THE DEVELOPMENT OF THE MICHIGAN NURSES ASSOCIATION'S ECONOMIC SECURITY PROGRAM ' Thesis for the Degree of M.. L. I. R. MICHIGAN STATE UNIVERSITY ALICE L. AHMUTY 1968 ICHI SSSSSS IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII " “ ' R A R Y 10672 6874 Mic} 'gan State ABSTRACT THE DEVELOPMENT OF THE MICHIGAN NURSES ASSOCIATION'S ECONOMIC SECURITY PROGRAM by Alice L. Ahmuty Methods used by ANA in the past had proven inef- fective in improving the economic status of nurses. In the 1940's there was increasing pressure from within the profession for a stronger more effective approach to raising the nurses economic position. ANA adopted in 1946 an economic security program which advocated collective bargaining as a means to achieve its goals of enhancing the nurses' economic and professional status, and of pro- viding quality patient care. Although ANA strongly endorses collective bargaining as a means to improve employment conditions, it does not endorse strikes by nurses as an economic weapon. The state associations have the prime responsibility for implementing the program and acting as the nurses' exclusive representative in collective bar- gaining. The ANA gives assistance to the state associations by supplying the'overall leadership for their programs, field services, assistance with educational program plan- ning, and information on current trends in economics and Alice L. Ahmuty industrial relations. With the stepped up bargaining activities by state associations, ANA has launched an expansion of its envolvement in these activities. The progress of ANA's economic security program has been impeded by such factors as the attitudes of the nurses, employer resistance, inadequate legal protection, lack of an effective economic weapon, organizational weak- nesses, and too many other programs. Factors in ANA's favor includes settlement of the debate over means to achieve its goals by its acceptance of collective bargain— ing, favorable public sentiment, the feeling among nurses they can do something to improve employment conditions, and the development of skilled leaders. The ANA is the dominate organization in representing nurses. After a 12-year delay, MNA adopted an economic fe security program as advocated by ANA. A reason for the long delay was that the ANA program was too controversial and generally unacceptable to the Michigan nurses. Follow- ing the adoPtion of an economic security proqram in 1958, MNA developed a program which was a modification of the ANA approach called a "multi-dimensional" approach. The "multi-dimensional" approach stressed flexibility--using means which best fit the situation. Collective bargaining was to be used as a last resort. The basic approaches used in the first five years were educational methods, public relations, consultation services, and representation without Alice L. Ahmuty collective bargaining. In only one instance did MNA attempt to utilize collective bargaining. The approach did make some progress towards the nurses' goals. Following the passage of the Michigan Public Em- ployees Relations Act, MNA was stimulated to include collec— tive bargaining in its economic security program. Competition from unions and a growing awareness of the advantages of collective action resulted in increased organizational activities. The nurses are looking at the implications of organizational activity on patient care seeing it as an 0p- portunity to improve patient care while in some instances it may impinge upon their professional judgment. A crisis was faced when MNA found it difficult to meet its commit- ments within its limited resources. Deciding to expand the program, a 150 percent increase in membership dues was ap- proved and industrial relations consultants were employed to conduct the negotiations and training programs. Organi- zational changes have been made in order to make the program more effective. By the end of 1967 MNA had been granted voluntary recognition in nine institutions, had experienced 18 repre- sentation elections, and had negotiated seven agreements. The MNA agreements reflect its dual collective bargaining and professional functions. MNA still has several areas to resolve. In the future, nurses will become more involved in collection bargaining activities with MNA taking on many of the characteristics and functions of a labor organization. THE DEVELOPMENT OF THE MICHIGAN NURSES ASSOCIATION'S ECONOMIC SECURITY PROGRAM BY Alice L.iAhmuty A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF LABOR AND INDUSTRIAL RELATIONS School of Labor and Industrial Relations 1968 ACKNOWLEDGMENTS I wish to express my deep appreciation to Dr. Daniel H. Kruger, professor, School of Labor and Industrial Relations, and my advisor, for his encourage- ment and guidance during the past two years. As chairman of my thesis committee his assistance and advice have been most helpful. My sincere thanks to Dr. Jack Stieber, director, School of Labor and Industrial Relations, and to Dr. Russell W. Allen, professor, School of Labor and Induse trial Relations for also serving on my thesis committee. I would also like to thank the MNA staff, espe— cially Miss Eleanor M. Troup, R.N., executive secretary, and Mrs. Joan Guy, R.N., assistant executive secretary, for their contributions and time. ii TABLE OF CONTENTS Page ACKNOWLEDGMENTS O O O O O O O O O O O O O O O O O O O i i LIST OF CHARTS O I O O O O I O O O O O O O O O O I 0 iv I. HISTORICAL DEVELOPMENT - AMERICAN NURSES' ASSOCIATION ECONOMIC SECURITY PROGRAM . . . . 1 Factors Leading to ANA Action . . . . . . . 3 Overview of ANA's Economic Security Program I O O O O O O O O O O O I O O O O O 11 II. MNA'S ECONOMIC SECURITY PROGRAM 1959-1965 . . 26 Structure of MNA's Economic Security Program . . . . . . . . . . . . . . . . . . 26 DevelOpment of the Program . . . . . . . . . 33 A "Multi-dimensional" Approach . . . . . . . 45 ESP ActiVities O O O O O O O I O O O O O O O 51 Measurement of Success . . . . . . . . . . . 67 III. IMPACT OF THE MICHIGAN LABOR RELATIONS ACTS O O O I O O O O O O O O O O I O O O O O O 7 2 Pertinent Provisions . . .1. . . . . . . . . 72 The Effects on the Nurses . . . . . . . . . 82 summary 0 O O O O O O O O O O O O O O O O O 103 IV. EXPERIENCE UNDER THE ACTS . . . . . . . . . . 105 Recognition . . .,. . . . . . . . . . . . . 105 Bargaining Units . . . . . . . . . . . . . . 109 Bargaining Activities . . . . . . . . . . . 123 Agreements . . . . . . . . . . . . . . . . . 129 V . PROBLEM AREAS O O O I O O I O O O O O O O O O 1 3 9 VI ' FUTURE OUTLOOK o o o o o o o o o o o o o o o 0 l4 5 SELECTED BIBLIOGRAPHY . . . . . . . . . . . . . . . . 148 LIST OF CHARTS Chart Page I. Official Representation by MNA, 1961-1965 . . 63 II. Salary Increases in the Statewide Average Minimum Monthly Salaries Paid to General III. 1966 Inventory of Registered Nurses In Michigan by Type of Position . . . . . . . . 84 IV. Number of Institutions in which MNA is the Exclusive Representative for Registered Nurses 9 o o' o o o o o o o o o o o o o o o 0' 105 V. Results of MNA Elections for Representation . 107 VI. Starting Salary Increases Per Month for General Duty Nurses Negotiated in MNA Agreements . . .*. .w. . . . . . . . . . . . 131 iv HISTORICAL DEVELOPMENT - AMERICAN NURSES' ASSOCIATION ECONOMIC SECURITY PROGRAM The American-Nurses' Association functions as a federation of 54 nurses associations in the 50 states, District of Columbia, the Panama Canal Zone, and the Vir- gin Islands, which in turn are composed of more than 800 district nurses associations.1 The national, state and district nurses associations form an organizational com- plex with each level assuming functions related to the sc0pe of its influence and to the overall objectives of the association. The purposes of the association are the same at all levels. Briefly these are: to promote the professional and educational advancement of nurses, to further high standards of nursing service and to promote the general and economic welfare of nurses. The ANA's policies and programs are established by the membership through representation in the ANA House of Delegates, the highest authority in the association. Each state association elects to the ANA House of Delegates lANA, Facts About Nursing, New York; American Nurses' Association, 1966, p. 234. three delegates-at-large and one delegate for every two hundred members. At the biennial convention, the House of Delegates elect the ANA officers and directors who are responsible for the overall administration of the association. The ANA Board of Directors appoint members to serve on the following standing committees: (l) bylaws; (2) convention program; (3) ethical, legal and professional standards; (4) finance; (5) legislation; (6) membership promotion; (7) nominating; (8) nurses' professional regis- tries; (9) nursing in international affairs; (10) profes- sional credentials and personnel services; and (11) research and studies. They also appoint the members who serve on the Commission on Nursing Education, the Commission on Nursing Service, and the Commission on Economic and Gen- eral Welfare. In addition to these programs, ANA has es- tablished divisions of clinical practice, occupational forums and advisory and coordinating councils. The ANA consists of the members and associates of its constituent associations. In 1966, there were 172,591 members. In 1965 there were 825,534 registered nurses in the U. S. Membership is open only to nurses who are 1i- censed to practice as a registered nurse. Upon admission to membership, a registered nurse becomes a member of a district association, the state association, and the na- tional association. Though the state association must comply with the ANA bylaws, each state association may decide for itself how it will develOp its own programs. ANA policies are guides rather than mandates to the state associations. The focus of this study is the association's eco- nomic security program. First, a background and review Aof the national association’s program is presented. Next, the develOpment of one state association's economic secu- rity program - the Michigan Nurses Association will be discussed. Factors Leading to ANA Action In 1946 the American Nurses' AssOciation (ANA) adopted an economic security program which included col- lective bargaining. The objective of this program was to improve nurses' working condition through the democratic process of group action. Prior to this action ANA had an economic security program but it stopped short of collec- tive bargaining. In fact, in the 1930's ANA discouraged membership in unions because the methods used by unions were not those advocated by the ANA and they were non- professional in nature.2 Rather, ANA relied upon an 2Joseph K. Hart, "Economic Security for Nurses" American Journal of Nursing Vol. 38 (April, 1938), pp. 39Ie395; editorial, flUnion Membership? No." American Journal of NursingVol. 38 (May, 1938), p. 573; Leo B. Osterhaus, "The Effect of Unions on Hospital Management" Hospital Progress Vol. 48 (July, 1967), p. 90. educational approach and presenting recommendations to employers. The impact of these recommendations appears to have been minimal. Joseph K. Hart, writing in 1938, described three methods for dealing with economic conflict: (1) force or the revolutionary methods; (2) arbitration in which unions helped to define the issues; and (3) educa- tional methods. The educational methods were for those labor situations which involved relationships of such high public importance that any cessation of service was highly undesirable and unthinkable. The educational meth- od was advocated by the profession - by the nurses them- selves. Hart further expounded on the educational approach to the nurses' economic security problems in a follow-up article.3 The most intelligent way to fight their battles to secure economic security was for the nurses to educate the whole public, which included their employers, " . . . since what people pay for and want is usually a matter of 'educated tastes,‘ getting them to want and pay for nurs- ing service is, likely, a matter of adequate education, and nurses themselves can help the most in this furthering of public education."4 3Joseph K. Hart, "Drift - Conflict - or Education?" American Journal of Nursing_Vol. 38 (May, 1938), pp. 544- 548. 4Ibid., p. 544. It was the opinion of that day (1938) that a nur- ses' union or utilizing union methods to improve nurses' salaries was "absurd." Results of a survey of a group of nurses by Hart showed two-thirds opposed a nurses' union.5 To think of pay was unprofessional. A nurse must be de- voted to service. He pointed out that "this purity of motive must never be degraded by any move on her part that would lead anyone, including herself, to suspect that she could even think of such a thing as 'pay.'"6 Thus, ANA did not recommend at that time member- ship in unions or union methods. By what means then were the nurses to use to improve their working conditions? ANA's economic security program prior to 1946 would rely primarily on an educational approach.7 The ANA urged the state associations to assume responsibility for standards of nursing care and employment conditions. It urged the acceptance of the published ANA minimum wage and hour standards. Action was to be based on the facts secured through its program of studies. An educational program was used to promote an eight hour day. The adOption of 5Joseph K. Hart, "Economic Security for Nurses," American Journal of Nursinngol. 38 (April, 1938), p. 392. 6 Ibid., p. 393. 7editorial, "Unions Membership? N01", American Journal of Nursing Vol. 38 (May, 1938), pp. 573-574. this recommendation by hospitals was voluntary. C00pera- tion with other organizations, such as the hospital asso- ciations, was encouraged to promote understanding of its problems. Factual materials were made available for use by the state and district nurses associations as well as by individual nurses. On January 23, 1939, the ANA Board of Directors adopted the following recommendation from the ANA Commit- tee to Study the Question of Nurse Membership in Unions: The American Nurses Association is urged to use every effort to arouse the interest of hospital board of managers and hospital administrators, also legisla- tors, as well as other related and interested groups and individuals in helping to improve the working and living conditions of graduate nurses in hospitals, giving special attention to the problem of hours, in— comes, and health . . .8 This was to be the substitute for nurses joining unions, and it provided their methods to improving their working conditions. The professional association would look after the welfare of nurses by making recommendations to nurses, their employers, and other interested parties. Recommended employment standards would be published and promoted. But the adOption of these recommendations remained voluntary, though strongly encouraged. Through education, the argu- ment went, employers would be encouraged to take the ini- tiative to make changes for the betterment of the nurses 8 American Journal of Nursing Vol. 39 (May, 1939), p. 560. working conditions. Needed improvements would be brought about by working cooperatively with other organizations and by interpreting for them the nurses' economic problems. These techniques to improve nurses' working condi- tions were relatively ineffective. In 1938, an economic committee of the Minnesota Nurses' Association made pro- posals for improvement of salaries, working conditions, and fringe benefits. These proposals were submitted per- iodically to hospital administrators and boards of trus- tees all over the state. Competition from local unions and resistance from management contributed to limited gains.9 As early as 1941, the nurses in the booming indus- trial centers of California, faced with rising prices, shortage of personnel and long hours, demanded a stronger program.10 They found hospitals unwilling to voluntarily raise salaries to help relieve the situation. Since the Association efforts were initially unsuccessful, some nur- ses joined unions. Others left the profession, and normal replacement lagged. In October, 1942, the War Labor Board 9Leo B. Osterhaus, "The Effect of Unions on Hos- pital Management" Hospital Progress Vol. 48, Part 2: "Factors Stimulating and Inhibiting Unions" (July, 1967), p. 90. 