Searching For a Pulse

We talk to Shift Change, who are fighting for more democracy in National Nurses United

Since 2020, North America has been swept by a wave of labor unrest that is unprecedented in most of our lifetimes. Large movements have sprung up spontaneously among the working classes to unionize sectors that have never before been organized by labor – the paradigmatic campaigns being Amazon in logistics and Starbucks in food service. And this labor unrest, in turn, is part of a greater wave of revolt by newly mobilized masses of ordinary people – encompassing both the Floyd Uprising and various countercultural trends from below1For some of the magazine’s past coverage of the post-2020 political situation in North America, see Frances Madeson, “A Pandemic Archive” (23 December 2022); Kyle Flannery, “A Division of Labor” (16 December 2022); Jared Spears, “It’s the Economy, Stupid!” (12 January 2023); and the editorial “Socialism with an Anarchist Squint,” Strange Matters Issue One (Summer 2023). – against the capitalist system.

It makes sense for the workers’ movement to push for greater unionization: after all, unions are supposed to fight for workers – right? Otherwise, what are they for? 

There is, however, another role played by unions as an institution – one that becomes especially clear in rigorous histories of the labor movement like Mike Davis’s Prisoners of the American Dream, Robert Fitch’s Solidarity for Sale, Stanley Aronowitz’s The Death and Life of American Labor, and Kim Kelly’s Fight Like Hell – whereby they’ve actually served to pacify the working class rather than promote the struggle for its interests. Sometimes, when left to their own devices, the right wing of the labor movement and the leadership of particularly top-down unions can become a tool for capitalists, negotiating partners in backroom deals that maintain a long-term labor peace by blocking the most radical demands of the rank and file while throwing them the occasional scraps to keep them happy. These so-called union bosses emerged as part of the New Deal coalition in the postwar period, seemingly a symbol of labor’s permanent integration into the social-democratic power structure; but ironically, it was precisely through such shoddy compromises and top-down self-sabotage that union leadership actually helped along the massive de-unionization of the private sector we’ve seen throughout the neoliberal era. This is closely related to the major unions’ love affair with the Democratic Party. Union bosses are often political bosses, treating their membership as little more than mass donors and get-out-the-vote canvassers for the Democratic politicians they make alliances with; yet when these Democrats upon getting elected push the same neoliberal policies that have devastated the labor movement for decades, the union bosses refuse to punish them for it – probably because of all the cushy sinecures and financial benefits the politicians throw their way. A union controlled by just a few bureaucrats is a union with fewer people to buy off; and from the point of view of the fight for workers’ rights, that’s a weaker union. One need only look at how the Biden administration used its ties to union bosses to stop the recent railroad strike (with no real concessions to the core demands of the rank-and-file workers) for a brutal lesson in how this works.

This sordid history has led some radicals to dismiss the importance of organized labor entirely for building anticapitalist social movements. But the fact remains that if socialism means worker control of production, power in the workplace is a key pillar of building it – and unions run as democracies directly by workers, which fight not only for higher wages but for more control over the work process, are seeds out of which a broader economic democracy can grow. By running their own affairs in the union, workers can train themselves to one day run the shop (indeed, their whole lives) in the same way; and in a union where rank-and-file workers call the shots, there’s no small group of people the capitalists can buy off, making it much more likely that the union will stay militant in its offensive against the bosses.

Thus, the current situation has many workers caught between the desperate need to build up union power and the equally urgent need to fight the entrenched bureaucracies of existing unions. Nowhere is this more evident than in the health care sector, where the nurses – often seen as one of the most politically progressive and well-organized segments of the working class – are currently in a pitched battle over the future of their most powerful labor organization.

National Nurses United – formed from a merger of the California Nurses Association, the United American Nurses, and the Massachusetts Nurses Association in 2009 – is the largest union of nurses in the history of the United States. With 225,000 members in hospitals across the country, it’s a powerhouse of labor organizing in a highly strategic area (health care) that’s of crucial importance to the living standards of the entire population. NNU has for most of its history been a top-down organization; but for a long time, it was also a militant one squarely on the side of the working class. Over the course of the last three decades, its members built up a reputation for supporting dissident social democrats like Bernie Sanders, mobilizing large protests and other actions against politicians and capitalists pushing hospital privatization or cuts, advocating fiercely for socialized healthcare, and demonstrating their willingness to go on strike to achieve their objectives (the basic litmus test for whether a union is truly independent).

But in recent years, many rank-and-file NNU nurses have felt burned by its actions – or lack thereof. Since COVID, capitalists in the healthcare industry have pushed for even more brutal cuts to the hospital system and promoted even worse conditions for the nurses who work in it. The pandemic has only accelerated long-term trends towards shoddier care, decaying infrastructure, and an ever-more immiserated workforce. But according to our sources in this interview, more and more nurses are coming to feel that the NNU’s leadership doesn’t have their backs in these struggles. They allege that the union’s high-ranking officials and staff have refused to get involved on behalf of rank-and-file nurses in their most urgent struggles, focusing instead on backing fruitless electoral campaigns – and often going so far as to negotiate with hospital management behind the rank-and-file’s back to secure superficial wins and prevent strikes. What’s worse, they allege that the union itself has become dominated by a culture of intimidation, where those who question the decisions of the union bosses, whether these dissenters are nurses or staffers, are systematically harassed and isolated until they fall into line or leave. And far from leading to a united organization, these actions have, it’s said, left NNU weaker at a critical moment of nationwide labor struggle.

The Shift Change caucus is fighting to change that. For the past few months, these nurses from California, Illinois, Texas, and North Carolina – Raina N. LenzyEric Koch, Mark Goodick, and John Hieronymus – have been preparing to run for NNU’s Council of Presidents.  They hope to transform the organization into a bottom-up democracy on the belief that the organization will fight more aggressively for the rights of its rank-and-file nurses if it’s they who are in the saddle, not a small cadre of union bureaucrats. Based on our interview, their agenda2For more of Shift Change explaining their strategy in their own words, see the “Our Platform” and “Action Plan” pages on their website as well as their interview with Mia Wong on iHeartRadio’s It Can’t Happen Here, “The Union Election That Could Change Everything” Part 1 (23 March 2023) & Part 2 (24 March 2023). can be summarized as follows:

In the hospitals:

  • Better and more humane nurse-to-patient staffing ratios, ideally in an agreement struck regionally or nationwide
  • An end to “just-in-time” inventory management standards, with more redundancy of staff and equipment planned in
  • Better contract enforcement so that nurses actually exercise the rights and benefits they theoretically have on paper (fully taking every lunch break, no more peeing in bottles)
  • No more unjustified firings due to labor actions, dissent, or racism

In the union:

  • An end to backroom negotiations between paid union staff and hospital management, behind rank-and-file nurses’ backs
  • Deprioritizing support for electoral politics, and instead pushing for more aggressive strike actions and other forms of pressure on management and politicians, in short the politics of the workplace 
  • Reorganizing NNU to be less centralized and top-down, turning it into a bottom-up federation of autonomous locals with power over real resources
  • A full review and reform of the bylaws and finances of the union, with permanent transparency on finances going forward
  • Political pluralism within the union and an end to the culture of intimidation around dissent
  • Internal training and education programs to promote extensive participation by rank-and-file nurses in the self-governance of the union

At the time of the interview, Shift Change was still in the middle of its race; since then, the slate lost to NNU’s current establishment. But the widespread support they garnered from rank-and-file nurses has inspired them to organize themselves into an ongoing opposition caucus. We caught up with two of the Shift Change nurses – John Hieronymus of Chicago and Eric Koch of Oakland – to learn more about the deteriorating working conditions for nurses in the hospital system, the problems within NNU that have spurred them to action, and what they intend to do about it.

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INTERVIEWER  

To start, could each of you each tell us about your personal story and why you got involved in the campaign?

JOHN HIERONYMUS  

My name is John Hieronymus. I’m a critical care nurse who works in PACU, which is surgical recovery at University of Chicago Medical Center. I’ve been working there for about 12 years, and I am a nurse rep, which is like the equivalent of a union steward at National Nurses United. I’ve been engaged with the political work of the union for some years, and I’ve been getting more engaged with the workplace organizing side of it since the run up to our 2019 Strike, which was the first nurses strike in a Chicago hospital since the 1960s. I’m also involved with Shift Change, because it has become more and more apparent over the years that the union is fundamentally undemocratic. It’s very top down, it’s very centralized, every decision that needs to be made at a local level ends up being double- or triple-checked by headquarters in Oakland. 

Even though our union often calls itself a rank and file union, it’s actually driven by the staff. We end up getting the worst of both a service union model and a rank and file model where nurses do a lot of this kind of work that is more mobilizing our co workers, or doing the basic work that staff would do in a rank and file union. So we get a lot of burnout and turnover. But then we don’t get a lot of say over the direction of the union work, especially in our local facilities. So many of my co-workers will say things like “I agree with the things that our union stands for, but it feels like there’s always some kind of agenda that doesn’t really take us into account locally,” and that’s why I’m running for the Council of Presidents.

ERIC KOCH 

I’ve been a nurse since I was a Navy corpsman in the Gulf War. My first civilian job was at our hospital, which I started in 1991. I’ve been there for over 30 years. I was an LPN, before becoming a Registered Nurse.3A licensed practical nurse (LPN) is able to provide basic care for patients after completion of a one-year course to attain a certificate. They tend to make less than and work under the management of registered nurses (RNs), who receive a professional license after attaining a university degree from an accredited nursing program and passing a licensure exam. –Eds. I’ve been active in the past three negotiating teams. Historically we’ve had nine strikes  in my first contract bargaining campaign that we had from 2011 to 2013 – and we didn’t settle that contract until we threatened a tenth. In 2015, I was on the negotiating team that negotiated on behalf of ourselves and 16 other facilities. I work for a hospital system run by Sutter Corporation, and I work at Alta Bates Hospital, which is part of Sutter. We thought these negotiations would be a powerful way to create a master contract across all Sutter hospitals and better the lives of nurses across all these facilities. I’ve also been active in lobbying in Sacramento and in Washington, DC. I’ve attended NNU meetings in other states. 

And by the way, I work as a telemetry nurse, meaning when someone comes into the hospital with an electrolyte imbalance or having recently recovered from a stroke or heart attack, telemetry nurses place a little monitor on you to watch your heart while you to walk around to so we can record measurements your heart in action. Prior to that, I worked in the ICU and before to that I worked in the burn center.

