themselves out because of the way labor law works, the way the courts work. There is a real question mark in the early moments of these fights about how they are going to go. Finding allies who can provide you with institutional support or money to help with transitional staffing, that can make the difference between survival and not. Some people argue this is that critical time for NUHW.

DB: Getting an all-RN union nationally—getting that from SEIU is no small feat. We, as nurses, are not about to jeopardize that. Because we believe that [NUHW President] Sal Rosselli and Andy Stern can work out their deal.

We understand the politics of the deal we made. But we have to do what’s right for the nursing profession, what’s right for our patients, and that is to form the national nurses union. And in the long run Andy and Sal will do what they need to survive, and other unions will help NUHW. And we’ll all move forward together.

During the Obama campaign labor came together despite all of their fights, when it came to promoting a cause they really believed in. They were able to check the guns at the door. We plan on working together with both groups eventually, because at some point they will come to some kind of agreement.

We’ve been thwarted in trying to get an all-RN union for decades. We can’t let the infighting of two other unions, however principled their fight is, come between us and forming a national nurses union that will speak on behalf of social justice, patient protections, nursing advocacy—all of those things that have been put aside because we belonged to an organization that was essentially funded by the hospital association. However the other politics falls out, we have to keep an eye on the bigger picture, which is single payer.

LN: Under the terms of your deal, SEIU will back single payer at the state level in a few places. But on the national level they’ve been opposed to backing single payer.

DB: What they did say is that they would advocate for trials of single payer in five states. What those five states are we don’t know; it would be nice if California was one of them.

LN: You see the contradiction that people are raising about the deal on single payer?

DB: I do, but there are lots of contradictions. The world is filled with them. The reality is that single payer has been and will always be on our agenda. We won’t compromise on that. We can’t! We’re nurses and we see the problems in our face every single day.

LN: But Stern has been much more pragmatic, arguing that we can’t copy the system from other countries. People read the agreement as putting you in a much more advantageous position around state-level health care policy, but SEIU is still doing what they’ve always done.

DB: People need to stop reading too much into the agreement. It is exactly what it is. We have worked out a détente with Mr. Stern and we will go forward. It does not preclude us from being still out there on our core issues.

We could never have made that agreement if we had to compromise. It would not have happened. Our members wouldn’t let us do it, for one thing. There is too much at stake in a nurse’s daily work life to compromise on that. I could not look my patients in the eye and say, “I sold you out in order to get a national nurses union.”

That is why we organize nurses well, that’s why we have the patient support that we do, that is why we have the community support we do. It’s because we cannot compromise on those principles. Andy Stern knows that. Our employers know that.

LN: Can the pact last?

DB: There are so many forces that are aligning right now to advance both unions, to advance unions in general. This is an opportunity, and shame on us if we miss it.


John Mehring (not verified) | 05/28/09

CNA was and is shamefully divisive vis-a-vis "healthcare workers". The reality is, RNs are just like any other healthcare worker (despite all their titles) --- they just make a pile more money. Yes, they take orders from doctors! Therefore, RNs are not independent workers; they, like all healthcare workers, are ultimately dependent on a doctor or healthcare manager telling them what to do.

Xver (not verified) | 05/23/09

I read this article and I feel...meh. I am not sure I am caring so much what the Nurses Union president thinks about her union's horse trading here and there.

Jimbo (not verified) | 05/22/09


Dude, there's a lot that SEIU does that I disagree with, and I'm not so sure what I think about the CNA's craft unionism approach, but the Hitler/Stalin comparison is a little extreme, no? Selling out to employers on contract details or dividing health care workers into separate unions are not the same as mass murder.

Anonymous (not verified) | 05/21/09

There will be no negotiated settlement between Sal and Andy. CNA has no concept for a war involving actual workers to scale--they only understand sabotage and diversions. They made an agreement to salvage losses to SEIU they were incurring on three major fronts: Vegas, Miami,Cook County. If they could actually win and maintain support from healthcare workers by a majority (over SEIU), they wouldnt have to make such a deal. It is one thing to play spoiler, its another to build real organization.