10Herbert R. Northrup, "Collective Bargaining and the Professions," American Journal of Nursing_Vol. 48 (March, 1948), p. I42; Osterhaus, op. cit., p. 90. was ordered by President Roosevelt to limit all wage in- creases except where substandard or flagrantly inequitable conditions prevailed. Wage control heightened the nurses' problem. Low salaries were agravated by the rise in the cost of living. To obtain salary adjustments required approval by the War Labor Board. During the wartime economy of the early 1940's, the necessity of collective action was recognized by sev- eral of the state nurses associations. Its effectiveness had been demonstrated by others. The pioneers in this development was the California Nurses Association. Under the leadership of Shirley C. Titus, executive director, the California Nurses Association set a precedent by act- ing as the collective bargaining agent for nurse groups in California with highly effective results.11 To get salary adjustments for the nurses, the California Nurses Association had to make its requests through the War Labor Board. This the California Nurses Association did with the members overwhelming support. The CNA obtained from the War Labor Board a 15 per cent "Little Steel" increase in salaries. The state hospital association had been in— vited to join them in its request before the War Labor 11ANA Manual for an Economic Security Program, 2nd ed., Economic Security Unit, 1956, p. 2. 12 Board but had refused. The CNA went to the WLB acting "in full dignity as a professional organization and not as a labor union."13 Following this success, the CNA con- tinued to develop its economic security program to include the negotiation of contracts. The CNA signed contracts with hospitals and industrial plants employing nurses. Its first contract was negotiated in 1946.14 Though California had made some progress in im- proving working conditions for its nurses, working condi- tions still remained highly distressing generally through- out the country. The ANA had relied upon education and persuasion techniques to bring about reasonable working conditions, but this approach had not proved to be very effective. Limited gains had been made, but nurses' sal- aries lagged far behind those of workers with less prep- aration and less responsibility. The nurses had to accept what was given to them, for they were not provided with a real opportunity to participate in the determination of 12Herbert R. Northrup, "Collective Bargaining and the Profession," American Journal of Nursin Vol. (March, 1948), pp. 142-143; editorial, Long on Funds-- Short on Personnel," American Journal of Nursinngol. 43 (July, 1943), p. 618; "W.L.B. Approves Salary Standards of California State Nurses Association," American Journal of Nursing Vol. 43 (July, 1943), p. 951. l3editorial, "Long on Funds--Short on Personnel," American Journal of Nursing Vol. 43 (July, 1943), p. 688. 14Manual for an Economic Security Program, 2nd ed., ANA Economic Security Unit, 1956, p. 2. 10 the conditions under which they worked. What did this amount to? A summary of the results are: (1) Employment conditions for nurses have not kept up with rapidly changing conditions - rarely have they kept pace with changes in the cost of living; (2) Nurses are restless and dissatisfied, and becoming increasingly articulate about their need for better economic conditions; and (3) Most serious of all, nursing service is endangered both in quality and quantity - because of present un- satisfactory economic and personnel policies. 5 The successful California experience provided the impetus for the ANA to explore the possibility of collec- tive bargaining by its other state affiliates. The nurses employed in hospitals wanted action. Indeed, a few rebel- lious nurses had joined trade unions. By 1944, when the oANA House of Delegates met in Buffalo, the question "could the basic economic problems of professional workers be solved through collective bargaining" was more than an academic interest to many delegates.16 It became recog- nized that improving nurses' employment conditions could be done effectively only by democratic group action. Thus, in 1946, the ANA convention gave overwhelming approval to a nationwide collective bargaining program. As a result of the pressures from within the profession, ANA has come 15"The ANA Economic Security Program," American Journal of Nursing Vol. 47 (February, 1947), p. 71. 16Mary M. Roberts, American Nursing: History and Interpretation (New York: the Macmillan Co.), 1954, p. 405. 11 to accept collective bargaining as a means to improve nur- ses' working conditions. This acceptance was made without developing any formal alliances with organized labor. Fur- thermore, ANA takes the official position that it should not be considered a labor union.17 The introduction of collective bargaining merely alters one of the means of achieving its goal of economic security. It does not alter the goal itself. It is not new for the professional association to take an interest in the economic welfare of its members. It has been of continuing concern. It is the method - collective bar- gaining - that is new. Overview of ANA's Economic SecurityjProgram Founded in 1896, the purposes of ANA have always been to foster high standards of nursing practice, to pro- mote the professional and educational advancement of nur- ses, and to promote the general welfare of nurses to the end that the people of this country will have the best possible nursing care. Thus, since the ANA was organized, its members have believed that in order to produce quality 17Archie Kleingartner, "Professional Associations: An Alternative to Unions?" in Contemporary Labor Issues, eds. by Walter Fogel and Archie Kliengartner (Belmont, California: Wadsworth Publishing Co., Inc., 1966), p. 250. 12 nursing care satisfactory working conditions are necessary. Over the years it became more and more apparent that the exercise of leadership necessarily involved more than the use of persuasion and the making of suggestions for im- provements. These procedures were not producing the de- sired results. Though recognized by society in general as an ef— fective methodfbr obtaining economic security for employed groups, the field of industrial relations and the philos- Ophy of collective action were new concepts for most nurses when applied to their own situation. Along with the rec- ognition of the need and the right of nurses to better em- ployment conditions came the recognition that nurses could not realistically depend on others to bring about improve- ments in their economic status. With the adoption of the economic security program by the 1946 House of Delegates, the ANA acknowledged its responsibility to assume stronger leadership in improving the economic position of its members. Acting upon this accountability, the ANA House of Delegates in 1946 adOpted the economic security program as follows: The American Nurses' Association believes that the \\ several state and district nurses associations are qualified to act and should act as the exclusive agents of their respective memberships in the impor- tant fields of economic security and collective bar— gaining. The Association commends the excellent 13 progress already made and urges all state and district nurses associations to push such a program vigorously and expeditiously. Since it is the established policy of other groups, including unions, to permit membership in only one collective bargaining group, the Association believes such policy to be sound for the state and district nurses associations. The broad goal of the ANA economic security program is to improve the economic status of the nursing profession by establishing the right of nurses to a voice in decisions concerning the conditions under which they will practice their profession. Specifically, the two main purposes of the program are: (1) to secure for nurses, through their professional associations, protection and improvement of their ec- onomic security - reasonable and satisfactory condi- tions of employment; and (2) through accomplishing this, to assure the public that professional nursing service, of high quality and in sufficient quantity, will be available for the sick of the country.19 ,// The goals of the economic security program included wider acceptance of the 40 hour week and the establishment of minimum employment standards; increased participation of nurses in the actual planning and administration of nursing service; development of state nurses associations in their role as exclusive spokesmen for nurses in matters affecting 18"The ANA Economic Security Program," American Journal of Nursing Vol. 47 (February, 1947), p. 70. lgIbid. 14 their employment; the development of collective bargaining techniques by state associations; the restriction of mem- bership of a nurse to only one organization which can act as a bargaining agent; and the elimination of employment barriers against nurses in minority racial groups.20 ANA firmly endorsed collective bargaining as a means to improve employment conditions for nurses. This endorsement was made clear when the 1946 House of Delegates adopted the economic security program. IThe state nurses associations "should act as the exclusive agents of their respective memberships in . . . collective bargaining."21/ The ANA encourages participation in collective bargaining whenever and wherever possible. However, it cautioned thattNCollective bargaining is not an end in itself. It is not the Economic Security Program. It is only one of the instruments which may be used for the achievement of the program."22j With this caution, ANA places high priority in promoting collective bargaining. A policy adOpted in 1948 called upon the state associations to refrain from enter- ing into “joint programs for economic security for nurses" 20See Initiation of Program, policy adopted by the ANA House of Delegates, September, 1946. 21"The ANA Economic Security Program," American Journal of Nursing Vol. 47 (February, 1947), p. 70. 22Ibid. 15 with state hospital associations on the basis this could bring charges of company unionism.23 There should be only a clearly responsible relationship, founded on democratic principles - no collusive or paternalistic relationships. Furthermore, the ANA called upon the American Hospital Association and its constituents to join them in imple- menting collective bargaining procedures in all hospitals.24 ANA asks that the nurses be granted the rights of collec- tive bargaining enjoyed by other members of society. ANA efforts to extend collective bargaining in- cluded seeking legislative protection of this right for nurses. It has exerted pressure on federal and state leg- islative bodies for favorable legislation. Almost as soon as it was passed, the ANA has sought the removal of the exemption of nonprofit hospitals from the Taft-Hartley Act.25 To strengthen their economic security programs, state associations are urged to promote . . . 1) the elimination of the principle of exemp- tions of hospitals from existing state labor relations laws; and 2) the enactment of comprehensive state labor 23Policy approved by the ANA Board of Directors and ANA House of Delegates, May, 1948. 24Resolution approved by the ANA Board of Direc- tors, June, 1958. 25Resolution approved by the ANA Board of Direc- tors, January, 1949. 16 relations laws to require collective negotiations be- tween employers and employees, including the employees' free choice of representation, and provision for media- tion and arbitration."2 Furthermore, the concept was incorporated into their Code of Ethics. The ANA House of Delegates in June, 1958, adOpted a recommendation authorizing the revision in the code of ethics that nurses should participate in es- tablishing terms and conditions of employment as a part of their ethical duty to maintain professional standards. This action stressed the professionls feelings that con- certed action by the professional association is apprOp- riate and necessary if it is to discharge its responsibility to the public.27 By such action, ANA committed itself to the principle of collective bargaining. Although ANA strongly encouraged collective bar- gaining as a means to improve employment conditions, it does not endorse striking as a weapon of the collective bargaining process. IA "No-Strike" policy was adopted in 1950 stating that nurses voluntarily relinquish the right to strike.28 But, in return, it was felt this imposed upon employers an obligation to recognize and deal with 26 May, 1956. 27ANA Interpretation of the Statements of the Code For Professional Nurses. Policy adopted by the ANA House of Delegates, 28Policy adopted by the ANA House of Delegates, May, 1950. 17 nurses through their authorized representatives. They recognized their responsibility to provide continuous nursing service to the public - to meeting the health needs of hospitalized individuals. At the same time, they asked the employers to acknowledge their responsi- bility in providing good working conditions for their employees in order that the mutual goals of quality pa- tient care can be obtained. To achieve the purpose of the economic security program, nurses have voluntarily relinquished the right to strike. All other customary and appropriate means would be used including collective bargaining. In conjunction with the "No-Strike" policy, the ANA has adopted a "Nurses in Dispute" policy to act as a guide for nurses' conduct during dispute between employers and non—nurse employees. In effect the nurses are expect- ed to "maintain a scrupulously neutral position" in any disputes involving other hospital employees.29 In other words, they should avoid any participation in activities which would influence the outcome of the dispute. In case of a strike, the nurses, in their neutral position, would continue to perform their distinctive nursing functions and would not accept the assignment of duties normally 29Policy adOpted by the ANA House of Delegates, May, 1950. 