At Sutter, I had no idea that there were people throughout the country suffering the same low workplace conditions and lack of representation. By a stroke of good fortune, I was interviewed by Sarah Hughes at Labor Notes over being disgruntled at how our union was handling our labor struggle during the last go-around in our negotiations. Sarah encouraged me to join their labor notes group. Through this group, I was able to meet John and other CNA/NNU nurses across the country. Unfortunately  (and I say that because I wish it wasn’t true), many nurses share my grievances against the union. So I met with John at the University of Chicago, Cook County Health and Hospital System, and numerous other facilities in Chicago, New York, the Carolinas, Texas, and Florida. 

Seeing that the problem was so widespread, We felt compelled to create this campaign to reform the union. To be honest with you, I had no intention ever running even six months ago for any kind of political office with our new union. It wasn’t until some staff labor reps in our union told me and a few others on the negotiating team that their greatest fear at CNA was us running politically for the board and the office of president. Thanks to John and our emerging group of organizers, we ended up discovering that the Council of Presidents is in fact the crux of power within the union.

HIERONYMUS  

They split the vice president and the president into four distinct roles that are co-equal – I just want to clarify that.

The Pandemic, Staffing Ratios, and Workplace Conditions

INTERVIEWER  

Before we go into more detail about the problems with the union, I want to talk more about the problems of the workplace and the hospital system right now. Because I think that that would probably provide a reader who is unfamiliar with healthcare as an industry with a better kind of overall picture of how things are going. 

Ever since 2020, there’s been talk of a strike wave and labor uprising across North America. From what I’ve been able to see in the media, nurses seem like they’re a big part of that. We’ve seen that in several cities, nurses have engaged in various forms of struggle with management. We’ve seen walkouts, marches, and picket lines, for example. I know that a lot of this has to do with COVID, and its aftermath. But I also imagine that a lot of it has to do with long standing problems in the hospital industry through the neoliberal period, and, the wave of privatizations, and the cutting of public funding. Do you see nurses as being part of this general strike wave that we’re in the middle of? And second of all, what are the conditions in the hospitals that are pushing nurses to take more labor action?

HIERONYMUS  

The pandemic triggered a wave of resignations and retirements. Staffing has long been one of the greatest costs to hospital systems. And so they’re always trying to keep staffing costs down by various schemes – they attempt to do to nursing staff what they do to everything else in the economy by insisting on “just-in-time” staffing, and by underpaying people for the amount you know that the hospital charges. Understaffing is a constant issue inside of our unions, and consequently it’s a big focus of our organizing. Many will say that the poor working conditions in hospitals are a big driver of nurses leaving the profession. Our union fights for things like staffing ratios, which they were able to get in California (almost 20 years ago at this point). There’s a big push to try to resolve staffing as a problem for nurses in general so that we’re not feeling like we’re constantly being told to do more with less. I worked for six and a half years in a medical ICU: I have seen short staffing kill patients. In the medical ICU at University Chicago, we had a turnover where every two years you had practically a brand new cohort of nurses. So you watch all the experienced nurses eventually walk out and leave the unit. That’s a huge investment to get someone to the point where they can provide care in critical care areas [only to watch them leave in a hurry]. They say in Illinois 30% of nurses quit within the first two or three years of practice. And that there’s more than enough trained accredited nurses in our state to make up for all the staffing shortage issues that the hospitals complain about – except that nurses repeatedly cite staffing and burnout as the reason why they don’t come back to work at the bedside. So that was already an issue pre-COVID. COVID pushed things over an edge to where units that were barely maintaining the minimum safe staffing numbers of nurses suddenly couldn’t manage even that. 

We have scientific research that shows that nurse-to-patient ratios have a direct link to patient mortality. During COVID, nurses were quitting at an accelerated rate. Additionally, more experienced nurses who had been hanging onto their jobs for an extra few years beyond what they normally would to build up savings, decided it was no longer worth it. Anything that’s set up on a just-in-time basis can have major consequences that build on each other. The union likes to say we’re not having a nursing crisis, we’re saying that nursing is in crisis itself. We see this within the union, and the fact that we’re able to run for the Council of Presidents and make any progress in our campaign is a consequence of a hollowing out of the union itself. The union used to have many nurses who were employed as staffers, including old union and labor militants from various socialist or communist groups. They’ve all retired over the past 10 years, and we’ve started to see a change in the union’s orientation towards its rank and file over the past 10 years. COVID accelerated that change. The same thing is happening to us. They’re bringing in people who have a different attitude towards us as dues-paying members, and the leadership that was the core of the union, even the rank and file nurses, have the same issues where they’ve retired or died. We no longer have a huge base of nurses who are committed to the vision of how the union was set up for years. So it’s given us an opportunity to step in and push to change things because clearly, the old guard’s bench is much thinner than they used to be, and we need to get new people in.

KOCH  

I agree with John that staffing is a major issue in the nursing profession. In some states, like California, there are nurse-to-patient ratios that help ensure adequate staffing, but in other states, there are no such ratios, which can lead to terrible patient care. For example, I’ve worked on a med-surgery floor with 4 or 5 patients, whereas in Florida or Texas, a nurse would have up to  6 or 7 patients.

Some hospitals used the COVID pandemic as a way to get rid of experienced nurses, who are more costly to employ due to their seniority and higher salaries. Older nurses are also more likely to have comorbidities that put them at higher risk of complications if they contract COVID. Instead of granting these nurses dispensations to work in lower-risk areas, some hospitals forced them to resign. This led to a loss of even more nurses during the pandemic.

I would also criticize the “just in time” philosophy that some hospitals use for supply management. This philosophy aims to reduce waste and inefficiency by only ordering supplies as they are needed, but it can leave hospitals short of essential supplies during a crisis like the pandemic. For example, the shortage of masks that led to controversy and confusion early on in the pandemic. Overall, I’d say that these issues in the nursing profession are leading many nurses, including young ones, to consider leaving the profession within the next five years.

INTERVIEWER  

So if I understand your critique correctly, a production method that would apply to human beings in need of medical care would be one where appropriate hospital redundancies are in place – you would want extra stock and extra inventory of everything, because you never know when there’s going to be a surge suddenly in demand due to something like the pandemic. Is that roughly your perspective?

KOCH  

That’s absolutely right. We used to have a clause in our contract that mandated staffing for core needs plus a little extra staff for flexibility, in case there was a surge in patient admissions. But when that was eliminated, we were left with horrible working conditions that cause young nurses like John – and even younger ones – to think about leaving the profession altogether. I can’t imagine being in my 20s and just starting out in nursing, thinking about how I have 35 more years of this. It’s just not sustainable, and that’s why so many young nurses end up leaving. In fact, I think the number one occupation for nurses when they leave nursing is actually becoming a real estate agent. It makes sense, because if you can convince someone to get a colonoscopy, you can definitely convince them to buy a house! So, in a way, nursing can be a good foundation for transitioning into real estate.

INTERVIEWER  

That’s an incredibly obscene detail. Thank you.

HIERONYMUS  

Any kind of customer service!

I agree with Eric that the “just in time” approach isn’t effective in healthcare, and this is something that hospitals have recognized in certain areas. For example, in the surgical and cardiac ICUs, where patients are receiving fully-funded procedures such as heart transplants, the staffing requirements are different compared to areas like the medical ICU, where patients are often dying from infections or respiratory failure.

In my current unit, which is the PACU, our staffing levels are prioritized because if we don’t work, the entire hospital’s operating rooms have to shut down, which would result in significant financial loss for the hospital. As a result, my working conditions are much better than those in the medical ICU where I used to work. This is because the hospital recognizes the importance of ensuring adequate staffing in areas that directly generate revenue.

Ultimately, hospitals are essentially factories that produce healthcare, and they run their units in different ways depending on what matters most to them. It’s clear that in areas where they prioritize financial gain, they are willing to invest in adequate staffing levels.

INTERVIEWER  

And to clarify, what makes the department more important to them is whether it’s more profitable, correct?

HIERONYMUS  

Absolutely, yes. The difference between the med surg telemetry units at the University of Chicago Cancer Research Center and the community health safety net hospital seems significant. Despite the fact that all patients require equal amounts of care and access to resources, the administration views them differently. Consequently, the staffing of the med surg telemetry units is distinct, and this only serves to perpetuate structural racism in the US healthcare system. This is why our working conditions are vital, not only for us as healthcare workers, but also for the community members we care for. We are convinced that everyone should have access to safe staffing, which is a fundamental value for nurses. We believe that every patient should receive the same level of care, regardless of whether they are from the community or paying the full price in cash. To me, there is no difference between my patients; however, the institution may treat them differently based on their profitability.

INTERVIEWER  

I have a few quick clarifying questions. One is about the nurses surplus versus the nurses shortage. If I understand correctly, there are enough nurses in many areas currently reporting a shortage to fill that shortage. However, the shortage is due to chronic understaffing caused by hospital policies, rather than a lack of trained nurses in the area. Is that correct? I want to make sure I have understood everything correctly.

KOCH  

Yes. It’s a counterintuitive thing, a jam that we are always having to explain whenever we’re advocating for patient ratio laws, that sort of thing.

INTERVIEWER  

And you think that a law regulating a patient-to-nurse ratio would basically solve that?

KOCH  

It would help across the country. There’s a reason why all the traveling nurses from Alabama, Louisiana, Mississippi, and Texas come to California because we have ratios. Some of them feel bad because they have to go back to non-union hospitals periodically to show they’re still okay with it. The reason they chose California is that we have ratios. Common sense tells you, would you rather take care of 15 patients or 5 patients a night if you’re a med surg nurse? When you have ratios, the mortality rate of patients goes down, and it’s better for the patients and even better for the hospital. We also suffer from staffing shortages, even though we have ratios. We fought for people to have breaks for many years, but when you have short staffing, you don’t get lunch break nurses, you pull the charge nurses to take care of patients, and you don’t have the luxury of smooth patient care. That’s what causes nurses to leave, even in states that have ratios.

INTERVIEWER  

To elaborate, the labor movement sometimes has problems when strikes or other actions impact consumers, because people may not understand what it’s like for workers on a day-to-day basis. So, to help illustrate the differences between the situations we’re discussing, let’s talk about what a nurse’s day-to-day life might look like. What’s it like when they arrive at the hospital in the morning, or whenever their shift begins? And what about when the hospital is properly staffed? And conversely, what does it look like when the hospital is understaffed? It’s important to paint a clear picture of these situations so that people can understand the impact of labor issues on the workplace.

HIERONYMUS  

I’ve worked in non-union hospitals where nurses typically work 12-hour shifts instead of the traditional eight-hour shifts. You arrive at work early in the morning when it’s still dark outside, knowing that you won’t be leaving until it’s dark again in the evening. If you’ve been working several shifts in a row, you’re likely already tired before your shift even begins, and this can make things more dangerous for both you and your patients.

INTERVIEWER  

What activities does a shift typically include?

