Recent labor disputes between registered nurses and hospitals in Minnesota, California, and Pennsylvania raise moral questions about nurses’ professional obligations, nurses’ right to collectively bargain to preserve or improve wages, benefits, and working conditions, and patients’ right to medical care. Deontology and consequentialism focus too narrowly on nurses and patients, and thus ignore the nature of the healthcare community as a system of competing interests. When considered in this context, nurses’ strikes are shown to be consistent with this system of (...) competing interests, and thus are morally permissible. (shrink)

In the United States, there has been a continuous debate between those who favour collective bargaining for nurses and those who believe it is not professional. Likewise, the controversy over whether nurses should strike has been longstanding and continues today. Those who oppose the idea of nurses striking often state that they are abandoning their patients, and that it is not ethical, even though federal legislation requires a 10- day strike notice so that management can make patient care arrangements. The (...) American Nurses Association (ANA) has supported the right of nurses to strike, as a last resort and after careful consideration of every factor. This support has divided the membership of ANA and the nursing profession, even though the strikes have been used sparingly and effectively by nurses in this country; and so the debate continues. (shrink)

Healthcare is increasingly impacted by chronic short staffing of nurses, which causes and is caused by increased nurse burnout and decreased retention. Nurses’ unions seek to address these problems by proposing safer nurse-to-patient ratios, retention bonuses for working through the COVID-19 pandemic, Personal Protective Equipment (PPE) stockpiles, sabbatical leaves, measures aimed at reducing workplace violence, and maintaining or increasing wages and benefits to keep nurses at the bedside. Chronic short staffing and burnout directly affect the quality and availability of patient (...) care—as the International Council of Nurses has pointed out, there is no healthcare without healthcare workers. This article draws on Neiman’s argument that the US healthcare system is best understood as a system of competing interests aimed at fulfilling the community’s obligation to provide access to quality healthcare. Nurses’ unions use contract negotiations, legislative advocacy, and strikes to pressure other members of the healthcare community to address chronic short staffing, burnout, and retention. Nurses’ unions in the US thus play a unique role in the system of competing interest as an organized group whose primary interest aligns with the community’s obligation to provide access to quality healthcare. This article argues that nurses’ professional duty to care for patients includes a duty to support nurses’ unions as an important way to address the factors outside of nurses’ direct practice that impacts the quality and accessibility of the care that nurses provide to patients. This duty to support unions applies to unionized and non-unionized nurses in the US, and includes duties to participate in union activities, to not cross picket lines, and to avoid work for strikebreaking nurse agencies. (shrink)