18 discharged by non-nurse personnel "unless a clear and pres- ent danger to patients exists." In reality this would be a most difficult, if not impossible, position to maintain. It is clearly defined that maintenance of hospital facil- ities is not a nursing duty. Even today, mopping and wax- ing the floors or doing the laundry may be considered by some to be nursing duties. In meeting the patient's phys- iological needs for food there exists some ambivalency towards fulfilling dietary functions. While recognizing their own and others rights in collective bargaining, the nurses were concerned that individuals receiving their services should suffer as little as possible in labor disputes. (In advocating exclusive representation for nurses, the ANA has appropriately adOpted the policy "to permit membership in only one collective bargaining group."30 This policy meets the requirements of labor relation laws which recognize only one exclusive representative for an appropriate bargaining unit. The question of dual member- ship had been raised since some nurses already were members of unions. Therefore, the matter had to be made clear. Holding membership in other organizations is neither ap- proved nor disapproved but simply discouraged when the 30Policy initiating the program, adopted by the ANA House of Delegates, September, 1946. 19 activities of such organizations are in direct competition with the ANA economic security program. The policy does not sanction the barring of union nurses from association membership unless the particular state association is con- ducting an active bargaining program. For the nurse can have only one exclusive representative in collective bargaining. (In following the principles and concepts of col- lective bargaining, the ANA does not appoint nurses who hold the position of hospital superintendent or adminis- trator to its Committee on Economic and General Welfare.31 This follows the policy for state associations in their relationship to hospital associations. To avoid the pos- sibility of a conflict of interests or charges of company domination or a. collusive relationship, nurse hospital administrators are prohibited from serving on this econ- omic security program committee. [The ANA itself does not engage in collective bar— gaining. Collective bargaining is the responsibility of the state associations. In implementing the program, ANA provides general direction and assistance to the state associations in developing and administering an economic 31Policy approved by ANA Board of Directors, August, 1949, and reaffirmed in June, 1961. 20 32 To carry out this function, an econ- security program. omic security unit with staff personnel was established at the ANA headquarters in New York. The ANA staff help the states by assisting them in developing educational programs and workshops; by providing consultation services and tech- nical advice in specific situations; by furnishing data not available at the state level; and by coordinating and collecting facts and other information pertinent to the program. Recently the state associations bargaining activi- ties have increased. Consequently, they have sought more assistance from the national headquarters. In response to these requests, the ANA has taken steps to give greater assistance to the states by becoming directly involved in bargaining activities. Whereas previously ANA had merely given support to the states, it is now entering into bar- gaining activities. In May, 1967, ANA decided it would assist with the representation of the 20,000 nurses em— ployed by the federal government.33 The staff member as- signed to handle the interests of federally employed nurses 32ANA A Manual For an Economic Security Program, 2nd ed., prepared by Economic Security Unit, January, 1956' pp. 3-40 33"ANA to Help States Bargain with U. S. Agencies," American Journal of Nursing Vol. 67 (July, 1967), p. 1369. 21 would provide information on regulations and agencies in Washington; would inform states about developments in other states; and would give field assistance to state staffs in organizing local units and in negotiating agreements. There are several problem areas which generally hinder the successfulness of the ANA economic security program. Obstacles impeding the progress of the program have been listed by Kruger to include the attitude of the nurses themselves; employer resistance; and inadequate . legal protection.34 To these, Archie Kleingartner adds lack of an effective economic weapon (no substitute for the strike); several organizational weaknesses; and too many other programs.35 The Opposition from most hospital employers seems to be the single greatest obstacle to implementation of the economic security program. Hospital employers are greatly influenced by the national and state hospital associations. The American Hospital Association has taken the position that voluntary nonprofit hospitals should not only continue to be exempt from the Taft-Hartley Act but also should be exempted from all collective bargaining 34Reprint from MonthlyLabor Review, Vol. 48 (July, 1961), Daniel Kruger, "Bargaining and the Nursing Profes- sion." 35Archie Kleingartner, "Nurses, Collective Bargain- ing and Labor Legislation," Labor Law Journal Vol. 18, (April, 1967): PP. 243-244. 22 36 The state hospital associations have legislative acts. been effective in implementing the AHA position on collec- tive bargaining. In addition, the hospital associations provides tremendous resources to individual hospitals that are resisting recognition.37 However, it is felt that a new generation of more enlightened, better educated hos- pital administrators now appearing may reduce this opposi- tion somewhat. Legislative protection would indeed enhance the nurses organizing and bargaining activities. The lack of favorable legislation however has not prevented several states associations from gaining recognition and engaging in collective bargaining. The attitude of the nurses themselves has been one of apathy. Furthermore, it has been observed "many members of the nursing profession are satisfied to accept uncrit- ically the subordinate-dependent position in an authori- tarian relationship."38 Though economic security program 36Leo B. Osterhaus, "The Effect of Unions On Hos- pital Management," Hospital Progress Vol. 48 (June, 1967), p. 72. 37Anne Zimmerman, "SNA Experiences with Collective Bargaining'fromlddresses on Trends Affecting_the ANA Econ- gmic Security Program, ANA Economic Security Conference, December 5-9, 1960, published by ANA ECU, 1961, p. 29. 38Harold L. Sheppard and Audrey P. Sheppard, "Pa- ternalism in Employer-Employee Relationships," American Journal of Nursing Vol. 51 (January, 1951). 23 activities have increased, the nurses, as a group, still show an unwillingness to promote collective bargaining. These factors limit the success of the program. Without a substitute for the strike, the program lacks an effective economic weapon. Recently, however, the trend has been developing towards an increasing use of mass resignations. Mass resignations are a drastic step for the nurses. It is even more drastic for employ- ers when the nurses are able to obtain readily positions in other nearby hospitals. Two state associations, Calif- ornia and Pennsylvania, have recinded the no-strike pledge in order to put more teeth into their bargaining activities.39 Several organizational weaknesses and too many other programs are serious problems. Organizational weak- nesses include lack of financial resources, inadequate communication among the different levels of the organiza- tion, and the practice of state affiliates of not entering a local situation until requested by the nurses. It ap- pears that the ANA is trying to do too much. Collective bargaining is just one aspect of the economic security program. And, the economic security program is only part of the total program for the economic and professional 39"Pennsylvania Nurses Rescind No-Strike Pledge" American Journal of Nursing Vol. 66 (November, 1966) and White Collar Report 502, A3, October 20, 1966. 24 enhancement of nurses. Other programs include Research, Professional Creditials and Personnel Services, Legisla- tion, Clinical Conferences, Professional Registries, and Public Relations. As a result, no part of the program receives adequate attention. Also, too many programs di- lutes the available resources which in turn limits the scope of any one program. There are positive aspects to the ANA economic security program. These have been summarized by Archie 40 The commitment to the idea of collective Kleingartner. bargaining as the best method to improve employment condi- tions resolves the debate over means which paralyze many professional organizations. The nurses receive favorable public sentiment in their attempts to increase collective action. There is an increased feeling among nurses that they can do something about their working conditions through organization. The ANA has taken steps to develop skilled leaders in organization and in negotiations. In- formation on the economic security program has been commu- nicated to the public and general membership. The ANA has not hesitated to use experienced "non-nurse" professionals and consultants for their purposes. Since the ANA is the single dominant organization representing nurses in all of 40Archie Kleingartner, "Nurses, Collective Bargain— ing, and Labor Legislation," Labor Law Journal Vol. 18 (April, 1967): Pp. 243-244. 25 their job and professional problems, there exists no sharp rivalry for members and representation as in other salaried professionals, such as the teachers. The ANA has been fairly successful in combining its responsibilities for the economic and professional enhancement of its members. While maintaining their other programs, improvements have been made in the nurses economic status. Since the pro- fessional organization conducts the negotiations, the pol- icies and procedures are uniquely related to the needs of nurses and their employers. MNA'S ECONOMIC SECURITY PROGRAM 1959-1965 Structure of MNA's Economic Security Program The Michigan Nurses Association plays a unique role in the profession's program for economic security. While the ANA provides policy direction, moral support and technical assistance, and the district nurses asso- ciation interprets the program to nurses and the public, MNA represents nurses in their efforts to improve employ- ment conditions and establishes the recommended employ- ment standards. The district nurses associations are constituents of MNA. Each of the 50 MNA districts elects one delegate for everyfifty members to the MNA House of Delegates. Districts with less than fifty members elect only one del- egate. The district conducts continuing education prog- rams, serves as spokesman for nurses in the local commu- nity's concerns with general health and welfare of the~ community and recruits members into the association. The districts encouraged and promoted MNA's economic security program. 26 27 It is through the state occupational sections that members formulate employment standards and institute prog- rams to implement them. Thus, the structure of any state association should be such that the arrangements both pro- vide for democratic participation of members of all occupa- tional groups and protect the rights of each group to con- sider and vote separately on matters affecting conditions of their work. When a nurse joins MNA, she becomes a member of an occupational section which is based upon place of employ- ment or position in the employment situation. MNA has seven occupational sections: general duty nurses; head nurses; nursing service administrators; public health nur- ses; private duty nurses; office nurses; and educational administrators, consultants and teachers. Among other functions, each section is "to study the economic needs and general welfare of its members and develop desirable standards of employment."1 Each level of nursing studies and establishes its employment standards. The section executive committee appoints a committee to draft employ- ment standards which are reviewed and revised annually if necessary. The MNA staff advise and assist with drafting standards by compiling and interpreting related data and suggesting provisions to be considered. The suggested lMNA Bylaws Article XV Section 5 (d). 28 employment standards are discussed and voted on at the section's annual business meeting. The section chairman then presents the recommended employment standards to the Board of Directors. When approved by the Board of Direc— tors they become official. Each elected section chairman serves on the Board of Directors, thereby giving occupa- tional interests representation on it. The established sections contribute to the economic security program by continuing to review and revise statements on functions, standards and qualifications and the minimum employment standards of those nurses which are included in each re- spective section. The Committee on the Economic Security Program (ESP) has as its function to submit recommendations to the Board of Directors on policies and procedures for the ec- onomic security program; to evaluate the effectiveness of the program; make recommendations for the implementation of the total program; and recommend revisions in employment standards in accordance with section recommendations.2 The sections and the ESP committee worked together in studying employment standards and in the determination of what the employment standards for nurses should be. The committee reviewed the details related to the program, provided guidance as necessary and offered recommendations 2MNA Bylaws Article XIV, Section 8. 