HIERONYMUS  

When you start your shift, you always begin by getting a report. This is called shift change, which is where the slate name comes from. You’ll show up and usually sit down in the break room to get a sense of what’s going on with individual patients and the whole unit together. You discuss how you’ll approach your assignments for the day? Sometimes the staff will determine assignments, while other times management will assign them based on the unit. The charge nurse from the previous shift will give a report, going over everything that’s happened during the previous and providing a broad overview of the patients. Depending on the staffing situation, you’ll take report and then make your assignment before heading out to the bedside to receive a report from the nurses you’ll be taking care of. Sometimes Shift Changes can be difficult when staffing isn’t appropriate. I’ve seen moments when nurses collectively refuse to take a shift because they’re not safely staffed yet. In such cases, it’s best to get a manager involved and discuss how to fix the situation. I’ve even seen nurses refuse to walk out and take their assignements. Usually, these situations get resolved because the minute you start talking that way, management gets real nervous and will find nurses to come in.

KOCH  

As if by magic, the nurse staffing appears.

INTERVIEWER  

Direct action gets the goods.

HIERONYMUS  

It can be, at times, a moment where people are telling jokes, talking a little, getting ready to go out. You take a report from the nurse directly who’s taking care of those patients and get an idea of how things are going. You check with them, hand off care, and transitions in care tend to be where dangerous things happen. You get a sense of how your day is going to be, then you meet the patients, introduce yourself, and find out about their families. You get an idea for changes in a patient’s condition. When I was in the ICU, I would schedule medications and procedures, and coordinate getting patients back and forth between procedures and diagnostic tests. During rounds, the doctors come around and talk about the plan of care with the nurse outside of the patient’s room. You work through your tasks, doing assessments, making sure patients’ vital signs are taken safely, checking blood sugar, and ensuring patient safety above all else. You identify when things aren’t going well and start to bring more resources to bear on that patient. If things are not going well, you activate the rapid response team, increase oxygen or life support, and get doctors’ attention if necessary.

INTERVIEWER  

How often do health crises happen to patients that are assigned to you? And do you find that they happen more often when you’re understaffed?

HIERONYMUS  

Everything happens more when you’re understaffed because your attention gets stretched, and you have less and less capacity to do the assessment work that helps you head things off before they become emergencies.

KOCH  

when John’s short-staffed during the day shift, and I come on at night and John’s like “Dude, I’m, I’m overwhelmed. I didn’t get to do this, this and this.” And then I’m understaffed [on the night shift] and I have to carry off for, justifiably, what John couldn’t do. Then I’m handing it off to John again in the morning, the things I couldn’t get done, and you have this exponential growth, and opportunities for bad things to happen. Things that shouldn’t happen. Go ahead, John. Sorry.

HIERONYMUS  

Things slip through the cracks, miscommunication happens, you’re tired, you’re distracted, your bedside manner isn’t as good as it could be, then you end up not feeling comfortable telling your family that this or that is going wrong. Those are the sorts of things that happen. Sometimes it can come down to questions such as do you get to eat? Do you get to pee?

INTERVIEWER  

Does it really get to that level?

KOCH  

My god, yes. You could be on call for the labor and delivery with NICU nurses. And I often thought to myself, “Oh my God, the nurses, they’re all on Cipro and Septra because they have urinary tract infections, because they’re holding their pee.” I know it sounds gross, but honestly, this is the reality at times.

INTERVIEWER  

Why would they care about you taking a few minutes for a bathroom break?

HIERONYMUS  

The thing you have to understand is that nurses are trained to prioritize patient care from day one of nursing school. This could be one reason why unions have not penetrated nursing as deeply as they have teaching. Since nursing is considered care work, the patient always comes first. If something goes wrong while a nurse is away from a patient, their license and job could be in jeopardy. It’s common for nurses to joke about walking around with a Foley catheter and not being able to take breaks. Nurses in ICUs might not feel safe leaving their patients alone due to staffing issues, and they might only have 15 minutes to eat during a 12-hour shift instead of the one hour specified in their contracts. Hospital restrictions on the types of snacks that can be kept in units can also make it difficult for nurses to maintain their energy levels. It may seem minor, but it’s important for nurses to be physically and physiologically capable of doing their jobs, especially when caring for critically ill patients.

INTERVIEWER  

Wouldn’t the quality of care go down in these scenarios? I’d have to think that the hospitals would be observing this behavior and thinking about their bottom line eventually, in terms of the expenses associated with it, at the very least.

KOCH  

They have a quarterly approach. How much money can you make this quarter? You’re thinking long term – what is best for the long-term interest? Financially, even if you have no good sense. Or even if you have no heart, and you just think of money, it’s better to think like what you just said –long term, right? In the end, you’ll make more money. In the end, you’ll have better patient outcomes. They don’t see things in these terms. I think businesses are just structured to be myopic, and I don’t mean to go back to the bathroom thing. But I guarantee all the women and men who are nurses wash their hands before and after going to the bathroom, even when wearing gloves and washing their eyes. They don’t want to touch themselves with their hands until they wash them first. So it takes nurses a lot longer to go to the restroom than the average person. But it’s a real thing. John and I aren’t being flippant or cute when we talk about that. But you can be when you’re a nurse negotiator and they corner you in labor and delivery and NICU, repeatedly telling you they don’t have bathroom breaks, they can’t go pee, and if a baby is going to crown, they don’t have time, and no one is available to relieve them. That is a real thing. It may not look good in print, but it’s a reality for women in labor and delivery and NICU.

INTERVIEWER  

It’s remarkable to me that John pointed out that theoretically, the contract says that you have an hour lunch, based on the descriptions that you’re giving, it seems like nobody has had an hour lunch as a nurse in ages. What other sort of nominal rights do you have, whether through the union contract or based on regulations where you have them on paper, but in practice, you don’t actually have them?

HIERONYMUS  

We’re dealing with just cause stuff, people getting fired without any hearing or that sort of stuff. It’s not as bad where I work currently, but we’re looking at issues where our union hasn’t been focusing on contract enforcement in the way that we would like, or the way that it’s organizing doesn’t provide the capacity inside our union to do the kind of contract enforcement we need. Eric, before I talk more about this, because I think you’ve got a lot more happening in terms of your contract in your facility, can you share what is and isn’t happening?

KOCH  

For example, I was texting with John before we got on – and I worked last night, so I don’t want you to think I lay around and sleep! I set my alarm and woke up for the interview! – and I was telling him, part of the reason I’m a little tired is because I’m helping a Black nurse who was fired. He was initially written up because they said they saw a Black man peeing on the wall outside by the Emergency Department. The union had to get the video, which showed it was a houseless man peeing on the wall who happened to be Black and look somewhat similar. Nonetheless, he was fired for another incident where they said he abused a patient. The day that he supposedly abused the patient, he wasn’t working. The evidence was brought up, but instead of admitting their mistake, they said it was a clerical error and fired him.

INTERVIEWER  

That’s literally illegal, isn’t it?

KOCH  

Our union is in a tough spot. As nurse reps, we advised the person to get a lawyer because the union isn’t fighting for them. Negotiating a contract after the contract ends can be tricky. The hospital can refuse to forward grievances to arbitration, and we can strike as workers. The person is stuck in limbo, and the union isn’t fighting hard for them. We’re trying to get their firing expunged from their record, and I’m writing a character letter for their court case. I’m also dealing with your interview, but these things shouldn’t be falling through the cracks. It’s common sense that the union should fight for the workers. Our union is slacking off, and management is pushing more ridiculous cases onto us. We’re organizing Shift Change because nurses should be a priority. The union exists to protect us collectively, and our priority should be the bedside nurse. We need to reform the union, just like other unions across the country are doing. We want to fundamentally change the quality of our workplace, and our priority should be the worker and our quality of life.

The Union: Its History and Politics

INTERVIEWER  

That’s a good transition into the union and your problems with it. Can you tell me about the NNU’s structure and history? As a reform slate, what positive things has it done for workers before we discuss any problematic issues with its structure?

HIERONYMUS  

It’s also known as the California Nurses Association and the National Nurses Organizing Committee. The names get switched around, depending on geography, but legally, it’s all the same thing. It started as a part of the affiliate of the American Nurses Association. It’s one of the oldest unions in California, initially starting in the 1900s. But it really was a combination of management and workers, working bedside nurses for decades. It would have been structured similarly to the NEA for teachers, where it’s both got management and teachers in the same organization. The union side of CNA, at the time, formally split with the American Nurses Association and removed managers from the organization in 1997. The formal change happened in 1997, but there had been moves in the years before that to become more like a union and less like an association.

KOCH  

The bargaining body of the AMA disaffiliated from the management portion of the union and became a labor-only union. The ones who fought for contracts took over the union, and they took a positive approach to nurses and their function in the union, which is praiseworthy.

INTERVIEWER  

What year was this in, roughly?

KOCH  

The fight was from the late 80s to about ‘97. The union had a Left tendency with people from the IWW and ILWU brought in as organizers. The union took off, and the magazine was even called Revolution at one point. It had articles not just about nursing but about the idea that we’re not just in this as nurses – that we need to help other people, too. 

But from the 1990s to around 2013-2015, there was a shift to labor reps taking charge of priorities, without nurses’ input.

HIERONYMUS  

Let’s put it in context. The national executive director, RoseAnn DeMoro, was not a nurse. She came from the Teamsters and was hired to direct the union by a group of nurses that reformed the union in the mid-90s. The union was never particularly democratic. Our campaign is the first democratic challenge to the leadership in 27 years of the union’s history. But when RoseAnn DeMoro was the executive director, it didn’t concern people that it wasn’t a democracy – because the union backed nurses to the hilt and fought to get the ratio bill passed in California, which is still one of the union’s crowning achievements. There were occupations of Sacramento and nurse mobilizations with thousands of nurses showing up outside of hostile politicians’ homes. Some even say that the union was instrumental in ending Arnold Schwarzenegger’s political career.

INTERVIEWER  

Seriously?

KOCH  

So when he took over, we’d had Governor Gray Davis in California politics. One of the reasons they threw him out was because he saw the movie Deep Throat in the 70s. (They found this out because he was interviewed for a biography on Jerry Brown, where he was an aide at the time. Even though this came out twenty years later.) So Schwarzenegger was pushed in. 

At the time we had ourselves a little bit of a financial upheaval here in California, and Schwarzenegger’s response was that he was going to side with the hospital management. Nurses disrupted his speeches, and he said they were a special interest. 

