What Is a Union?

A union is an organization of workers who are employed by the same employer and who use their collective power to:

• Stop the employer from doing what workers don’t want, such as firing employees without justification, discriminating against workers, making changes without workers’ input, cutting staff to increase profits.

• Make the employer do what workers want, like paying fair wages, providing decent benefits, and hiring enough staff to provide quality care.

Without a union, the employer can do what he wants. He can fire employees for no reason. He can cut pay. He can eliminate benefits. And he can do that because workers on their own, as individuals, can’t match the power of their employer, who has the ability to fire you.

For more than 200 years, workers have learned that together, as a group, they have the power to match the strength of their employer.

One common mistake that some workers make (often reinforced by employers) is that a union is some kind of outside entity, an insurance product, a third party that intervenes between management and workers. But that perception is wrong.

You and your co-workers are the union. So when the employer attacks the union, he is really attacking you and your co-workers. and the more unified you are, the stronger the union will be. A union is the expression of workers’ collective power.


Why is there conflict between management and workers?

The conflict between management and workers does not exist because managers are inherently bad and workers inherently good. The conflict is systemic: The conflict exists because an employer makes a profit by demanding as much work as he can from his employees in exchange for an hourly wage. The more work produced at a lower hourly wage, the more the employer profits.


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This is especially true in healthcare, where so much of an employer’s costs are labor. In a factory or retail, generally less than twenty percent of an employer’s costs are labor; the rest is machinery, supplies, energy, and other production expenses. In healthcare, more than fifty percent of an employer’s costs are labor—staffing—so there is a greater motivation to get fewer people to do more work. It increases an employer’s profits.

In the healthcare industry, whether you work for a for-profit or a non-profit institution, there really isn’t much difference. Most employers are now large corporations where the CEO and other top administrators command millions of dollars per year in salaries and benefits, typically two hundred or more times what the average worker earns in a single year.

When healthcare workers are not represented by a union, it is management that determines what workers will be paid, what benefits they will receive, how many workers will provide care, who will work and who will be laid off. But when healthcare workers organize a union, the workers have the collective power to demand a say in these important issues. This is why employers oppose workers organizing a union.


Union contract

A union contract is the legal, binding agreement negotiated between the union and the employer. Sometimes referred to as a collective bargaining agreement, the contract is an agreement between the union (your co-workers and you) and the employer.

A contract represents both the collective strength and the struggle of workers, past and present. Setting forth the rates of pay, benefits, and other terms and conditions of employment, the contract represents what the union has forced management to agree to through our collective strength. Although management often implies that it would provide your wages and benefits on its own, experience has shown that management rarely offers higher pay, better benefits, or improved working conditions beyond the bare minimum unless they have been compelled to do so. The union (your co-workers and you) is the institution that forces an employer to go beyond the bare minimum, and the union contract incorporates those improvements into a legally enforceable document.

A union contract is unlike other types of contracts, like those used to purchase a car or a house. If those other kinds of contracts are violated, you have to go to court and then convince a judge to enforce them. Your co-workers and you, on the other hand, are responsible for enforcing the contract. Because of his drive for greater profits, an employer will often try to skirt around the contract if given the opportunity. If your co-workers and you do not vigilantly enforce the contract, then the employer has no reason to abide by it.


Contract enforcement

Union members enforce the contract through a variety of ways: petitions, meetings, collective action, and through the grievance procedure. To effectively enforce the contract, the union must be well-organized, union members must be well-informed, and union unity must be well-established. To accomplish this, union members in each department or work unit should elect one of their co-workers, someone who is well-respected, as a shop steward.

At each facility, the democratically elected shop stewards meet monthly to organize the workers’ collective power at that workplace. Rank-and-file members and stewards must work hand-in-hand to ensure that the contract is enforced and that the employer is held accountable to the contract. The union’s way to accomplish this unity is through meetings, followed by actions democratically determined by the membership.

If you have a problem or issue that affects your working conditions, it is important to discuss it immediately with your shop steward, because the contract has time limits for filing a grievance.

It’s important to remember that your co-workers and you—the members—are the union. The members as a whole own the contract. Collectively, the members decided whether a problem or issue is a grievance or something that should be addressed in a different way. That’s why it is so important for members to participate in the union and be part of making these important decisions.

In departments or facilities where members are active, the union is strong; where participation is low, the union is weak. It is only when workers are active and participate in the building of the union do we have the power to force the employer to do what we want and stop him from doing things we oppose.



When you were hired, management may have informed you that you “had to” join the union. It’s true that paying dues to support your organization is a condition of employment. NUHW members established the dues formula through a democratic, union-wide vote. The NUHW constitution and bylaws, ratified by a membership vote, established the dues formula at 1.5 percent of an employee’s straight-time hourly base wage rate, with one dollar of that amount per month going into the union’s Strike and Defense Fund. Union dues pay for staff salaries, offices, supplies, affiliation fees to other labor organizations, legal fees, phones, copying, negotiations costs, and organizing non-union workers into NUHW. A healthy strike fund is necessary to ensure that if workers vote to strike there are resources available to make the strike successful.