29 to the Board of Directors on policies, procedures, and problem situations. It also helped to plan educational programs relating to the economics of nursing and the economic security program. The Board of Directors, other than section chair- man, are elected by the House of Delegates. The Board of Directors are responsible for managing the affairs of the MNA. The Board establishes the policies to meet the Asso- ciation's goals and determine which objectives are to be given priority following the general direction of the House of Delegates. Through budget approval, the Board of Direc- tors affect the priorities and maintains in balance the many programs needed to discharge its responsibilities to the members. In addition, the Board of Directors acts upon the recommendations and requests sent from the various committees and sections. The Board of Directors appoints the standing committees which assume specified and assigned duties, such as the Committee on the Economic Security Program. It is thus the Board of Directors which is di- rectly responsible for the total over-all administration of the Economic Security Program. The Board of Directors analyzes all the programs of the MNA and their relationship to one another. Any im- plications for the economic security program are consi- dered in the development and adaptation of plans for all its proqrams. The Board of Directors appoints the 30 executive secretary who supervises the administration of the program. They provide for the services of legal, in— dustrial relations, public relations and other consultants as needed. It is their responsibility to provide adequate financial resources for the implementation of the economic security program. They appoint the Committee on Economic Security Program with the duties previously stated. The actual activities of the ESP program are as- signed to one of the professional staff. The Board of Directors in April, 1960, appointed Avis Dykstra as the assistant executive secretary responsible for carrying out the program's activities. The assistant executive secretary directed the program, recommended changes or additions necessary for its proper fulfillment and kept the Board of Directors informed. She assisted the sections in the preparation of employment standards and gave guid- ance in their distribution and use, as well as handled the printing and mailing of them. She set up procedures to keep the program functioning smoothly and efficiently. She maintained official records and files of basic and related facts - salary data, case histories, etc. Field service was provided to groups of nurses who requested help with employment problems. Briefs and supporting data were compiled for presentation to employers. She served as the chief spokesman when representing groups of nurses; appeared at districtmeetings speaking on the economic 31 security program; conducted surveys of the employment con- ditions for nurses in Michigan; and called upon the consul- tants when needed for their advice and assistance. She worked with two very important committees - The Committee of the Economic Security Program and the Michigan Nurses Association - Michigan Hospital Association Liaison Committee . Industrial relations, public relations and legal consultants were employed by the MNA. The industrial re- lations consultant, Daniel H. Kruger, assistant director, Industrial Relations Center, Michigan State University, at that time, began his services with MNA in November, 1959. The industrial relations consultant conducted sur- veys on the economic status of nurses; wrote articles about the program for the MNA's official publication, the Michigan_Nurse; spoke to groups of nurses on the program; and participated in ESP workshOps. He provided valuable services in the guidance and direction of the program by supplying his experience in research and in the use of economic data. He met frequently with the Committee on the Economic Security Program and the MNA-MHA Liaison Com- mittee and was called upon quite often for advice on the employer-employee relationship problems. Public relations is an essential part of the econ- omic security program. In this area, the services of Mrs. Kay Fuller were acquired in early 1960. Not only was she 32 instrumental in keeping members informed through articles in the Michigan Nurse but also extremely helpful in publi- cizing the nurses' economic story in the public press and other news media. Public relations media was used to in- terpret the need for improved employment conditions and to tell this story as widely as possible. Though MNA did not retain legal consultant speci- fically for the economic security program in the first few years of its operation, they did have legal services avail- able if needed. As for the nurses themselves, they participated in the establishing of employment standards in a democratic fashion as explained under the role of the occupational sections. The program requires the full support and in- terest of the nurses. The sc0pe of the program's Opera- tions, in part, depends largely upon the specific requests from nurses for assistance with problems related to employ- ment conditions. As Patricia Walsh, president, MNA, wrote in 1960 "In order to realize the broad goals that are en- visioned in this new program, we place high value on the contribution, interest, support and participation of every member of the Association. In fact, every nurse employed in Michigan has a role in this."3 Recommended employment 3Patricia Walsh, "The What and Why of the MSNA Economic Security Program": Michigan Nurse Vol. 33 (May- June, 1960), p. 61. 33 standards generally are not put into effect unless the nurses themselves work to do so. Only when the nurses joined together to seek MNA help could MNA take an active part in a local agency to bring about improvements in em- ployment conditions. Development of the Program Before initiating any new program, an extensive preliminary preparation usually occurs. A conditioning process to set the stage for a major change in organiza- tional activities takes place. ANA adopted its program in 1946. Twelve years elapsed before Michigan Nurses Association initiated the program recommended by the na- tional association. This long delay was due to the atti- tudes of the nurses. To the Michigan nurses, the ANA pro- gram advocating collective bargaining was too highly controversial and generally unacceptable.4 During these 12 years, the economic security aspects for nurses in Michigan were not being overlooked entirely. But, the methods used by the MNA to improve employment conditions for the nurses were not getting effective results. 4Letter to Mrs. Margaret B. Dolan, R.N., pres- ident, ANA, from Avis J. Dykstra, dated March 31, 1964. 34 Along with keeping current.on employment conditions for nurses, the methods used were primarily recommendations and persuasion.5 As noted each occupational section in the MNA prepared and adOpted recommended personnel policies for that section. At periodic intervals, each occupation- al section would review and make revisions as needed. The recommended personnel policy booklets were helpful in ad- vising employers of the employment standards set for nur- ses. However, they were not sufficiently effective, since the adoption of the recommended policies were strictly voluntary by the employers.6 There appears to have been no real systematic plan of action. Assistance was given to groups of nurses in writing personnel policies for their institutions and in interpret- ing them to the employer.7 Also, at the request of the hospital administrator, the MNA would give guidance and assistance to the administration in preparing personnel policies. Though there was some accomplishment towards the improvement of the economic status of professional nur- ses, an analysis of the employment conditions of nurses in Michigan Hospitals showed much more needed to be done. 5"Progress on MSNA's Economic Security Program," Michigan Nurse Vol. 32 (January, 1959), p. 15. 6"Annual Reports of Michigan State Nurses Associa- tion: Report of the Office Staff," Michigan Nurses Vol. 31 (September, 1958), p. 107. 7"Progress on MSNA's Economic Security Program," Michigan Nurse Vol. 32 (January, 1959), p. 15. 35 In early 1953, a committee on economic security consisting of three members was appointed, but it was only to be activated when matters pertaining to the economic security program arose.§ The committee's principle func- tion was to review the personnel policies yearly. The act was recognition of a need for action but it in itself was not strongly positive. Some members were aware that a stronger course of action for bringing about improvements in employment stand- ards was needed. 'During this period, the MNA president and staff members attended the ANA economic security work- shOps held annually. The leaders were becoming more con- scious of the problems and were recognizing the need for an economic security program, as advocated by ANA. But, they wanted to find a "dignified fair approach" to the problem from within the profession. It was up to each state nurses association to adOpt the ANA economic secu- rity program. It was the state's responsibility to repre-, sent the nurse. But, to have such a program required the support of the nurses themselves. The leadership, however, must supply the guidance and direction. It is part of Itheir duty to prepare the nurses for making changes and keeping them informed on current trends and developments. 8Emma Antcliff, "Economic Security," Michigan Nurse Vol. 25 (May, 1952), p. 75. 36 After attending an ANA economic security workshop in September, 1952, Mrs. Emma J. Antcliff, president, MNA, wrote in her report to the membership "as MSNA continues to consider this responsibility, the membership must con- tribute their views as well as financial support to a pos- _sible program within our state that will serve as a chal- lenge to present and prospective nurses."9 The need for a more positive and active program had been recognized by the leadership. This is the first step towards a well de- veloped sound program. The second step is to create an understanding of the program among the membership. The membership had to see the need for and desire to have such a program before it can be effectively instituted. The members had to become aware of the trends in society to fully accept the philOSOphy and approach suggested by ANA. Lack of understanding leads to the unacceptability of a program. As was pointed out in the Fall of 1952 by Mrs. Porter, president, ANA, in her address to MNA's advisory council, no other program was so little understood as the ANA Economic Security Program. And that, furthermore, "Nurses should move along with the trends of time."10 This-was true of the Michigan nurses. 9Emma J. Antcliff, "ANA Economic Security Workshop" Michigan Nurse Vol. 25 (November, 1952), p. 139. 10"ANA President Stresses Democratic Action and Need for Well-Informed Members" Michigan Nurse Vol. 26 (January, 1953), p. 30 37 The ANA had adopted a program of collective action in recognition that this was an effective means to achiev- ing its goals. But, the Michigan nurses had not fully awakened yet to the realities around them. The time had passed when an individual nurse could act alone to improve her employment conditions. It was growing very apparent that collective action was necessary. An individual nurse needed the support and backing of all the nurses - the professional organization. But, it was up to the member- ship to decide whether action should be taken. Since no action was taken at this time one must assume the nurses were not quite ready to proceed forward with an aggressive program. It was still too controversial and generally unacceptable. The wheels turn however slowly. As previously, the MNA staff continued to give assistance to members on matters relating to personnel policies when requested. Little progress can be made however by stamping out little fires here and there. Or, waiting for requests which usually come when the situation reaches a desperate point. It was not until early 1957 that the wheels really began to move. The leaders began to plan a definite ed- ucational campaign as a preliminary stage in preparing to adopt an economic security program. At the MNA Board of Directors meeting on April 16, 1957, plans for an economic security program workshop were discussed. And, the Board 38 of Directors decided to hold three workshops in June that year for the Board of Directors and district officers.ll An editorial stressing an economic security program ap- peared in the same issue of the Michigan-Nurse.12 To make sound decisions or to plan a course of action, an indivi- dual needs information. WorkshOps and staff visits to district meetings were methods used to inform members on the need for an economic security program. Comments on an economic security program began to appear regularly in the MNA's official publication, the Michigan Nurse, a year prior to the adoption of a program in 1958. The membership had to be informed and prepared to debate the issue. They were the ones to make the deci- sion whether a program would.be adopted or not. In her report to the membership, Phyllis MacKay, president, MNA, explicitly pointed out "At some date in the near future a decision should be made as to the adoption of a more active 13 program in this state. They were also "urged to become ll"Board Highlights," Michigan Nurse Vol. 30 (June, 1957), p. 89; and "MSNA Sponsors Economic Security Work- shops," Michigan Nurse Vol. 30 (June, 1957), p. 89. 12editorial, "The Economic Security Program and the Nurse," Michigan Nurse Vol. 30 (June, 1957), p. 82. . l3Phyllis MacKay, "Report of President," Michigan Nurse Vol. 30 (September, 1957), p. 104. 39 familiar with the details of this program and call on the MSNA Staff for assistance with needed information."14 Members were informed about current situations and events. The situation was demanding a more effective means for improving nurses working conditions. In their annual report in September, 1958, the staff told the mem- bership "a constructive, effective program of improving A the economic status of the professional nurse is rather imperative."15 The stage had been set. It was clear that an eco- nomic security program would be a top issue at the 1958 MNA convention in October. Every effort had been made to convince all nurses of the importance of the program. Be- fore the nurses made their decision, the topic was well covered at the convention by such speakers as William Haber, professor of Economics, University of Michigan, and May Bagwell, consultant in Industrial Relations and Eco- 16 nomics, ANA. The issue was resolved by the members au- thorizing the adoption of an economic security program.17 4"Report of Office Staff," Michigan Nurse Vol. 30 (September, 1957), p. 107. 15"Annual Reports of Michigan State Nurses Associa- tion: Report of Office Staff," Michigan Nurse Vol. 30 (September, 1957), p. 107. 16From the program of the Michigan State Nurses Association, Annual Convention, October 29-31, 1958; and "Program MSNA Convention" Michigan Nurse Vol. 31 (Septem- ber, 1958), p. 113. 17"Some Convention Highlights," Michigan Nurse Vol. 31 (November, 1958), p. 150. 40 The members voted that "an Economic Security Pro- 18 and that the MNA dues be in- gram be started by MSNA," creased from $10.00 to $15.00. The increase in dues would be used for expanding all MNA activities and for the adop- tion of an economic security program.19 Immediately following the 1958 MNA convention, the Board of Directors appointed a special committee on Eco- nomic and General Welfare to study the problems related to employment conditions and to present recommendations for policies and procedures to be used in the economic security program. The first two years following the action of the 1958 MNA convention may appropriately be called the plan- ning stage. The special committee on Economic and General Welfare began studying the situation and developing rec- ommendations for policies and procedures in order to get the program in operation. The committee under the chair- manship of Mary M. Weinschreider, received guidance and help from Hazel Gabrielson, then executive director, MNA. While the committee was busy at work developing guidelines for the program, nurses were being more fully informed about it. Direct assistance to nurses continued as in the past. 8Manual of the MichiganIState Nurses Association Program For Improying PersonneITStandards for Professional Nurses, prepared July, 1960, p. 3. lgIbid., p. 3. 