Now, nurses are the number-one most trusted profession in the country. They clean you up when you’ve soiled yourself, hold your hand when you’re frightened in the hospital, and hold your parents’ hand when they are passing. When he was attacking nurses as governor, it caused his popularity to plummet. Nurses formed affiliations and partnerships with firemen and other unions who were being shortchanged by the government. We had a big hand in destroying Schwarzenegger’s career, and we were also instrumental in bringing down Meg Whitman when she was running against Jerry Brown. We ran a campaign where we hired a young lady to put a tiara on and a fancy gown and go around saying “I’m Queen Meg!” Whenever she showed up at a rally, we would bring Queen Meg to the rally. We also went to Meg Whitman’s house and protested in front of it. 

Our union had a progressive function, and bedside nurses were a priority. Our union was not democratic, but we didn’t care when we had an autocrat that was fighting the battle for us.

HIERONYMUS  

Another thing to add is that the union developed an effective strike strategy and brought strikes into nursing unions, which had been tepid. 

Here in Chicago, nurses hadn’t gone on strike at a hospital since the 1960s. The union recognized a large pool of scab nurses, tens of thousands of them, ready to cross picket lines. They [management] fly them in and pay them an incredible amount of money. 

But if you can line up several hospitals to go on strike at the same time – not indefinitely, but for shorter periods – you can undermine hospitals’ ability to sustain paying for staffing agency scab nurses. (They [management] like to wait out a strike when individual hospitals go on strike indefinitely. The longer regular staff nurses are replaced by scab nurses, the more knowledge those scab nurses have about the patient population and the facility itself – our specialized knowledge, which makes what we do so important.) There are some hospitals not in our union, like Stanford nurses. They can go on indefinite strike and command much higher wages based on the cutting-edge treatments they provide, many of which are developed at hospitals like University of Chicago Medical Center (where I work). 

So one upside of our union is the effective strategy for building power through strike action. One downside is that the strategy gets applied to every hospital in the union, with no wiggle room. They have a set playbook for every situation, whether it’s helping nurses unionize a new hospital, going into a strike campaign, or lobbying. Gone are the days when nurses would do creative things like chase political candidates, mock them, or occupy streets. 

Now it’s one thing to have that fighting spirit in a union that isn’t democratic; it’s a whole other thing when you don’t have the fighting spirit, and it’s still not democratic. Because now what we were seeing is the shift. And this is since RoseAnne was replaced with Bonnie Castillo – who was a nurse at one point, but has been in the union staff for years and years. She’s now, I think, the only nurse who works officially for the union.

KOCH  

Yeah, she hasn’t worked at a bedside for over 30 years.

HIERONYMUS  

But there used to be – at one point, there were director-level staffers who were nurses. The last nurse, I think, who wasn’t Bonnie and that worked for our union as a staffer was Marti Smith.  She was the Midwest director, and she was fired because they suspect that she was – well, it’s rumored that she was working on a staff coup to split the Midwest nurses away from the California Nurses. That’s not fully substantiated, but she was fired. And she was the last nurse working for the union, who wasn’t Bonnie Castillo. 

So anyway, once you remove the nurses from staff – and because there was no real democratic structure in the union, as these have been gradually stripped out since the 90s – now we’re stuck with a union that both doesn’t have that kind of fighting spirit that it used to have, and it doesn’t have the democratic mechanisms for bringing that fighting spirit back. And unfortunately, in our experience of trying to run [for office] in the union, we’ve gotten the full force of what it means to be not in a democratic union – you know, to put it lightly.

KOCH  

I also want to just put in there that, during our transition away from being an ANA-led union with managers in it, RoseAnne, when she helped push this coup in 1992 – well, at Kaiser Permanente Medical System, they actually went on a three-week strike over some words

The idea was that they wanted to be able to have sympathy strikes with other unions. And so they went out – the nurses went out, the housekeepers, the nurses’ aides, they joined together and struck for over three weeks. No pay, no nothing; no strike fund, no nothing. And we supported them, just so that we can have the words in our contract saying that we can, as a union, issue a strike notice to go out in support of other unions. The words themselves were that important to nurses and to our union – the words, and the solidarity with other workers. 

That was in 1992. It was a three-and-a-half week strike. One of my coworkers through it all was working as a nurse and, like John mentioned, was working in positions within CNA [California Nurses’ Association] also. And, frankly, when they had that revolution and split the nurses’ union proper from the management side, there were many nurses who worked for the union too. 

And I think that’s also what gave us a lot of traction to grow as a union, because – and please don’t take this as me discrediting people that aren’t nurses that are organizers, because many of them are outstanding – but it’s something important for John or myself to actually be able to talk to another nurse who can say, “Dude, I’m here with you. I know where you’re coming from. Yeah, I went without breaks. This happened to me too, that happened to me too.” Someone who relates to another nurse, who can say to another nurse, “I’m there with you. I know, I have that empathy, I know exactly what you’re going through.” I think that helps with organizing. 

And I don’t want to demean those [staffers] who aren’t nurses, who do a great job most of the time. When we first started out, there were many that helped us. I don’t want to get into the weeds. But I remember we had those great labor reps who, when we had a strike line, were like, “We’re missing Paul Robeson. Why aren’t we playing Paul Robeson on the CD there, we need to hear Paul Robeson! We need to hear Solidarity Forever!” And that’s good, because it allowed people to get a labor education, right? So that’s important, I don’t think it just needs to be nurses. We need to have people dialed into that. 

But if you’re a labor rep, and you’re working for the union, your priority needs to be the worker you’re representing first, and the union second.

INTERVIEWER  

This is fantastic. Let’s backtrack to the strike stuff. How exactly do nurses go on strike? What is the nitty-gritty of the strike strategy, short-term versus long-term strikes? Management argues that if nurses go on strike, patients will die, so it’s unacceptable for them to strike. What tactics did NNU develop to address these concerns? You mentioned that these tactics don’t work when they’re imposed upon everybody. Why don’t they work in every context?

HIERONYMUS  

Talking about nurse strikes: generally speaking, nurses’ knowledge of the facility, the patient population, the electronic charting, and so on, takes about a year to build up. The longer the strike, the longer scabs have to gain that knowledge. Short-term strikes can be disruptive, and there has been a lot of work to make them more and more legally difficult.

During the early years of unions in America, the IWW and the CIO used to do Whistle Stop strikes where a shop steward would blow a whistle and everyone would lay down their tools and stop until management came and sorted it out. This kind of workplace power depends on the organization of workers. 

The big, long strike that many people hold up as the most powerful form of strike is not necessarily the best option for us as nurses. On the other hand, symbolic strikes that are too short don’t cause enough disruption – my strike in 2019 was a one-day strike, and then we were locked out for five days! The gold standard is three to five days, as there’s a minimum length for a contract nurse or scab nurse to show up. In an institutional universe, they can afford to pay that five days, so they lock us out. 

Nurses go on strike to improve patient care and working conditions, which in turn improves outcomes for patients. We strike only when management refuses to address the issues that would improve conditions for our patients. Nurses who are striking are doing it for the patients, not for personal gain. Patients themselves understand why it’s necessary for us to go on strike.

KOCH  

 The Kaiser nurses they had a series of one to five day strikes, about 10 of them over a year, and it was quite successful. It raised their salaries and improved their working conditions. Those successful strikes enraged the corporate industry because they had never seen anything like it before. It was so innovative that they had to keep flying strike breaking nurses, which was costly, and the quality of their care went down. John is right that the union has become too predictable. They have a set pattern of having one, three, five, and ten day strikes. Instead, maybe they should just have a five day strike right off the bat. The union has become like a plow horse with blinders. We’re screaming as nurses, just like John. We had to knock on Bonnie’s door to get them to allow us to go on strike. Our union had 3 strikes, while the other tables had only one. We had the biggest strike ever, with 617 hospitals out on strike, but it did nothing. We needed to have a longer strike when the hospital was at its weakest, which made us suspect that the union was actually working behind the scenes with management.

HIERONYMUS  

During COVID, Cook County Hospital nurses were only allowed to strike for 12 hours. They were being hustled back into the hospital the minute the strike was over. The power they had in that moment, in 2020-21, was being squandered. Discussions are ongoing between management and the union staff about what they can and can’t win, or what they think is acceptable. When nurses raise demands of the union, our pension was unilaterally taken away by the University of Chicago about six years ago. We asked if we could get our pensions back, but staff said we’d have to strike six times to get that, which seems impossible. Our union has struck 10 times in the past to get these sorts of things. If we were properly supported and organized democratically, we could get language around no-strike clauses and other issues stripped from our contract. We have nurses in hospitals where momentum builds earlier than others, but they’re told to wait instead of being allowed to strike. We want to build a national strike council where nurses from facilities in the middle of a contract campaign send delegates to coordinate when it makes the most sense. Nurses learn their power during strikes, and they become capable of organizing. The more nurses are given the capacity to control these things, the more capacity we’ll have to push through reforms, like ratios in states outside of California, or other priorities.

INTERVIEWER  

Based on what you said earlier, it seems there was something like a social contract during the golden years of the NNU: the union was run in a top-down manner, but as long as there was a benevolent dictator pushing forward direct actions, labor strikes, and innovations, it was mostly good for nurses and took them out of the mid-century period of not being able to take militant action. 

However, the existence of this reform slate indicates that this social contract has been broken, and the top-down union structure no longer supports rank-and-file nurses. So, my question for you is – first, is this an accurate picture of how we got here? And second, in what ways (please provide lots of details) is the union letting down rank-and-file nurses?

HIERONYMUS  

Everything you said is true. The transition started about ten years ago, when RoseAnne DeMaro was transitioning into retirement and Bonnie Castillo was taking over. Bonnie Castillo came from a lobbying background in the union, so political lobbying became the focus of the union. This meant building relationships with politicians instead of threatening to end their careers. The focus shifted to building closer relationships with the progressive wing of the Democratic Party, especially in states and regions with fully Democrat-controlled legislatures and governors. The work of building closer relationships with politicians has become more acute, with little input from nurses on policy decisions. The focus of the union staff has been on wrote mobilization and turnout for lobby days, with political endorsements being brought forward to specific activists in the union. The union doesn’t hold mass union meetings to discuss the direction of the union or specific priorities. There is no forum for nurses to bring up their concerns except for calling labor reps and yelling at them as individuals. Multiple conversations with staff from local labor reps all the way up to national directors have resulted in bedside nurses being ignored.

KOCH  

Their favorite response is a management response – that you learn. One time my wife, a case manager, was listening to (and laughing at) Stewart, the labor rep who was the head of negotiations, and we were literally yelling. “Look, we have proposals we want to put forward. We don’t want you to sit on them. This is our priority.” And they’d reply: “I hear you. I hear you. Of course. No, I understand. I hear you. But no, we can’t put that forward.” So it’s placating. It’s what you tell disgruntled patients, when you can’t do anything about their complaint. That’s how they played us. 