Dues are the union’s only source of funding. Without dues, the union could not function.



Ensuring that our union is financially healthy means that we will have the resources to expand the power of healthcare workers, improve how patient care is provided, and improve the wages, benefits, and working conditions of healthcare workers, themselves. It’s important to organize unorganized healthcare workers to protect the wages, benefits, and working conditions of workers who are already unionized, taking wages and benefits out of competition between unionized and non-union employers. That way, employers will have to compete based on who can provide the best care, not who can provide the care the cheapest. By taking an industry-wide approach, we can improve wages, benefits, and working conditions for all healthcare workers. In the healthcare industry, almost every component of the industry is organized in some fashion to promote its interests: insurance companies, healthcare systems, doctors, and medical suppliers are all organized. Healthcare workers should be, too.


Equal rights

Among the things that make a union different from other types of member-organizations is that when these organizations—social clubs or church groups or softball teams—are created, the members of those organizations choose who belongs to them. Because a union is an organization of everyone who works for the same employer, it is the employer who chooses, by whom he hires, who belongs to the union. Collectively we have to work with whomever the employer hires, including new hires and probationary employees, and create the unity and strength to have the power to win goals that we all support.

Even though employers and their administrators and managers are a tiny part of the population, they exercise and exaggerated influence over the rest of us. But workers are a majority of the population. To remain powerful, and to undermine the enormous power that workers have when they are united, employers continuously attempt to divide workers: by race and ethnicity, by gender, by sexual orientation, by age, by legal status, even by job classification, education, and training. Employers use differences to dive and weaken the union.

NUHW fights discrimination in two ways. First, we support all movements that fight against racism, bigotry, and prejudice of any kind. Our contracts include strong language that prohibits the employer from discriminating against someone based on the basis of race, creed, sexual orientation, age, gender, gender identity, and union activity. Second, he have a simple standard: all union members have the absolute right to be judged based on their own actions and behavior, regardless of what they look like, where they come from, what language they speak, who they love, or what religion (if any) they believe in. We believe that an injury to one is an injury to all.

The power of the union comes from uniting all workers who were hired by the employer. The union must be truly democratic with room for everyone, including those with different ideas. The union should be the safest place in our society to disagree. In short, a union must be a place where all workers and their ideas are welcome: What divides us is bad, what unites us is good.


Political action

Perhaps no industry is more heavily publicly regulated and financed than healthcare. Every day, politicians and regulators make significant decisions at City Hall, Sacramento, and Washington D.C. that affect the healthcare industry, healthcare providers, and our patients. Healthcare corporations, insurance providers, doctors and other interest groups are heavily involved in the political process and we need to be involved as well to ensure that the voice of healthcare workers is part of the public discussion.

The amount of public dollars devoted to healthcare, through Medicare and Medicaid primarily, but also at the local government level, are the result of political decisions. We fight with employers for our share of the budget in our contract negotiations, and we fight with politicians for our share of the budget in City Hall, Sacramento, and Washington. Political action is critical in the healthcare industry. We encourage people to register to vote, but a real political voice for healthcare workers and our patients requires much more than that. Healthcare workers must actively work to hold elected officials accountable.

The corporate lobbyists have succeeded in passing legislation that prohibits unions from using dues revenue in the federal political process. That weakens our ability to influence political decisions that would be favorable to healthcare workers and patients. The only way we can raise money to have a voice in these important decisions is to ask union members to make donations to the Union’s Committee on Political Education (COPE) Fund. There is no other source of money to advocate for national legislation that will protect patients and healthcare workers.


Medicare for all

Healthcare is a human right. Recent efforts to reform the healthcare system under Obamacare make some improvements to the system by expanding who is covered, but the basic flaws in the current system remain intact: Private insurance companies remain in control of healthcare, not patients or the public.

However, by expanding the nation’s most successful and efficient healthcare program—Medicare—to cover all Americans we could solve the country’s historic healthcare crisis once and for all. Under an expanded Medicare plan, everyone is included, regardless of age, preexisting medical conditions, or ability to pay. Costs would be controlled through elimination of wasteful insurance industry paper work and unnecessary, expensive bureaucracies. Focus would shift toward preventive primary care to keep people healthy rather than waiting until people get sick. For the first time, the caregiver and his/her patient would be in control of making healthcare decisions, not the insurance companies who are more concerned with making profits.


In unity, there is strength

The strength of NUHW comes from what you put into it, not what you take out of it. Employers continue to expect more from healthcare workers. To be successful in winning for healthcare workers and patients, healthcare workers have to be strong and united.

Our union functions through meetings, committees, and involving members in making decisions that affect them. We encourage you to get involved.

You are now part of the fastest growing healthcare workers union in the country, and the only union devoted to representing only healthcare workers. Together, we are building a great union.

Join us.


— Sal Rosselli, NUHW President, and the NUHW Executive Board