41 To get assistance the nurses employed in an agency were requested to do the following: 1. Write a letter to the MSNA office stating specifi- cally the problems upon which assistance is needed. 2. Since MSNA membership status of the nurses employed in that agency needs to be ascertained, a list of the employed nurses must be supplied to the MSNA offices. It is required that more than 50% of the nurses em- ployed in the agency must be members of MSNA before any assistance can be given. Upon request, the MNA staff would proceed according to the demands of the individual situation presented and in accor- dance with the guidance given them by the Special Committee on Economic and General Welfare and the Board of Directors. The staff did provide assistance in response to several requests.21 During 1959, the Special Committee on Economic and General Welfare met three times and developed some suggest- ed additional policies. The policies developed were: 1. That all agencies be encouraged to have written personnel policies. There should not be separate sets of policies for the nurses, other than those for other employees of the agency. 2. The Director of Nursing should always be informed and included in all activities when nurses are writing or revising personnel policies. 3. When a group of nurses want assistance with im- provement of personnel policies, they are to submit their request in writing to the MSNA office. 20"In Unity There is Strength," Michigan Nurse Vol. 32 (May-June, 1959), p. 78. 21"Report of MSNA Staff," Michigan Nurse Vol. 32 (September—October, 1959): p. 120. 42 4. No assistance can be given to any area agency un- less more than 50% of the nurses employed are members of the MSNA. A total list of nurses employed in any agency wishing assistance must be submitted with the request for assistance to the MSNA office. Specific recommended personnel policies were also develOped. The program was actually slow in being activated. Although the membership had voted in 1958 to start a pro- -gram, it was 1960 before the program really got underway. One of the greatest deterrents was to find a qualified professional nurse who would step into this relatively strange and rather foreign role. While the year 1959 was spent developing policies, ‘in 1960 MNA worked on the implementation of the economic security program. In April, 1960, Avis Dykstra, R.N., joined the MNA staff with the responsibility to administer the program.23 The special committee, working with Miss Dykstra, developed a manual to serve as a guide for the program. It was accepted by the Board of Directors on August 17th. The Manual of the Michigan State Nurses Asso- ciation Program for Improving Personnel Standards for Pro- fessional Nurses was distributed to all the members attend- ing the 1960 MNA annual convention. The contents of the 22" . . Annual Reports of MSNA: Spec1a1 Committee on Economic Security Program," Michigan Nurse Vol. 32 (Sep- tember-October, 1959), p. 138. 23 "Report of the MSNA Staff," Michigan Nurse Vol. 33 (September-October, 1960), p. 115. 43 manual included: its purpose; the basic belief and phil- osophy of an Economic Security Program; the development of Economic Security in the state; the role of ANA, MSNA, and the districts; and the policies and procedures as related to the program.24 A strong educational program has always been a vital part of the program from the very beginning. The foundation and success of the program, it was felt, de— pended on a well informed membership. This was emphasized in the introduction of the manual as it stated "to accom- plish the defined purpose of this program, constructive, cooperative action by a well informed membership will be 25 needed. In 1960, two special newsletters on the Economic Security Program in Michigan were sent to all members. Also, MNA sponsored four one-day conferences in Grand Rapids, Flint, Lansing and Marquette. The one-day confer- ences on "What is the MSNA Economic Security Program?" were held for directors of nursing, presidents of districts and executive committee members of all sections.26 24Proceedings of the MNA annual business meeting, October 5-7, 1960, "Report of the Special Committee on Economic and General Welfare." 25Michigan State Nurses Association, Manual of the Michigan State Nurses Association Program for Improving Personnel Standards for ProfessionaI Nurses, prepared JuIy, 1960, p. l. 26MSNA Proceedings of the annual business meeting, October 5-7, 1960, "Report of the Special Committee on Economic and General Welfare." 44 The educational program not only focused on inform- ing the membership of its own program but also on the gen- eral field of economic security. Towards this end, the universities were approached on offering non-credit courses to nurses on economics. Miss Katherine Faville, member of the Economic and General Welfare Committee, was instrumen— tal in getting one such course started in the College of Nursing, Wayne State University in 1960.27 The MNA also had to keep informed. MNA needed to have information on the employment condition for profes- sional nurses. The facts were necessary to set up the design of the program. Since the last survey to determine the employment conditions in hospitals and public health agencies was conducted in 1958, another survey was again. conducted in 1960.28 The surveys were an effort to collect more complete and up-to-date information on employment con- ditions for professional nurses. The program's course of action would be based on facts. To further implementation of the program the spe- cial committee appointed a subcommittee to study how the districts would participate in the program. The subcom- mittee was to investigate the feasibility of having local 27Ibid. 28Ibid. 45 committees on economic and general welfare organized in all districts, and the possible functions and activities that might be assumed by local committees. A pilot study in the fall of 1960 was conducted in five districts.29 A "Multi-dimensional" Approach MNA modified the ANA's approach to the economic security program. It developed what was called a "multi- dimensional" approach. In the specific design of the pro- gram, flexibility was stressed. The multiplicity of the problems involved in the economics of the nursing profes- ' sion coupled with the many goals of the MNA demanded a multiedimensional approach. The design of the program was influenced: by the goals which were set; by the progress in reaching them; by the support and interests of the mem- bers; by the specific requests from the nurses for assis- tance in employment problems; and by the resources of MNA- time, knowledge, funds and personnel.30 In providing its services to all nurses, MNA has tried to be as versatile 29Ibid. 3OPatricia Walsh, "The What and Why of the MSNA Economic Security Program," Michigan Nurse Vol. 33 (May- June, 1960),p. 60; Manual of the Michigan State Nurses Association Program forI ImprovingfiPersonnel Standards for ' Professional Nurses, preparédj JuIy, 1960, p. 2; and Avis J. Dykstra, "The First Five Years in the DeveloPment of Economic Security Programme," International Nursing Re- view, p. 46. 46 and flexible as possible and not be limited to any one approach but rather chose an approach to each situation which was most likely to succeed. As Avis Dykstra suc- cintly put it "We have not limited our program to any one single approach. We have left the door Open so that there 31 A multi-dimen- is always flexibility in our planning." sional approach provides flexibility - using means which best fits the situation. In his comments on MNA's program Daniel Kruger stated "it is this flexibility which accounts, in part, for its forward thrust."32 The basic approaches used for improving working conditions were education, shared information, consulta- tion and representation.33 'The program included an educa- tional program for the public, the nurses and the employ- ers. It also provided consultation services for directors of nursing and hospital administrators. A c00perative ap- proach was sought to resolve employment problems. The 31Proceedings of the annual business meeting, October 31, 1962, "Report of MSNA Economic Security Pro- gram" as presented by Avis J. Dykstra. 32Daniel H. Kruger, "An Approach to Improving Eco- nomic and Professional Status," Michigan Nurse Vol. 37 (January-February, 1964), p. 23. 33"A Statement of MSNA's basic approach in the Economic Security Program," November 29, 1962 (mimeograph); and MNA The District's Role in Promoting the Economic Se- curiterrogram, "Know Concepts and Approaches of MNA's Economic Security Program," April 22, 1964 (mimeograph), p. 3. 47 Program recommended that staff nurses have a voice in.the formulation of personnel policies through a staff commit- tee which should meet with the administration periodically, and give support and help to the director of nursing in her efforts to improve salaries and working conditions. If this approach did not produce results, the staff nurses would seek assistance from MNA. In some instances, the nurses should request MNA to be their spokesman. MNA did not rely on collective bargaining complete- ly as a means to improve the nurses professional and eco— nomic status. It believed "There is a need and a plaCe for collective bargaining in selected situations, where other approaches have failed to improve the employment practices."34 Collective bargaining would be used when necessary. Without relying solely on collective bargain- ing the implementation of the above approaches did help the Michigan nurses to make advances towards their goals.[ Their goal was to improve the economic and profes- sional status of nurses to the end that quality patient care can be provided. The main purpose of the program is to improve employment conditions for nurses and to relate this program to other activities of the association. 34From "A Statement of MSNA's basic approach in the Economic Security Program," November 29, 1962 (mimeo- graph). 48 By doing so, it hopes to attract more young people into the profession, reduce turnover, eliminate competition between hospitals based on salaries, and improve the util- ization of nursing manpower. The policies related to the Economic Security Pro- gram have been reviewed and revised periodically. The Board of Directors has the primary responsibility for the total administration of the program. The Special Committee on Economic and General Welfare, later made a standing committee called the Committee on the Economic Security Program, provided guidance and offered recommendations to the Board of Directors on policies and procedures. A pro- fessional staff member was assigned to carry out the ac- tivities of the program. Though one staff member was assigned specific responsibility for the program, all the staff were to give attention to the over-all association activities relating to the program and to local groups of nurses who requested assistance. The program was run by registered professional nurses who were to direct the pro- gram towards the interests of registered professional nur- ses. The staff were authorized to call upon the consultants for assistance in the various phases of the program when necessary. IThe staff was authorized to respond to requests for assistance from groups of nurses in agencies even if the percentage of membership in the MNA was low. However, 49 before the staff could meet with the administration of the agency there had to be more than 50% membership in the association, among the full-time employed nurses. Two reasons were offered for this policy. The membership re- quirements were necessary to furnish financial resources in order to supply assistance. Then too it strengthened MNA's right to speak for the nurses - their members! It was important in avoiding the embarrassing question "How can you represent the nurses when so few are members?" The nurses when making their request to the MNA had to put it in writing. Signatures of the members had to be af- fixed to the request. A basic policy of the economic security program was that there should be written personnel policies in all 35 Efforts were made to have nurses places of employment. employed in an agency to be represented and to participate on the agency's committee to develop and/or revise an agency's personnel policies. It was recommended the per- sonnel policies be reviewed annually and revised as needed, and be made available to the staff. Participation on per- sonnel committees was a concrete demonstration of utilizing democratic methods in the decision-making process which the association was advocating. 35Manual of the Michigan State Nurses Association for Improving Personnel Standards for Professional Nurses, prepared July, 1960, p. 8. 50 A belief, so strong in fact that it can be class- ified as a policy, is that "nurses can best speak for 36 nursing." The professional association was to be the official spokesman for registered professional nurses. In 1962, the Special Committee on Economic and General Welfare reviewed a possible position on mass res- ignations. This action was prompted by the request of a group of nurses for assistance where the situation was such they were ready to resign their positions. The ANA had taken no official position on mass resignations. Mr. Charles Davies, acting chairman, presented to the members at the 1962 MNA annual convention the items the committee had formulated in relation to mass resignations. They were: 1. At this stage of our Economic Security Program we do not condone mass resignations as a threat to cripple the nursing services. Mass resignations, when used as a threat to the employer, constitutes a strike. 2. Mass resignations are implemented only after all other alternatives and resources for action have been explored. 3. Nurses who decide to resign en masse will write individual letters of resignation. They should fulfill their terms of employment and give prOper notification of resignation, clearly stating their reasons for leaving. 4. Where mass resignations are planned there should be orderly staggering of these resignations, for exam- ple, a two week advance notice, three week advance no- tices, four week advance notices, and in some instances, they might take as long as a three month period. 36Ibid., p. 2. 51 5. Mass resignations should be considered as termi— nating employment. This should not preclude re- employment if the nursing situation has improved, and the nurse chooses to re-apply for employment. The proceedings of the annual business meeting in which these were presented shows no evidence that any official House of Delegates action was taken. Rather in discussion of other issues they appeared to have been forgotten and overlooked completely. Though it appears the House of Delegates took no action, the Board of Directors did ac- cept the statements as formulated by the Committee on Eco- nomic and General Welfare.38 ESP Activities After a year of planning and developing policies, a program to educate the nurses on the economic security program's concepts and procedures was begun. In the Spring of 1960, the first conferences were held, primarily for the directors of nursing and district presidents and rep— resentatives, considered the leaders for other nurses. 