It’s infuriating. We called it gaslighting. They gasped at us when we pointed out, “Hey, you can’t do that,” they would say, “oh, really? What happened?” When we caught management telling us “hey, we heard you liked this other proposal better,” we were like, “who did you hear that from?” Well, we know who they heard it from. The labor rep was talking to them offline. In their proposal, originally, I would have lost my arm. In the new proposal, I would have just lost my hand. Well, I like losing my hand, just not my arm. That’s the stuff we were facing in negotiations. 

The word I said that got me in trouble was “our union frittered away during COVID the power and respect that nurses had.” During the pandemic, we were at the apex of what we could have gotten done, and our union was too busy following their little roadmap of working with management and saving money. One of the labor staff reps at the strike line said, “Oh, these strikes cost so much money.” Well, whose money is it? It’s nurses’ union dues. But most of our union dues are being used to lobby for politicians and to beg us to donate to a political action campaign for blue politicians. That’s their priority now.

INTERVIEWER  

I suppose you could just as easily say that a political campaign is costing a lot of dues money and maybe the union should save its cash for more important things – like strikes!.

KOCH  

Oh, absolutely. You support Gavin Newsom and give him money. He says the words, but his actions never follow through. He’s Reagan-like: Teflon, nothing sticks to him. When he ran for mayor of San Francisco, he sent his aide out to work in different regions. Newsom had an affair with the aide’s wife while he was out working for him. To openly continue to support this guy says something about one’s character. California had a big hubbub about him eating at the French Laundry during COVID – with hospital and healthcare lobbyists, without a mask. A few days after, he issued a proclamation that if staffing was bad, nurses could just get rid of management to get rid of ratios. Our union continues to support him.

But the priority shouldn’t be politicians. We need to hold their feet to the fire. You don’t have to be rude or obnoxious, but just remind them of what we did for them and what we’re asking for.

INTERVIEWER  

How does the union’s failure affect nurses’ wages and working conditions? Some people believe that nurses have it good, and the union has made it a working-class job that can be done without a PhD. It’s one of the better-paid working-class jobs, and some leftists might even say that they’re part of a labor aristocracy due to unionization. However, some of the conditions that you described present a different picture. Has the union’s focus on campaigning for Democrats caused them to effectively betray rank and file nurses on basic issues like wages and conditions?

HIERONYMUS  

We’ve noticed that the union is only pushing for wage gains in large privatized systems like Kaiser or University of Chicago, where they can take a percentage of our wage gains as to who’s right. I constantly hear from my coworkers that the dues are very high compared to other healthcare unions, and they’re not fighting for the things that would make being a nurse a long-term job, like pensions, retiree benefits, healthcare benefits, and that sort of stuff. You know, the sorts of things that would lead someone to stay being a nurse in spite of the issues that we’re raising in terms of staffing and working conditions. When people often complain that nurses are making too much money, I usually hear that from people who seem to be in a weird kind of media or academic space, mostly people that I run into who are working workers, like they see nurses make what they make because they do a hard and difficult job. Many people see nursing as a potential avenue for them to improve their lives. I became a nurse first as a nursing assistant, then I became a licensed practical nurse, which is a one-year certificate, and I got an associate’s degree in nursing. And I have a bachelor’s in nursing. There are very few professional jobs where you can enter with less than a bachelor’s degree. Most people generally in the population don’t actually think of nurses as being overcompensated. There was a brief moment in the mid-2000s, during the financial crisis, where they were able to mobilize some of that sentiment, and the unions in Wisconsin during the Wisconsin uprising, under Scott Walker, were ineffective and pivoted away from strike actions to political mobilization around a political candidate. But I really just don’t see many people getting very resentful at how much money nurses are making because of the important work that we do. Our union focuses on fighting for a wage gain that they can take a percentage of out of dues, that gets put back into these political things that we’re talking about, over the sorts of things that will make our jobs more tolerable, make a career as a nurse more attractive. We’re suffering from that because we’re seeing people either choosing not to become nurses or leaving nursing. So, those are key ways.

INTERVIEWER  

This raises another question for me. You both mentioned at one point or another that you feel strongly that union staff, upper level union staff are colluding with or talking with hospital management. Why do you think they would do that? Doesn’t that go against the interests of the union for them to engage in that sort of thing?

HIERONYMUS  

Just like we were saying before that the hospital’s interests are undercut by short-staffing nurses, the union shoots itself in the foot too. I think it’s just fundamentally easier [for them]. To give you a sense, we have a labor rep here in Chicago, who we overheard telling a newer labor rep: “You’re getting yelled at by the nurses? Don’t worry, I’ve got a system set up where I just sit in my garden, watering my plants, with a nurse yelling at me on speakerphone – and I only go into the facility once a once a month.”

The union is notorious for burning through union staffers, especially more idealistic ones – they run through them like tissue, practically – and the ones who stick around call it the golden handcuffs. The union pays staff better than many other unions, and during the pandemic, the staff all got 19% raises to ensure their loyalty. But this basically means they end up in a cult where they have no say. NNU’s staffers have a union themselves – but it has very little power, and the collective bargaining agreement gets regularly violated. We know there’s [NNU] staffers attempting to run their own slate to take over their own [staffers’] union. In 2021 several of those union staffers fought back – and those union staffers got fired. They [high-level NNU staff] rigged the election, they made people give their votes over by proxy, so that the [rank-and-file] staffers couldn’t have more say over how their working conditions were being run. They accused anyone who has any dissent of being union busters. NNU accused people of wanting to decertify the union and being pro right to work, but that’s not true. So when we talk about, like, our own union, which professes to have all these really great progressive values, literally engaging in union busting themselves, that quite frankly is really upsetting. 

Union democracy makes strong unions. The Chicago Teachers Union has a vibrant internal democracy, with multiple rank-and-file caucuses of teachers competing to direct the union. And when they get a tentative agreement, they have several weeks to go look over the contract, debate its merits, reject it or accept it. These are all things that make that union one of the most powerful teachers unions in the United States. Meanwhile, our current union leadership is afraid of any step out of line – even questioning something as corrupt as giving an executive director luxury apartments. (When RoseAnn DeMoro was in the process of retiring, she was basically gifted an apartment by the union. A nurse who was on the board asked, why are we doing this? And simply for raising the question they initiated proceedings for a vote of no confidence in this board member – and they called her a union buster.) The difference between a democratic and undemocratic union is that [in the latter] the union is fundamentally us – but the [high-level] staffers treat it as though it’s to serve their interests. These are people who fear the democratic input of nurses. They give themselves raises and then tell us we can’t go on strike, that we have to lower our expectations.

KOCH  

So it became apparent to us that we had worked over a decade to try to get a master contract like [the one with] Kaiser with the Sutter Corporation, Sutter Health. And we had been working since about 2008, to move in that direction – we would be definitely stronger with 17 or 20 hospitals all negotiating at the same time. We would have the power that they [the nurses] did with Kaiser, you know, to say, “Hey, we’re all gonna go out on strike.” That’s pretty hard, to fill 17-18 hospitals, right? Well, that’s the power of the Kaiser strikes – if they decide to strike, Kaiser doesn’t even allow the nurses to walk out, the nurses will give a strike notice and guess what, usually an agreement happens right before the strike! Because Kaiser just doesn’t want to spend that money. 

Now, for us at Sutter, we worked over a decade – you know, at this point, it would have been 13 years – to try to get this master contract. We were making about 20%, some nurses 40% less than Kaiser. And of course, if you’re a new young nurse, Kaiser doesn’t hire new grads – who do you come to? You work for Sutter. And after you get six months to a year at Sutter, what do you do? You apply to Kaiser – and Kaiser hires them, because they have experience now and they don’t have to train them much. And why wouldn’t you, as a young nurse, go make anywhere from 20 to 40% more? So we’re hemorrhaging staff to Kaiser. That’s why we wanted to get as close as we could to pay parity with Kaiser. 

And we wanted a lot stronger staffing language. We wanted better anti-violence-against-nurses language. We wanted more safety on the hospital grounds.  Jesus Christ, can you put some light bulbs in the garage where the nurses are getting mugged? Can you put a patrol in the garage when a nurse comes off work and her car is actually on cinderblocks, because the tires and the catalytic converter got stolen? You can’t put a camera in there? You can’t put a walking patrol?

That’s the stuff that we were pushing for. Okay? And we were told by the union, “Well, if it was up to us, Eric, we would do that for you. Hell, I’d give you a 50% raise if I could. B-b-but, we can’t, it’s not realistic. This is what we’ve agreed to at the other hospitals.” Well, why did you agree to that at the other hospitals? We had, what, 16 or 17 facilities total – 16 others beside ourselves – and you walked away from striking. Huh? Why? Because they already had the side deal, that’s clearly evident. They didn’t want to ask for more because they’ve already agreed in principle that’s all they were going to ask for from Sutter. And the reason you don’t have strikes at 17 facilities is because you’re saving up money for political causes [i.e., campaign donations]. You’re giving labor reps 19% raises during COVID, and you’re not allowing the labor reps to come into the goddamn hospital.

HIERONYMUS  

And then on top of that, we just know that, like – for the Sutter nurses at Alta Bates [Summit Medical Center], where Eric works, they were told [by the union] that they could get 20% raises, but the nurses at Alta Bates wanted 30% raises over four years, so they would actually catch up to inflation, which has been even worse in California than in other parts of the country. That’s what they were being told had to happen – until the day came when all of our applications [Shift Change] to run as a slate showed up, and were declared valid. That’s when all of a sudden, miracle of miracles, the 30% was back on the table. And so the question for all of us is: how is it that these people are telling us what is and isn’t acceptable to demand, when, as soon as they feel that they’re threatened, then what’s possible suddenly becomes much closer to what nurses are asking for? Threatened, that is, when nurses are actually saying, “Maybe nurses should really be in charge of these decisions, not you all.” 

I know our labor reps at University of Chicago Hospital are afraid of the labor relations lawyer there; I know that at Cook County Hospital, the nurses there have watched their staff make deals that are in contravention to ordinances passed or resolutions passed by the Cook County Board of Commissioners to give nurses retention pay, that they’re watching labor reps allow those negotiations to be cut down from the maximum demand of $15,000 retention pay – and this is in a hospital where over half of the bargaining unit has now been replaced with agency nurses. (These are temporary nurses.) 

Our union is always talking about the threat of Uberization of health care and of nursing, and they’re literally watching it happen here in Chicago, – but the staff are not fighting, like, over half the positions at Cook County Hospital being filled by agency nurses, and they’re not fighting to increase the amount of of pay for the nurses so that they stop leaving. It’s similar to what’s going on out in California: nurses who are working in facilities where they were making what would have been considered, before the pandemic, a solidly middle-class wage are now facing all this inflation. And the offer of traveling contracts and agency contracts where you can make two to three times what a staff nurse is making – well, people just quit and walk away from the regular staff positions, because the short-term benefit is really transparent, you’re gonna make substantially more money up front. The problem is you don’t get any of the benefits. And you don’t have any of the power when you’re an agency nurse, you’re not in a union. So our concern is that the union is letting facilities basically just dissolve the union power of the nurses – and that this is happening with, you know…either people are being – what’s the term, useful idiots, or dupes? – because they believe that this is in the best interest of everybody; or, they’re actively just colluding because it’s the easier path for those labor reps if they just want to keep the golden handcuffs on and keep getting paid.

INTERVIEWER  

A lot of great labor journalists and historians – like Mike Davis, Robert Fitch, Stanley Aronowitz, and Kim Kelly – have often pointed out the correlation between authoritarian unions where union bosses have the final say, and the overall decline of union power.  How has this played out in your particular union? You’ve mentioned rank-and-file workers and staff getting screwed over; has this made the union weaker, in your eyes? What is the constitutional structure of NNU? Who really has the power, as opposed to these other groups that clearly don’t? And why specifically does the concentration of power in their hands lead, in your eyes, to these substandard results?

HIERONYMUS  

So for a bit of context: who’s making these decisions, how we got to the point where they control us and control the union – these are the outcome of decisions that were slowly being made over the course of 20 years. And we know this because we [Shift Change] have looked at every set of bylaws going back to the split from AMA. We have this research document that goes line by line looking at every set of bylaws, going back for over almost 30 years. And you can see a slow and steady erosion of the democratic structures inside the union. 

There used to be local autonomy. We used to have regional meetings of the professional practice councils, we used to have regional meetings of nurse reps. So these are people whose only focus or at least their main focus is on working conditions and defending the contract – and nowadays we’re lucky if we have something called the Metro Council, which is really just a political organ, it exists for things like political endorsements and political campaigns. And we’ve seen how these things were just slowly taken out. I think the last big change was in 2014. And no one can remember, in 2014, the actual vote on the bylaws – so we believe that things are being kind of, like, shifted around in ways that are aren’t very transparent. 

We’ve had people who’ve been involved with trying to reform the union and who tried to insert an amendment to an anti-war resolution, probably like two conventions ago, and tried to get the bylaws from the union – because the person who was doing it didn’t understand that you could probably find that stuff through the federal websites like the OLMS [the Office of Labor Management] – and instead they were given, like, the copy of the copy of the copy of the bylaws, it looked like shit. And then when they introduced the resolution at the convention, everyone was told that these are terrible people who want to destroy the union, that they’re union busters. And that was a vote that Eric was on – where he didn’t know what was going on, right? – and so he was just following what the staffers were telling him to do. And the staffers in these conventions are constantly cajoling nurses to do this or that, and to keep everything very on plan and on track. And after they attempted to make that amendment, the nurses were like, “Oh, I thought that that was supposed to be some terrible thing. But actually I’m really grateful, thank you for doing that.” Right?

KOCH  

Yeah, you’re pushed into thinking, “Hey, you’ve gotta be careful.” 

Or even with the voting. I remember when I got the ballot, there was a labor rep telling me, “Hey Eric, here’s a list of people you should probably vote for. These other people, though? They’re anti-union.” Well, at the time I was naive, I had no idea – I mean, why would she lie to me? Why would you say people are anti-union when they’re not? I know it sounds naive now, but I had no idea why she would lie to me. This is how they controlled the democratic, or the faux-democratic, aspect of the union. As a delegate, you’d mostly look at all the given items and say, “that’s good, that’s good.” For instance, ensuring that immigrants aren’t discriminated against and get the healthcare they need. Who’s not supportive of that? (Surprisingly one or two weren’t, but for the most part people were.) However, whenever people tried to make any little amendments, that’s when they became anti-union, even though there was nothing anti-union about it. It was simply not what the union wanted.

INTERVIEWER  

But who is “the union?” Presumably you mean leadership.

KOCH  

The union’s power is vested in the Council of Presidents. That’s why they’re scared and spreading lies about us. I mean for God’s sake, one of John’s arguments is that he has 3,000 union nurses at the University of Chicago, but only 1.5 labor reps – John, correct me if I’m wrong on that number – 

HIERONYMUS  

It’s about 2,200 nurses, represented by just one and a half labor reps.

KOCH  

Yeah, that’s ridiculous. And the union claims to the membership that John is actually fighting to eliminate labor reps. It’s just the opposite. John wants more labor reps actually involved in helping nurses at the bedside make grievances and fight for their rights.

INTERVIEWER  

How many people are on this council? How are they selected?

KOCH  

For 28 years, they rotated the same people in and out, right? One person would be on the board, then they’d become a president later. The power is in four people who work with the executive management of the union. Non-elected people like Don Nielsen, who’s a labor lawyer running the IT department, he ran the political outreach and lobbying group; Bonnie Castillo, elected by the board and an executive member, non-elected; Kenneth Zinn, another power behind the throne. There’s this coterie. 

That’s why their greatest fear is that if we [Shift Change] make the Council of Presidents, we have – it’s like the glove of Thanos or something – we have the power to reform the union with four people. Not that it would be easy, but we have the power.

The board is broken down into regions, and each region gets a board member. Down the ballot line, Shift Change are running against the incumbents in the Council of Presidents; and in the VA division there are two people running against each other – but in all the other positions, it’s just one person in that region running uncontested. It’s like the GDR, you know, in East Germany – “We have a democracy here, look at this!” And it’s just one person, you know, it’s like, you just put a checkmark by the one person that they [the bosses] selected.

The last election, guess how many voted? 1,350 votes, out of around 150,000 people in the union.

INTERVIEWER  

So based on your description, the Board of Presidents uses low turnout to effectively appoint its successors and members; reinforces low turnout by having the same people win repeatedly, which gives people less incentive to vote; and ultimately gives the Board of Presidents more control. Is that roughly the pattern?

KOCH  

Exactly. “Why bother?”, essentially.

HIERONYMUS  

Yeah I was gonna say that, according to like the staff handbook, the union itself has declared that they’re democratic centralist in principle, because they believe that there needs to be a small group of people able to make quick decisions, without having to [consult the rank-and-file], being able to pivot and be wherever they need to be. 

Now, for people who don’t know, because most people don’t: democratic centralism is explicitly the organizing principle of the [Leninist] party – like Eric was saying, the East German state, the Soviet state, these are all states that basically were run by older and older, ultimately geriatric leadership, to the point where they effectively collapsed. And this is explicitly how they tell everyone what kind of organization they are. They’ll tell you at the beginning of, say, contract negotiations: “Oh, you should know, if you’re going to be on the bargaining committee, our union uses democratic centralism; which means that we all have our debate, and then we vote on it; but once we vote, we all have to agree, right?” And so they’ll tell people that you can’t disagree with the decisions made by, you know, these ever smaller and smaller groups; and then also inside the bylaws changes you can see how they’ve made it so that “accountability” is central, they keep talking about accountability of elected leaders – and what they’re talking about is: if the Board of Presidents wants to remove any nurse from an elected position, they can be removed by the Board. So like, if you’re a nurse rep, and they decide that they that they don’t want you to be a nurse rep anymore; or if they don’t want you to be a Chief Nurse rep, which is like basically the chief steward of the hospital or PPC chair – we’ve had instances in Chicago where someone missed like two meetings, because they had to take care of family member, and they were removed from their chair of the PPC by staff, basically. And so the accountability isn’t to the rank-and-file; it’s to them.

So the union, if it doesn’t exist to serve the rank-and-file members – then what is a union, if it doesn’t exist to do that? The way that it’s structured right now, they expect us to basically act like soldiers in an army that are told, “you have to do this or that.” And, they add, if you have anything to say about it that isn’t toeing the party line, we can remove you – and they do remove you, they go out of their way to marginalize you inside the union, to keep you from participating. It’s always a fight, when you’re a dissenting voice in our union, to stay involved in the union, because they make it so miserable, they stop telling you when meetings are happening. It’s really…[sighs]…

And then their supporters will tell you, “Well, nurses run our union.” And they say this without any understanding that it’s the director-level staff, the executive director and the directors that basically keep her supported, who really make these decisions. We watch directors like Corey Lanham, who’s one of the top-paid people in our union – he’s the director of bargaining, who’s very comfortable with basically lying to nurses or misleading nurses about what is or isn’t happening in the union. The other kind of creepy thing is that we know that Don Nielsen – who is the head of tech security for the union – has installed a bunch of internal surveillance software on every staffer’s phone and computer. It’s very cult-like at bottom, very top-down. And really, it’s just not healthy and good. And I think it’s fundamentally making our union weak. I want our union to be strong and powerful.

INTERVIEWER  

How do you think that this centralizing tendency cashes out in terms of making the union weak? How do you feel it contributes to the complaints that you guys were putting forward before about the union not having people’s back in particular struggles?

KOCH  

I can give you an example. From 2011 to 2013, we would negotiate; and afterwards, we put out the negotiation flyer, right? “Management came forward” or “we had a TA on this or that” or “management refuses to budge on staffing or refuses to budge on this or that,” etc etc. I remember one of our headlines was: “chutzpah!” As in, “management has the chutzpah to deny nurses this or that.” We would put out the flyers. We would basically make them up in the time it took to type them and we’d all be around. “No no, say it this way, say it that way.” We could put out a flyer in 35 minutes. We’d have to wait two hours because we’d have to print out the 800 copies of it. It would be shipped electronically downtown to the union. Then we would go down and pick up the flyers and hand them out.

But this go-round, we’d write flyers, but they would have to be approved, my friends – they’d have to be approved by all these upper union hacks. So it wasn’t just the labor rep and the nurse negotiators. Now, it had to go through an approval process. We would write a flyer. By the time the flyer would come out 48 hours later, it would be totally different than what we would have to say. And it’d be filled with misspellings. It’d look unprofessional. We would be embarrassed to put this out. Because the flyer would have to be vetted by all these upper mucky mucks who had no idea what we’re even talking about at the table. Part of it is, they didn’t want us to poke at management – because they’d worked with management behind the scenes. So we didn’t have anything that was worthwhile. Now our flyers, I gotta tell you, I look back at some of our flyers [before this shift], and I’m like, holy cow, that was brilliant, we really took it to management. I can tell you, we’ve never done anything this go-round to even raise the ire of management during this round of negotiations.

INTERVIEWER  

Why would the union bosses even want to overwrite a perfectly good flyer?

KOCH  

It’s called control. It’s called central control.