37Proceedings of the annual business meeting, Oc- tober 31, 1962; "Report of MSNA Special Committee on Eco- nomic and General Welfare"; also see "Reports of MSNA Spe- cial Committees: Economic and General Welfare," Michi an Nurse Vol. 35 (September-October, 1962), p. 146; Luther Christman, "The Nurses Will Resign - Rather than Strike," Michigan Nurse Vol. 35 (September-October, 1962), pp. 153- 154. 38"Deliberations of MSNA Board," Michigan Nurse Vol. 36 (January-February, 1963), p. 5. 52 The four one-day conferences were to explain "What is the 39 These conferences were further MSNA Security Program." supplemented by institutes such as the one held in Decem- ber, 1961, co-sponsored by MNA and Michigan State Univer- sity. This institute covered such topics as: "A Critical Appraisal of Employment Practices for Hospital Nurses"; "Financing Medical Care"; and "Hospital Business in Mich- igan."4O Only a part of the total program, these confer- ences and workshops were efforts to implement the program through dissemination of the facts. By interpreting the facts it was hOped to create a greater awareness and the need to take measures to improve employment practices for nurses. They were attempts to gain greater influence in hospital administration through more knowledgeable direc- tors of nursing in order that they would be instrumental in making the changes needed. But, the directors of nursing were not the only ones to be educated. There were many other nurses too. The Board of Directors and the staff participated in nu- merous district nurses meetings to spread information 39"Report of the MSNA Staff," Michi an Nurse Vol. 33 (September-October, 1960), p. 115; and Report of Spe- cial Committee on Economic and General Welfare," as re- corded in the proceedings of the annual business meeting, October 5, 1960. 4 0"MSNA Staff Report," Michigan Nurse Vol. 35 (September-October, 1962), p. 131. 53 about the program.~ For example, in 1963 it was reported that formal presentation on the economic security program were given at eight district meetings and two state universities.41 To increase the nurses knowledge in the economics of the nursing profession non-credit courses were held by local universities in the field of economic security. In the Fall of 1960, the course "Labor Management Problems for Nurses" was conducted in the College of Nursing, Wayne State University. Focusing extensively on collective bar- gaining techniques, it was attended by nine registered nurses.42 It was repeated in the Fall of 1961. A similar course was offered at Michigan State University in the Spring of 1961. It was a ten week course on "Economics for the Nursing Profession" attended by seventeen regis- tered nurses.43 The courses were repeated regularly with increasing number of nurses attending them. In the Fall of 1965 Wayne State University conducted "Hospital Nurses 41"Annual Reports of Michigan State Nurses Associa- tion: MSNA Staff," Michigan Nurse Vol. 36 (September- October, 1963), p. 127. 2Proceedings of the annual business meeting, Oc- tober 5, 1960; and "Annual Reports of MSNA: Special Com- mittee Reports, Economic and General Welfare," Michigan Nurse Vol. 34 (September-October, 1961), p. 144. 43Proceedings of the annual business meeting, Oc- tober 19, 1961; and "Annual Reports of MSNA: Special Com- mittee Reports, Economic and General Welfare," Michigan Nurse Vol. 34 (September-October, 1961), p. 144. 54 Course in Labor Relations" with sixty—five registered nur- ses enrolled. Also, Michigan State University conducted a course entitled "Economics and Labor Relations in the Nurs- ing Profession“ with twenty-eight registered nurses partic- ipating.44 The strong interest developed on these tOpics had brought many requests for a repetition of the courses on economics for nurses. Since the adoption of the program, MNA has strongly felt the need for informing the public about the adverse conditions nurses were working under - the critical short- age of registered professional nurses, low salaries, im- prOper utilization of nursing personnel. It wanted the public, the users of nursing services, to know what they may expect by way of nursing care. They had a right to know why professional nurses found it difficult to provide the kind of care patients have a right to expect. MNA utilized every possible opportunity through various media to inform the public of the professional concern about the quality of patient care.45 44"Annual Reports of Michigan Nurses Association: MNA Staff," Michigan Nurse Vol. 39 (September-October, 1966): P. 8. 45Avis J. Dykstra, "What's Happening in ESP," Michigan_§urse Vol. 36 (March-April, 1963), pp. 35-36; andevis J. Dykstra, "The First Five Years - DevelOpment of an Economic Security Programme," International Nursing Review Vol. 12 (March-April, 1965), pp. 47-48. 55 A comprehensive public education program was beyond the means of MNA. When sources for funds failed to appear, MNA requested ANA to explore the possibility for a nation- wide public information campaign. This was done through a resolution submitted by MNA at the 1960 ANA convention. The resolution, which was passed, called for a national public relations campaign to pave the way for improving the economic status of nurses throughout the country.46 In 1962, MNA submitted another resolution at the ANA con- vention calling for ANA assistance in promoting a public information campaign. In response to this, ANA developed informational materials and slides to help focus public attention on the economic problems in nursing. These were distributed to and used by the districts with supplemental facts prepared by MNA.47 An MNA committee on public relations worked with Mrs. Kay Fuller, MNA public relations consultant, in the promotion of the program to the public. Regional confer- ences were held for district public relations representa- tives in order to help the districts in interpreting the 46Kay Fuller, "1960 Roundup - MSNA Style," Mich- igan Nurse Vol. 34 (January-February, 1961), p. 3. 47editorial, "Operation: Speak Up for Nursing," Michigan Nurse Vol. 36 (September-October, 1963), p. 122. 56 nurses problems to the public.48 From the very beginning MNA has considered this a vital part of its economic secu- rity program as did ANA. To give this aspect a strong start the theme of its 1959 convention was "Professional Progress Through Public Relations."49 In early 1960, an approach was made to the Michigan Hospital Association. It was felt apprOpriate to initiate and establish a more suitable working relationship and liaison activity with the Michigan Hospital Association.' MNA's main objective in developing liaison activity with the MHA was to provide an avenue of open communications with hospital administrators. It was an endeavor to help minimize misunderstandings and misinterpretations for both groups. The liaison activity was looked upon as a coopera- tive approach to help improve employment practices and to effectuate desirable changes. The discussions of the liaison committee centered around a variety of subjects. But, as may be expected, the focus was primarily centered on the nurses' concern for improved salaries and working conditions, particularly 48"Committee Reports; Public Relations," Michigan Nurse Vol. 35 (September-October, 1962), pp. 144-145; see also subsequent annual reports published in the September- October issues of the Michigan Nurse. 49"Michigan State Nurses Association Convention Program," as published in the Michigan Nurse Vol. 32 (September-October, 1959), pp. 131-132. 57 in the early period. As summarized from minutes and re- ports of these meetings the topics discussed covered: in- crease in nurses’ salaries; providing nurses with written copies of personnel policies; informing employees on the problems of hospital costs; retirement program for nurses; employment standards for regular part time employees; con- tracts; resolving a particular problem in a certain insti- tution; and legislation. Other areas of mutual interests were also discussed such as the need for working together for improved patient care; for more effective utilization of nursing personnel; and for changes in nursing education. It seems to be agreed that communications with the MHA did help to facilitate and expedite the hospitals implementing MNA's current recommended employment standards. There is no doubt there have been differences be— tween both groups. However, the opportunity for objective discussion of differences of opinion has been viewed as being healthy. The MHA however is a stronger more power- ful organization than MNA. As a consequence, the relation- ShiP between the two organizations has not been as equals. BUtr rather MHA has tended to dominate and have greater influence than the nurses would have preferred. The MNA-MHA liaison committee was unique and at- tracted national attention. A committee of this tYPe was not Cemmon to state nurses associations. At the 1964 MNA convention, Avis Dykstra reported that ten states had made 58 inquiries because of the national reputation of the suc- cessful working of this particular committee.50 In re— sponse to inquiries regarding the functions of this com- mittee, Dorothy Cornelius, executive secretary, Ohio Nurses Association, and first vice-president, ANA, attended the September 9, 1964, meeting of the MNA-MHA liaison commit- tee. She wanted to see at first hand the committee in Operation and determine how, if possible, to start similar committees in other states. Another aspect of the economic security program activities included conducting periodic surveys in order to assess the climate in which the ESP would be developed. In April, 1960, an opinion survey on registered nurse shortages and low salaries was sent to 1000 leading cit- izens and key groups throughout Michigan in the fields of 51 The cover letter government, health, and the press. solicited their understanding and support. They were asked their advice as to how they viewed nursing's economic problems and what they thought would be the most effective approaches for seeking improvements. Most responses 50From the proceedings of the annual business meeting of the MNA House of Delegates, October, 1964, "Report of the MNA-MHA Liaison Committee." 51Kay Fuller, "1960 Roundup - MSNA Style," Mich- igan Nurse Vol. 34 (January-February, 1961), p. 3. 59 indicated that many of-the leaders were sympathetic to the nursing problems and advised that the profession itself had to take a strong stand to bring about necessary changes. Groups of nurses were surveyed, too, to ascertain how they viewed the role of the professional association in exerting appropriate pressures to bring about salary improvements. Their response was that the professional association must assume strong leadership and help nurses throughout the state by utilizing various types of approach- es and collective action. Studies such as the one conducted by Daniel Kruger, MNA industrial relations consultant, in 1960 on the economic status of registered professional nurses,52 helped to pinpoint the major problems as the nurses saw them. These were the problems the economic security program had to work on. Through surveys and ques- tionnaires, MNA identified the concerns of the nurses so that it could plan a course of action for resolving these problems. To have complete and up-to-date information on the employment conditions for registered professional nurses, MNA conducted annual surveys on salaries and fringe ben- efits in all Michigan Hospitals and public health agencies. 52Daniel H. Kruger, "The Professional Nurse Speaks Out," Michigan Nurse Vol. 33 (July-August, 1960), pp. 94- 95. 60 These surveys were conducted with the assistance of MNA's industrial relations consultant and students from Michigan State University. These surveys showed there was great need for improvements in nurses employment conditions. MNA provided assistance to nurses primarily in two ways - (1) consultative services to directors of nursing, and (2) representation of nurses. The director of nursing is administratively charged with the responsibility for submitting periodic budget re- quests for the nursing department which includes salary recommendations and other requests for improved personnel policies. In such a situation, MNA gave the director of nursing assistance by compiling salary data; by preparing special reports; and by preparing materials which would help the director of nursing in presenting her case to the administrator, personnel director or the board of trustees. This situation is the traditional method of economic secu- rity action in which the director of nursing interprets the necessity for salary revisions through the channels of command. Another approach was working directly with groups of nurses. The type of assistance rendered depended upon the situation. In any instance, it was suggested the nur— ses work through the director of nursing first in request- ing improved working conditions. If this failed to bring results, the nurses were then to call upon MNA for further 61 assistance. Where results failed to materialize by work- ing through the prOper channels the nurses were to inform the director of nursing they were seeking help from MNA. On the one hand, the staff action could be interpreted as being supportive to the director of nursing, particularly when she had tried to bring about improvements but unsuc- cessfully. In many hospitals the director of nursing could do little to bring about needed improvements. If the director of nursing was in agreement with what the nurses wanted then she would most likely interpret it as a supportive act. On the other hand, the staff action could be interpreted as a threat to the director of nurs- ing by showing up her inefficiencies and her weakness. The reaction would possibly hinder or even block any ac- tion by the staff. The type of assistance given nurses were consultant services and/or representation by serving as their official spokesman. In each case, upon request for assistance, an MNA representative met with the nurses to ascertain the sc0pe of their problems and then assessed how best to pro— ceed to get the desired improvements. At a general meet- ing with the entire staff of nurses in an agency, the MNA representative interpreted the policies and procedures re- lating to the economic security program. At this time too, the concept and principle of collective action was pro— moted and interpreted. 