HIERONYMUS  

It is very much like a control thing. There’s a panic whenever nurses say or do a thing that isn’t explicitly approved by these upper-level people. And fundamentally, it’s because I think that there’s an insecurity on their part that none of these people have been nurses, or they haven’t been nurses in so long that they really don’t understand what our conditions are anymore. And so I think they kind of overcompensate by exerting all this control, because they don’t really know why, on a fundamental level, we’re so angry or upset. I’ve had to yell and cajole – with my partner, Nina, who’s from a strong union family – literally, like, shouting at the staffer while I’m on the phone with them, about how angry we were that they weren’t doing anything to support us better when I was personally dealing with Long COVID symptoms. You would think that you’d want to turn that sort of anger and energy into organization and action. But instead, they sort people into – “well, these people are pro-union, and these people are anti-union. The people who complain at us are anti-union, right? And those are the people who we will marginalize and ignore, versus the people who are pro-union who either don’t complain or just work inside the union until they literally can’t do it anymore.” And they stopped, by the way, because they’re so burned out. And then we wonder why it is that we have an ever shrinking number of people who are willing to do the basic union work? It’s very, very frustrating. 

As an organization we should want to be expanding, always bringing in new people who are then bringing in their friends, building a dynamic base of people. Nurses are not. Nurses are trained to write. Nurses are trained to do education. Nurses are trained in leadership – we were all given classes in public speaking, research, and writing, especially in larger hospital systems. Even as an LPN we had to learn how to do public speaking. But the way they treat us is as though we are children. That’s where it gets kind of infuriating: when these people who, frankly, I don’t find very impressive, treat us as though we’re children who don’t, who can’t, understand the business of the union. I think that’s one of the reasons they’re so afraid whenever nurses do flex their own power – it’s startling to them, because all they can do is sort people into these categories of supporters vs. enemies of the union, even when the so-called enemies can bring up valid points. This time last year was the Labor Notes conference; I went to three talks, and the three talks were about your democratic rights within the union. I’ve read books like Labor Law for the Rank-and-Filer. I’m not incapable of figuring this stuff out. If I’m capable of keeping someone who should be by all rights dead, alive, through all the skills and capacity I have, you’d think I could also figure out how our union works. Multiply this by, like, 100,000 – nurses need to have thinking and organizing skills like this to do our jobs. But these are an under-used resource by the union, because they’re fundamentally afraid – they’re more concerned with their own power.

KOCH  

I’d like to give some examples. This comes from labor reps, who are told that of course they can contact other labor reps to say, “hey, can you help me pick up these flyers? We’re supposed to go organize and pick up the signs.” They can talk that way. But it’s discouraged that labor reps have conversations with each other. We called it siloing. 

Like during the negotiations with Sutter. There were 16 other tables besides ours, and we were told (the union told us) that the federal mediator banned us from talking to the other tables. Remember, we’re in a common table, we were trying to create a master contract amongst 17 Sutter facilities. And supposedly we couldn’t talk about individual things that were happening at our separate tables. Like if, say, John was at the local Sutter ten miles down the road from mine, I wasn’t allowed to talk to him about what was happening, what we were talking about at my negotiating table – especially money. Why was that? How is it that you take the power of 17 tables, and you break it off? That you fray the power that those 17 tables would have had, if they were bound as one? Why would you do that? 

Now, they didn’t want to reveal it to the nurses, but they connected the dots. “Hey, wait a second, they’re telling you that we need to do that too?” Well, we ended up finding out of course, the three of us that had been already on to other negotiating teams besides this one, realized that was –  pardon my French – horseshit; that the federal mediator never tells nurses they can’t talk to other nurses. Sure, we are bound at times when we speak about certain things in negotiations, that you don’t share it right away. But why can I not talk to other nurses and other tables when we’re trying to get a common agreement? 

Each table had already been basically bullied into accepting the terms; ours was the only one because they couldn’t bully us, we had veteran negotiators on the table. And every time CNA wants to have a negotiating team, they try to reach out and grab new nurses to be on that team. They don’t want experienced people. 

INTERVIEWER  

So it’s divide and conquer, basically.

KOCH  

Exactly. 17 tables – together.  It’s the marrying of those who know with those who can do. We would have marched over Sutter and gotten a fabulous, maybe an industry-leading contract. Why was our union opposed to that? Because they had already set a deal on their own. They’d already established a deal. We found out at the other tables, they were asking for the same pay rates and telling them, “oh, you can’t ask for more.”

But why? Like I told you, we’re woefully behind Kaiser. Centers are hemorrhaging. John will talk about safety to the staff. As a night charge nurse, I have five nurses on the floor with me. One nurse has over one year experience, and the other four have less than a year of experience. I feel scared without anyone to bounce ideas off of, as they don’t understand what I’m saying.

HIERONYMUS  

Part of this is related to – you know, I’m in the middle of my nursing career, Erik is coming up on the end. One of our goals is to make nursing a thing, so to speak. Raina especially, one of our running mates, is focused on defending nursing as an actual practice. There’s a saying that “nurses eat their own,” where burned out nurses bully younger nurses. We believe that if we fix these problems with our union, it’ll make nursing attractive to younger nurses. We want every nurse in a union facility to quickly understand the value of the union. If we want our profession to survive, younger nurses must feel empowered to use the union to make their lives better. The union seems to be failing at this, stripping nurses out of the staff and democratic processes. Existing incumbents sling mud at us, calling us union busters and Trump supporters. It’s antithetical to what a union should be focused on, concerns of working women. Our union should make sure every nurse feels comfortable and ready to move into leadership. Most women leaders in our union in Chicago didn’t feel competent or prepared to begin to challenge the incumbents. We want the union to be run by nurses again, so we can build our power and translate it into improvements in working conditions, so nursing remains viable as a profession.

KOCH  

The most telling thing for me is we wrote a letter asking the Board to address the things we asked – about our flyer. As a nurse negotiating team, we asked for integrity, honesty, transparency, and we wanted the people that held back the livelihood of nurses at 17 hospitals fired and removed from the union. We were told we were union-busters. The meeting started out with the intent they were going to invite and fire the entire negotiating team for rebelling against them, for being anti-union. Now I’d love for you to see the letter we wrote; and then for you to see the audio clip of them discussing their response. And when you read the letter, you’re going to be like, “Wow, that’s pretty pro-union to me – it’s pro-honest union.”

Our union is moribund. Our hospital and our union itself is more about gaining new members by raiding other unions. Nobody’s beating down the door to be in our union anymore. Because of dissatisfaction with how the union operates as more of a management, SEIU-like union, it’s difficult for people to say, “I want to be in that union.” If you have a great organization, the word of mouth alone is going to have nurses and techs beating down the door to be a part of your union. Your reputation alone will precede you, and bring people into a wider, bigger union. 

John is right, we need to get rid of this central control where Oakland is the center of this empire, and its tendrils choke out the other regions. We need to hear the opinions of the regions, and they need to have control over their autonomy. (I hate to go all EF Schumacher, Small Is Beautiful and all that, but there’s something to it!) There needs to be a little more autonomy and growth. By having smaller units, the regions have some control over what’s going on. We need to have a national vision. The vision we need to have is number one, the majority of the eyes should be on the bedside, what nurses need, and the other eye looking a little forward to making nurses’ lives and the lives of everybody in the country better. That’s what nurses do, we take care of patients, and we want to extend that vision to make a better world so that the patients don’t become patients again.

The Future of the Union

INTERVIEWER  

I noticed that you mentioned that a lot of the elections are uncontested. So this is kind of unusual, right, for union activity? It immediately makes me want to ask: do you feel like this has been a free and fair election?

HIERONYMUS  

We know that the election is not a free and fair election. And we know that the staff are doing everything that they can – without, like, obviously coming out and saying “as a staff, we don’t want these people to be elected” – to work against us. We have photographic evidence of the incumbents handing out their own flyers at meetings, which is a thing we’ve been told cannot happen. We have evidence of the incumbents basically handing out their literature over meals bought and paid for by our dues. We’ve been told that in a normal democratic union, if you run for office, you are supposed to have free access to all the normal methods of communication for union business, which includes email – we had to fight for that. I think it was about three weeks of like, emails and threats saying like you can’t not give us access to normal communications. 

They sent an email to people asking if they wanted to opt-in for email communication about the election. Only around 1,500 people clicked through and filled out the form, and engagement with these sorts of emails is low. Some interesting things were said in their emails, but people find these kinds of emails asinine and not very interesting. Staff in various hospitals set up their own internal Facebook groups of union nurses, and hospitals where the nurses have kept staff out of those spaces have been able to post about the election. But the staff admins have taken down posts by nurses who are not affiliated with their slate about the election, accusing those nurses of electioneering. 

The application to run as a nurse asks why they are running for office in 50 words or less. It is hard to condense their case for new leadership into 50 words, but they understood who they were organizing against. They had people with long histories in the union giving them encouragement and advice. They are doing remarkably better than anticipated, going from three hospitals to hospitals all over the US and the VA system. 

We were even threatened with arrest outside of a union meeting. We were thrown out of a space [just] for being a[n opposition] candidate, not even for being particularly confrontational. When we set up outside the hotel, we were threatened with arrest again. We were also asked to come inside to “participate in a training” at this meeting – when really we were being expected to  participate in a debate we had not been told about. We do not think this has been a free or fair election – and we prepared for that.

KOCH  

The woman we mentioned, who is running for treasurer? We obtained a picture of her text exchange where she’s collecting ballots. She will be responsible for the union’s money, which is not our campaign focus. However, we have serious issues with how our union dues are being spent, which we turned over to the Office of Labor Management. 

This union needs to change. It will either happen in this election or the next or the next; either way, this union will be dragged kicking and screaming into the reform room. Nurses are tired of not being listened to. We work hard and get paid a lot because of the responsibilities we have. It’s not a job for everyone, and it’s not just about money. You have to have a calling for it. We need to hear all viable opinions, and our platform is transparency. Nurses need to know where our union dues are being spent. We should work well with others, including nurses in other unions.

HIERONYMUS  

In Illinois, we’re trying to pass the nurse-patient ratio bill. We’re working with the Illinois Nurses Association, which represents several hospitals that are not represented by NNU in Illinois. Most NNU hospitals in our state used to be Illinois Nurses Association hospitals, but there were concerns about corruption and issues inside INA. They left, but there was a rank and file takeover of INA about 18 months ago, and the nurses on the board are people I consider friends and want to support. Due to our election campaign, our union canceled joint lobbying events and no longer participates in the joint campaign. Politicians wonder why the two nurses unions can’t support each other on this important issue. The reality is that the people currently running the union value their own power over the organization more than advancing the working conditions of all nurses. They’re ready to throw their own political priorities out the window to prevent nurses from talking to each other. Unfortunately, in our union political campaigns are where nurses are most likely to get together during political events and lobbying. That’s how I know most of the participating nurses – we’ve worked together on political campaigns. The actual union work is very siloed, and people get targeted if they start talking to a nurse or chief nurse rep from another hospital. 