62 Consultation services consisted of mainly helping the local group of nurses get organized and recommending the procedure they should follow to resolve their problems. In other words, the group acted on its own with only advice from MNA. In addition, MNA would supply them with informa- tional material and economic data as indicated. For exam- ple, MNA's recommended employment standards booklet would be sent to them to compare with their present personnel policies. The local group collected much of their own data and put their requests in writing to be presented to the employer.. Representatives from the local group would meet with the employer to present and discuss the nurses requests. Any action taken depended upon the employer's receptivity and voluntary adoption of the recommendations. The nurses' efforts depended,in part, on their ability to sell their recommendations. When MNA acted as the official spokesman, it became more involved at all stages of preparation and representa- tion. MNA representative would meet with the nurses' com- mittee to identify critical areas of needs and drafted the requests. In addition to the data collected by MNA, the nurses' committee gathered data more specific to the insti- tution such as staff turnover. MNA prepared and printed the final brief or report. In meetings with employers, whether an administrator, board of trustees, city council or county board of supervisors, the MNA representative was 63 the spokesman for the nurses.e Though collective action was the method used, no actual collective bargaining took place. Rather, the nurses relied on rational decisions based on the facts they presented. It was expected the nurses' recommendations would be acted upon and adopted by employers. CHART I OFFICIAL REPRESENTATION BY MNA 1961-1965 Public Health Other Hospitals Departments Agencies 1961 6 4 2 1962 7 3 1963 2 1 1964 7 4 1965 3 3 Source: annual reports published in the Michigan Nurse Chart I shows the number of institutions in which MNA served as the official representative over a five year period. In each instance, a written report or brief was prepared and the special recommendations with supporting data submitted to the employer. It must be remembered there was only one staff person assigned to carry out the duties and responsibilities of the economic security program. 64 In addition to serving as the official spokesman in these institutions, the MNA representative each year filled numerous requests for consultation from directors of nursing. In 1963, consultant services were provided to nine (9) directors of nursing. The number of directors of nursing given consultant services were not always avail- able, therefore it is not possible to determine the full extent these services were provided. To these activities should be added the special assistance given to groups of nurses and individuals each year. For instance, in 1963 not only did MNA serve as of- ficial spokesman for two (2) hospitals and one (1) public health department, provide consultant services for nine (9) directors of nursing, and gave special assistance to groups of nurses in their place of employment in five (5) dis- tricts, Greater Detroit District, Bay District, Muskegon District, Van Buren District and St. Joseph District.53 Among other duties in 1963 the staff person gave presenta- tions on the economic security program at 8 district meet- ings, 2 state universities and an Indiana public health nurses workshop. 53"Annual Report of Michigan State Nurses Associa- tion: MSNA Staff," Michigan Nurse Vol. 36 (September- October, 1963), p. 127. 65 MNA worked with some groups of nurses on a contin- uous basis over the years. The most notable of these is the Highland Park General Hospital Nurses.54 Not only did MNA officially represent them continuously since 1962 but they also were the first and only group for which MNA sought a written contract prior to the passage of the Michigan Public Employees Relations Act in 1965. The nur- ses from Highland Park General Hospital first requested assistance from the MNA in January, 1962. The spark which sent the nurses to their professional association was an invitation from the American Federation State County and Municipal Employees, AFL-CIO, to join the union. Instead, they met and voted to utilize the professional association as their "spokesman.“ When MNA became involved the situation was such that it had become increasingly difficult to maintain or upgrade the standards of nursing at Highland Park General Hospital. The nurses salaries were low and inequitable by both internal and external comparisons. The nurses were performing many non-nursing functions such as cleaning units for discharged patients and clerical duties. Aides would refuse to perform functions because it was alleged 4 . . . . 5 Jeanne E. White, "Highland Park Story," Michigan Nurse Vol. 40 (January-February, 1967), pp. 15, 17 & 20. In addition, much information was obtained through inter- views and conversations with the nurses employed at High- lzgd Park General Hospital; and materials on file in MNA 0 ice. 66 that it was not in their job description. The union, rep- resented all employees except professional nurses. Fur- thermore, many budgeted positions for registered profes- sional nurses were empty. Following the first meeting with the MNA represen- tative, about two months was spent by the professional nurse committee of Highland Park General Hospital and the MNA representative gathering data, outlining problems, and drafting requests. On March 29, 1962, the first formal meeting was held with representatives from the professional nurse committee, MNA, and the hospital administrator. In the next few months, the nurses were involved in a series of meetings with the hospital and the various Highland Park city officials. Among the requests sought was recog- nition of MNA, a contract, and salary increases, a high priority item. All requests were denied. On June 6th the committee presented a signed petition threatening a mass resignation of the professional nurses if no favorable action was forthcoming. A special meeting was called on June 15th with the mayor, the city personnel director, the hOSpital administrator, the MNA representative and the nurses committee. It was mutually agreed at this meeting that the City of Highland Park would enter into a written agreement with MNA. Also, special consideration would be given for a salary revision. The nurses did receive the salary increase. But, the written agreement, promised in 67 2 or 3 months, was not signed for another four years. During these four years, many meetings took place between_ the nurses, the hospital administrator and city officials. The nurses were persistent and gradually improvements were made. Omitting the contract and threat of mass resigna- tions, the situation and circumstances were similar to others confronted by Avis Dykstra during her years of work in the MNA's economic security program. Among them were Detroit Health Department, Pontiac General Hospital, Wayne County General Hospital, and Bay County Health Department, to name a few. Measurement of Success What is the criteria for success? If it is the number of collective bargaining agreements, which the ANA program emphasizes, then it would have to be said that the MNA program has not been successful for the first five years of effort. But, the MNA program did not claim col- lective bargaining as its prime tool. Therefore the num- ber of collective bargaining agreements cannot be used as a measure of success in this case. One of the stated goals is to improve the economic status of nurses. Progress towards this end would be one indication of success. As Chart II shows there have been improvements in the average beginning monthly salary paid 68 CHART II SALARY INCREASES IN THE STATEWIDE AVERAGE MINIMUM MONTHLY SALARIES PAID TO GENERAL DUTY NURSES IN MICHIGAN* 1960 - 1965 Year Average Minimum $ Increase % Increase 1960 $315.00 1961 331.40 $16.40 5.2% 1962 344.70 13.30 4.0% 1963 359.30 14.60 4.2% 1964 381.17 21.87 6.1% 1965 396.68 15.51 4.1% *Source of data MNA salary survey 1960—1967 to the general duty nurse. Between 1960 and 1965, nursing salaries in Michigan improved by 23%. Thus, a look at the 1965 salary as compared to 1960 indicates that economically substantial progress had been made. From 1961 to 1965 the nurses salaries increased 16.5%. By comparison the teach- ers salaries in Michigan between 1961 to 1965 increased 9.7%, $388.70 per month (12 month basis) to $430.41.55 55Statistics calculated from the table "Teacher Salary Schedule data 1961-62 through 1966-67," p. XI in Teacher Salary Study 1966-1967, East Lansing, Michigan: Michigan Education Association, 1966. 69 In review, these improvements came about with only minimum official representation by MNA. At_most MNA offi- cially represented nurses in 12 agencies in any one year, not enough to make any significant impact. Great reliance was put on the nurses themselves to initiate and effect changes, either through their position as directors of nursing or through collective action by the staff nurses. MNA's liaison activity with the Michigan Hospital Associa- tion was probably, in part, a contributing factor in its economic success. Not all the criteria for success can be tangibly measured. Daniel Kruger, MNA's economic consultant, listed the criteria for measuring progress in the program as being: - whether employers are providing employment opportu- nities under which quality nursing care can be pro- vided. - whether employers of nurses accord them dignity and respect. - whether employers are willing, in good faith, to work with nurses to the end that the quality of nursing care is enhanced and improved. - whether there are written and well-defined personnel practices in operation. - whether professional nurses are more willing to speak out on matters affecting their professional and eco- nomic status. - whether the profession is develOping the necessary leadership in all parts of the state. - whether there are improvements in the economic status of professional nurses in Michigan. 56Daniel H. Kruger, "An Approach to Improving Eco- nomic and Professional Status," Michigan Nurse Vol. 37 (January-February, 1964), p. 23. 70 The last criteria has already been discussed. DevelOping leadership and a willingness to speak out on matters.affecting them are important for they effect the first three measurements of progress. The ability and willingness to speak out depends, in part, on knowing the facts. Educating the nurses on the economic facts of life has been a large part of MNA's program. Not only were an- nual surveys on employment conditions conducted but the results were published so they were available for all the nurses. After getting the facts its knowing what to do with them. Publicity through the Michigan Nurse, presen- tations at district meetings and personal contacts with local groups helped to create a greater awareness that something could be done and the way it could be done. The number of requests for MNA assistance is evidence that there was an increasing awareness among the professional nurses. This awareness led to the development of leader- ship and a willingness to speak out. Sometimes necessity helps to bring out qualities and abilities thought not present among the membership. MNA had only one person assigned to the economic security program. With approximately 300 hospitals and 60 public health agencies not counting the other institutions employ- ing nurses, it was too much for one person to handle. MNA had to rely on individual efforts. Consequently, as Avis Dykstra observed from her years in charge of the program 71 "more and more, they [nurses] are exerting the necessary initiative and leadership to help effect desirable 57 Initiative and greater interest in economic changes." security for nurses shows up in the increased number of nurses attending courses on labor relations at the state universities. As presented earlier, the number of nurses who participated in these courses at Wayne State University and Michigan State University in 1965 were 65 and 28, re- spectfully, as compared to 9 and 17 in 1961. While it is difficult to appraise accurately the accomplishments of MNA's economic security program for the first five years, it does seem progress as a whole had been made. Greater accomplishments were limited by the amount of resources available for the economic security program. An increased tempo did not come until labor re- lations legislation was enacted which permitted collective bargaining in the public sector. 57"Annual Reports of Michigan State Nurses Asso- ciation: MSNA Staff," Michigan Nurse Vol. 36 (September- October, 1963), p. 127. IMPACT OF THE MICHIGAN LABOR RELATIONS ACTS Pertinent Provisions On July 23, 1965, Governor George Romney signed the Public Employees Relations Act (PERA) which gave pub- lic employees in Michigan the right to organize and to choose an exclusive bargaining representative to represent them in bargaining over hours, wages and working condi- tions. The public employers are required to bargain with the exclusive bargaining representative. The Michigan. Labor Mediation Act (LMA) was also amended so that the Michigan Labor Mediation Board had the power to hold an election for representation in the private hospital area. Previously, the LMA had only a special mediation procedure for hospital disputes. There was no specific provision for hospitals to select an exclusive representative. Prior to 1965, the public employees were covered by the Hutchin- son Act which prohibited strikes by Public employees., The Hutchinson Act also had a mediation process which provided that the majority of any group of employees could seek‘ mediation of grievances. 72 73 The Public Employees Relations Act (PERA) retains the prohibition against strikes by public employees (Sec- tion 2). But, the automatic termination provision and the very severe penalties on reemployment have been eliminated. PERA provides that the public employer may discipline an employee who does strike in violation of the prohibition against striking. The discipline imposed can go as far as discharge. However, the public employee, if he feels he did not violate the provisions of PERA, has a right to a hearing "with the officer or body having power to remove or discipline such employee." (Section 6.) In other words, he has a right to a hearing by the public employer.. Then, if he is still not satisfied he has the right to appeal to the circuit court to determine whether the dis- cipline action is supported by sufficient evidence. The term strike, as defined in PERA, means concerted action with others to abstain from work for the purpose of influ- encing or coercing a change in working conditions or compensation. Following the ANA policy the Michigan nurses have voluntarily relinquished the right to strike. Therefore, it would seem this provision would have little applica- bility to the nurses. This, of course, could change if the nurses after reviewing their position rescinded their no-strike policy, which has been done by the Pennsylvania and California nurses associations. There is no indication 74 however MNA will do so. What happens is the individual nurse resigns when conditions become unbearable and ob- tains employment elsewhere without difficulty. The posi- tions are there. On only three occasions known have the nurses in Michigan resorted to the threat of mass resig- nationsil Though some question whether such a measure con- stitutes a strike or not, it has entirely different impli- cations. A resignation, as intended, is the permanent severance from an employer and the giving up of all in- vested rights in the position. It indicates the individual has no intention of working for that employer any longer and is free to seek employment elsewhere. Withdrawal from unpleasant working conditions is an Option open for nurses. It is MNA's objective to improve working conditions in order to attract nurses into active employment and to discourage nurses from leaving their profession. Both PERA and LMA provide a medium for MNA to achieve this ob- jective. PERA protects the right of public employees to organize. The provision granting this right or organize is Section 9 which states: It shall be lawful for public employees to organize together or to form, join or assist in labor organiza- tions, to engage in lawful concerted activities for the purpose of collective negotiation or bargaining 1Highland Park General Hospital in 1962, Coldwater Community Hospital in 1965 and Detroit General Hospital in 1967. 75 or other mutual aid and protection, or to negotiate or bargain collectively with their public employers through representatives of their own free choice. Thus, under PERA, publicly employed nurses have the right. to form or join a labor organization. MNA meets the qual- ifications and has been recognized as a labor organization. Thereby, the nurses have the right to engage in organiza- tional activities for the purpose of collective bargaining. Both acts set up the mechanism whereby employees may choose a collective bargaining representative. To be the exclusive representative MNA must be designated or se- lected by the majority of employees in an appropriate bar- gaining unit. Recognition as the exclusive representative for a bargaining unit of nurses may be obtained through voluntary recognition by the employer or through selection by an election. To obtain voluntary recognition, the labor organi- zation must show that a majority of the employees in a unit wish that organization to represent them for collective bargaining purposes. For this purpose, MNA had printed authorization cards for the nurses to sign. Upon signing the cards, the nurses authorized MNA to be their collective bargaining representative. The nurses do not have to be MNA members to sign the cards. However, they all are ex- pected to become members. At first, a petition form had been used by MNA but later switched to the printed auth- orization card. Proof of membership or the intent of 76 membership such as applications for membership cards, could possibly be used. Once a majority of the nurses have signed the authorization cards, MNA may request vol- untary recognition from the employer. An employer may request proof that a majority of the nurses have desig- nated MNA to be their representative. A meeting then may be held during which the employer examines the authoriza- tion cards and checks them with his record of employees. Thereupon, the employer may grant voluntary recognition to MNA if satisfied a majority of nurses have truly auth- orized MNA to be their representative. The bargaining unit must be defined however, and mutually acceptable to both parties. The recognition and definition of the bar- gaining unit is put in writing. Most often it has been an exchange of letters. In the case of Alpena General Hos- pital, MNA wrote requesting recognition. The Board of Trustees adopted a resolution recognizing MNA as the ex- clusive collective bargaining representative. Then the hospital administrator wrote a letter to MNA stating it had been recognized and the bargaining unit was defined. If voluntary recognition is not granted, MNA may file a petition for an election with the Michigan Labor Mediation Board. Petition for election is authorized under Section 12 of PERA and under Section 27 of LMA. The labor organization is required to show it has thirty percent or more of the employees in an appropriate unit who have 77 designated it as their bargaining representative. Thus, MNA must obtain signed authorization cards from at least thirty percent of the nurses in any claimed bargaining unit. To avoid embarrassment because of the high turnover rate among nurses and to make a strong showing of strength MNA has usually not petitioned for an election unless fifty percent or more of the nurses have signed authorization cards. As noted above this is not required by law. When a petition is filed, the MLMB schedules an informal hearing with both the employer and the labor or- ganization. If there is no question on the appropriateness of the bargaining unit and the prOper showing of interest is demonstrated, a consent election can take place. The parties sign an agreement for the consent election. A secret ballot election is then conducted by the MLMB at a time and place agreed upon by theparties. If there is disagreement on the bargaining unit or some other point in representation, then a formal hearing is held to resolve the contested issues. Depending upon its findings, the MLMB may dismiss the petition or direct an election be held. Where MNA has not been granted voluntary recognition, the employers have agreed to a consent election. An organ- ization can intervene in an election if ten percent of the employees wish to be represented by it. MNA intervened for the nurses at Genesee Memorial Hospital when council 25, AFSCME petitioned the MLMB to represent the nurses and 78 was placed upon the ballot along with the union. By set- ting up the mechanism whereby employees may choose a col- lective bargaining representative, the Acts eliminate much strife between employers and employees and between rival labor organizations. Section 14 of PERA and Section 29 of LMA are of importance. They state "An election shall not be directed in any bargaining unit . . . within which, in the preced- ing lZ—month period, a valid election has been held." Should MNA win the election, it means for a one year peri- od no other labor organization can petition for representa- tion and no group can petition for decertification. MNA thereby has time to negotiate an agreement without inter- ference from other labor organizations. Should MNA lose an election, no organization can petition for an election for a one year period. During this time there is the possibility the nurses may lose interest in MNA representa- tion altoqether or it gives time for another labor organi- zation to recruit the nurses into its membership. Of particular significance to some Michigan nurses is the "contract bar" provision included under Section 14 of PERA and Section 29 of LMA.' "No election shall be directed in any bargaining unit or subdivision thereof where there is in force and effect a valid collective bar- gaining agreement which was not prematurely extended and which is of fixed duration." Thereby, nurses who find 79 themselves being represented by a union in a conglomerate bargaining unit must remain in that bargaining unit for the duration of the agreement. A conglomerate bargain- ing unit includes several different occupations such as dietary employees, maintenance employees, laundry employees, nurses aides, licensed practical nurses, etc. And such is the case in at least one instance, the public health nurses, City of Grand Rapids, represented by Local 1061, AFSCME. There is a stipulated period of time prior to the agree- ment's expiration during which the nurses can petition to be excluded from the union. In the matter of an appropriate bargaining unit, Section 13 of PERA provides that: The board shall decide in each case, in order to in- sure public employees the full benefit of their right to self—organization, to collective bargaining and otherwise to effectuate the policies of this act, the unit appropriate for the purposes of collective bar- gaining as provided in section 9e of Act No. 176 of the Public Acts of 1939. . . . and Section 9e of Act 176 of Public Acts of 1939 as amended (LMA) provides: The board, after consultation with the parties, shall determine such a bargaining unit as will best secure to the employees their right of collective bargaining. The unit shall be either of one employer . . . not holding executive or supervisory positions . . . Pro- vided, however, that if the groups of employees in- volved in the dispute has been recognized by the employer or identified by certification, contract, or past practice, as a unit for collective bargaining, the board may adOpt such unit. The MLMB decides on a case by case basis, on its own merits, 80 an approPriate bargaining unit. The appropriate bargaining unit must insure the public employees their full right to organize, and to collection bargaining. The parties involved are encouraged to reach a mutual agreement on the appropriate bargaining unit. If they are not able to do so, the MLMB is authorized to hold a formal hearing to determine the appropriate unit. For an election to be conducted by the MLMB, the bargaining unit must not violate the provisions of the Acts. For in- stance, supervisors may not be included in a bargaining unit with non-supervisory employees. For this reason MNA has agreed to accept two bargaining units for nurses rather than the preferred all inclusive unit. A determining factor on the appropriateness of a bargaining unit is a community of interest among the employees, a prime factor used to resolve the issue in two cases involving MNA and the Mich- 2 The MLMB concluded igan Association of Nurse Anesthetists. the nurse anesthetists did share a community of interests in common with other registered nurses. PERA, under Section 15, requires that a public em— ployer must bargain collectively with the exclusive bar- gaining representative of the employees in an apprOpriate 2In the matter of Highland Park General Hospital and Michigan Association of Nurse Anesthetists and Michi- gan Nurses Association, MLMB case No. R66L-429; In the matter of Alpena General Hospital, and Michigan Association of Nurse Anesthetists and Michigan Nurses Association, MLMB case No. R66L-432. 81 bargaining unit. This is a new concept in the public area. Never before in Michigan have public employers been re- quired to bargain with their employees. The refusal to engage in collective bargaining is an unfair labor prac- tice for which the MLMB is vested with the power to issue a cease and desist order. Collective bargaining is the mutual obligation of both the employer and the employees exclusive representative. They must "meet at reasonable times and confer in good faith with respect to wages, hours, and other terms and conditions of employment. . . ." Fur- thermore, it is "the execution of a written contract, ordi— nance or resolution incorporating any agreement reached if requested by either party. . . ." But, it does not mean either party is compelled to agree to a proposal or to make a concession. To the nurses at Highland Park General Hospi- tal, Section 15 of PERA had the utmost importance. MNA had been seeking a contract with the City of Highland Park on behalf of the nurses since January, 1962. Its efforts were to no avail as the employer was not required "to make and enter into collective bargaining agreements" with their em- ployees exclusive representatives. With PERA, the nurses finally did obtain their collective bargaining agreement which they had been struggling to get for four years. Under the LMA, the private hospital employer is also required to bargain collectively with the exclusive bargaining repre- sentative and execute an agreement. 82 As already mentioned, the refusal to bargain col- lectively with the public employees' exclusive representa- tive is an unfair labor practice under PERA Section 10e. The public employer's conduct must show his duty to bar- gain as described in Section 15 of PERA. That is, his conduct must indicate he is negotiating in good faith with the intention of reaching an agreement. The LMA has the same requirement. The prohibited unfair labor prac- tices are fundamental ground rules in the.collective bargaining relationship. They are designed to protect the employee by restricting certain employer activities. In addition to not refusing to bargain collectively as re- quired by the Acts, employers must not interfere with employees when they are organizing or bargaining collec- tively according to the Acts; engage in "company unionism?; discriminate in hiring or in other conditions of employment among employees to encourage or discourage labor organiza- tion membership; or discriminate against employees filing charges or giving evidence under the Acts. The MLMB is provided remedies for unfair labor practices under both acts. The Effects on the Nurses In Michigan there are 244 non-federal hospitals which would come under both the Public Employees Relations Act and the Labor Mediation Act, 156 voluntary non-profit 83 hospitals, 58 county or city owned hospitals, 22 state hospitals and 8 proprietaryhospitals:3 There are also 53 extended care facilities. In addition, there are 45 county or city operated public health agencies and 32 osteOpathic hospitals.4 Altogether there are 374 hospitals and other health institutions in Michigan. In 1966, there were 22,005 registered nurses em- ployed in Michigan. Of these, 15,423 were employed in hospitals and other health institutions, and 1,049 were employed in public health (see Chart III). Accordingly a large majority of the employed registered nurses were ef- fected by these two acts. The Acts generated a great deal of interest on the part of the nurses. At the MNA's 1965 annual convention, many hours were spent discussing their meaning, interpre- tation and implications for the nurses. Robert Howlett, chairman, Michigan Labor Mediation Board, interpreted the acts. Implications of this legislation for the nurses was discussed by Daniel Kruger, MNA economic consultant, and- Thomas Walsh, MNA legal consultant.5 As Mr. Walsh explained it was not whether or not the nurses wanted to be represented 3Figures obtained from Hospitals, Vol. 40, Guide Issue, Part II, August 1, 1966, pp. 112-119 and p. 454. 4Figures obtained from MNA. 5Proceedings of the MNA annual business meeting, October 26, 1965. 84 smo.tm Heeoe mom.m omuuommm uoz va.mH tmmoamEm uoz moosmm pomonEm mmmusz commumflwmm Had no msumum mufl>flpo¢ .mcfimusz mo Unmom cmmflcoflz “mouaomt moo mos.H mos GHH sm~.m oom mHs.m me¢.~H moo.- Heeoe mom m oH H om mH so mHH one omuuommm uoz . mm N s H m m NH mm umsuo . H mm H mm . msH omo.H mom.H mossz monmo I m «H m we H «ma mom amasa omucz Hmwnumdch . m mH om oH . mm osm sum omusz Hoosom o4 o mm Ho NoH mm on amp oso.H tuHoom oHHnso . mes . n n u u . mom muse muo>Hso m o moH oH HH ooo 4H MH mos msHmusz mo Hootom Hm mo mm soo. o m . . . soHusoHumsH s o m mm N mm s o N has m mme mH sosuo so HouHomom m m Wm m we u we a m men. 3 "H com u aid 3 cos u 1 .d e e 1;! 5 Tie 1. 1:9. 9 e TLL.L H I su n 51 J S I T. OU.P a «+1. T. «4A n «wN e rno d BS 1. ET. 0 en I 830 0 U1. 2 us 1. HI PSI. I 1.1 u 1.0 0 1.8 G n e 1 1 1 a n .tv.m e 1. 1. us P 0 o o .A 1.d 1 1 x NytT. S usuo o 4 :.s5 1 e s.Lm I. TX... I. u u 5 1. ZOHBHmOm ho mmMB Mm «ZdemUHZ ZH meMDZ Qmmmamemm m0 wmoazm>ZH mwmfl HHH Bm