Reforms should give nurses the opportunity to learn how to be leaders in the union context. We have to rebuild all the infrastructure that was there and get nurses back into staff. We need to offer release time to nurses interested in union leadership so they can learn the ins and outs of staff perspective, and if they’re elected, they can tell staff when something is wrong.

KOCH  

A longshoreman and foreman take turns working in the union to understand not only how the union functions, but also what’s right. You can’t sell out your workers because you won’t be sitting on your ass for long. It keeps people moving and fosters respect for each other’s position. We’re moving towards a union where everyone is the union, not us vs. them. The union is for nurses, not the physical building or non-nurse staff. Nurses need a bigger say in the union, not just as yes-people, but as critical thinkers prioritizing what’s good for nurses at the bedside, not their own political position or future hierarchy.

INTERVIEWER  

Any other major reforms?

HIERONYMUS  

We want to implement term limits for elected nurse leaders. We need to audit the union’s finances and provide transparency to nurses about how dues are spent. A database of collective bargaining agreements should be created for nurses to review. Evidence-based unionism should be created with best practices. An ethics board should be created, staffed by nurses. Nurses should have more decision-making power and hold staff accountable with performance evaluations. It’s important to make the union stronger and prioritize these changes.

INTERVIEWER  

I want to draw one thing out a little. You both mentioned your admiration for the old style bylaws, when you had stronger locals that were more decentralized. It shouldn’t just be Oakland with the tentacles and all that. Does that imply that you want to bring back a more decentralized or federated structure for the union? And if so, what does that look like concretely?

HIERONYMUS  

Yes, it does mean that. First off, the union has board seats, regional board seats. The regions don’t make geographic sense. I’m in Region 13. It goes from Chicago and Illinois down to Missouri, over to Kansas, down again to Texas and Arizona. That structure doesn’t make sense. It has one board member who’s been there for years and she’s retiring. There were existing regional structures in the union’s bylaws that allow local regions to have actual voting control over resources, having local governing bodies governed by nurses – we need those again. Step one is probably implementing some sort of constitutional convention where we come up with something that’s closer to a federated structure where regions have local autonomy, pick their staff, and their staff are accountable for them. The national work would be done through a national federation. We’re not only doing that to reassert the regional autonomy of the nurses in our union but also to preserve the autonomy of existing state associations that are affiliates right now. (These are large organizations.) We’ll have to hash out together how federating our union will look through the process of building this convention.

KOCH  

One of our biggest projects, if we win the presidency, is that our union predominantly has a large percentage of VA nurses who have seen very little return on their union dues. They have some serious issues there. This is the biggest safety net – we talk about socialized medicine, but you can get more socialized than the biggest safety net hospital chain in the country – the VA. We all agree, I’m a veteran, veterans deserve the VA and a well-run VA, and happy VA nurses. That is one of our biggest priorities, taking the presidency, to make sure that VA nurses have a bigger say. 

For example, VA nurses, when you’re Chief Nurse rep, they call you a director. When you’re in the federal bureaucracy, a director is a position of respect, and you are an equal with somebody else who is a director. Our union has just announced that they want the nurses who are Chief Nurse reps and could call directors to not have that title anymore, and to be Chief Nurse reps, basically stripping them. And they’re saying no, don’t do that to us. But the union bosses want a uniform union throughout the country and don’t listen to the VA nurses. By stripping them of the respect that they have for management to deal on equal footing with management, there are so many things we can do better for VA nurses, and we’re not doing it. We’re not listening to them. 

That is one of our big reasons, thanks to VA nurses, that you’re even probably listening to us. Really, the reason we took off was that we had some discussions with VA nurses. We got out a policy and wrote proposals on what we would do for VA nurses, and many of them were impressed by it. We stand by that we want to make the lives of VA nurses better. We don’t want the beneficiaries of their union dues telling them to sit down, thanks for the dues now sit down. They need to have input on how the VA is run. They’re very restricted, they don’t have the same things that you and I would have in a civilian-run union. Their hands are somewhat tied by the structure of the federal bureaucracy. But it doesn’t mean that we can’t do more for them. That’s a big priority for us. 

No one should be left behind. That’s a military motto that gets overused but look – your corps, as a corpsman, when somebody’s down, you’re up. Somebody needs to stand up. The VA nurses are under fire. Somebody needs to stay and grab them and bring them to safety. That’s one of our biggest priorities. Nobody should be left out, nobody should be just seen as dollar signs and dues. It’s about reforming the union and making the lives of bedside nurses better. We’ve said it 1,000 times and we can’t say it enough. We matter, we’re nurses, we matter. We’re not just little apparatchiks that you wring union dues for, for your bigger progressive vision, we matter. You make our lives better, you have a stronger union, that stronger union attracts more people, more people make a stronger union. That’s, to me, a simple plan. It’s very easy to see. Yet we have people who are more addicted to the power drunk on this power that they have. They don’t actually see what’s better for nurses. They supposedly are nurses. So, I don’t know why they don’t see it.

INTERVIEWER  

Shift Change supports greater nurse participation in managing the union, which it claims would lead to a stronger union and better outcomes. You claim this can be achieved through nurses rotating through union roles or a more federated structure of locals. However, nurse participation has not been a trend in recent decades, so nurses may need to build up this skill set. Some potential candidates may not feel qualified to come forward for this reason. Will this be an issue for your agenda?

KOCH  

Oh it’s not that they didn’t feel qualified. They felt that they would be overrun; feeling powerless in the face of the union [leadership]. Or they had other commitments that they felt, is this really worth my time? Will I really succeed at this? They were like, “I have other priorities that I think I need to focus on.” It was the matter of being run over by a semi. And John, I, Mark, and Raina were stupid enough to say, “No problem, I can take a few tire treads on me.”

INTERVIEWER  

Sure, but I guess my question then is: assuming that Shift Change gets elected, once you’re in office, what steps do you feel like you can take to help nurses who still feel afraid – for all those reasons – to get involved in the union, so they can actually participate in these new structures that you’re going to be creating? As Oscar Wilde supposedly said, the trouble with socialism is it takes too many evenings – how do you avoid that problem? What steps would Shift Change take to address these and other concerns of nurses who still might feel hesitant to participate?

HIERONYMUS  

A couple of things about that. Right now, what’s going on is that the current leadership are in the process of retiring – or else people are quitting nursing altogether. More and more work is getting piled on fewer and fewer people. And it’s happening because people, correctly I think, assess that they don’t have a lot of stake in the discussions that are being had. 

First off, I believe that we will have to do the work of reintroducing the union to nurses, and that’ll mean organizing inside of previously organized hospitals. So like my hospital, half of the nurses have never even been in a union until they started working at our hospital in the past two years. We should be approaching those nurses as though they aren’t in a union in the first place, with the attitude that says, let’s get them organized by directing staff resources at building organizations. We need to create schools and real programs of internal education for nurses. The staff participate in pretty extensive education programs to do, you know, what they’re required to do; we have a nurse rep training where you go through and you sit through like four hours and then all of a sudden you can be a nurse rep; well, we think that there should be like 102- or 103-style follow-up training to everyone who’s already been inside the union in some sort of formal sense. 

And then we need to establish an actual organizing model; our union doesn’t really have an organizing model. So, there are unions that use something called relational organizing – which means not building an army of people who will turn up when you send them a text message to through text for this or that sort of thing, but rather building up the relationships between people and understanding that organization is really about trust, and using the relationships built through trust and solidarity to produce the capacity to take collective action, and using that collective action to build more trust and solidarity. This is the sort of thing that the Council of Presidents has a lot of control over, they just currently don’t seem to have either the interest or will to exercise that control. They’re just comfortable to kind of let the existing staff just do whatever they think they need to do. They literally flew a Council of Presidents member to Texas, Zenei Cortez, and she said, “We just trust the staff, they’re the pros,” that sort of mentality. 

And the thing is, nurses are already trained in leadership, nurses are trained in all sorts of things that many workers don’t usually learn. You don’t come to an Amazon warehouse, having already been nominally trained to do public speaking or nominally trained to do policy research. And these are things that nurses have to go through to become nurses at this point. We think that if we give nurses a space with actual democratic stakes, where they can actually have real discussions and real debate, leaders will emerge naturally; and then, we’ll have to implement an internal organizing and education program to build up the people who feel that they’re not there yet. 

We want everyone to know: What are your union rights? Do you know that every union staffer has an obligation to look out for your financial interest? Do you know that the union has an obligation to actually, like, uphold the contract? These are things that many people out there in the union don’t know about. Do you know that you have the right to free speech inside union spaces? These are the sorts of things that our union, I think, goes out of its way to not let people know, because it makes their job easier as staffers if you have a kind of compliance, nurses who just kind of fall in line. 

One of the things that really struck me last year was, in these discussions with the other nurses’ unions in our state about ratios, how much the nurses from the other nurse unions spoke, and how little the nurses in our nurses’ union spoke. And it wasn’t because the nurses in our union were less competent or not capable; it’s that often our union specifically moves people into leadership that they see as kind of compliant, and they sideline people who are more confrontational or have more of a willingness to push and to change things inside. So I think that those nurses are there, we just need to give them an opportunity. And the nurses who don’t feel like they’re prepared, we’re gonna give them every opportunity to be educated in how to exercise their power as nurses.

KOCH  

Also, to add to what John is saying, we have already had, we’ve already expanded and touched more people across the country. We have broken down the silos that our union has created. Our union, in no way, wanted me to ever speak to Hieronymus. Our union never wanted me to speak to the various directors at the VA, the Chief Nurse reps there, and John having the Zoom meetings we’ve been having.  We have reached more people across the country and have made connections that basically will not stop. You talked about too many evenings. John can tell you how many evenings he’s had to set up zoom meetings. And we’ve had discussions with new people coming into the Zoom meetings every time we have them, and those are people that are coming in and wanting to be involved. So we have made more efforts to grow the union and bring it together than our CNA NNU has in the past 10 years, probably.

INTERVIEWER  

And it’s good that you guys are bringing new people in, because the more people are spending an evening working on union stuff, the fewer evenings everybody has to spend.

KOCH  

Exactly. You know, more and more ants do less work.

HIERONYMUS  

I tell people at the end of all of our meetings that every time someone decides to spend a few hours of their life that is their free time to discuss the union and union business, that is always something I consider to be privileged to even be part of. 

You know, there’s this idea that our union can be ruled by this top-down command structure. But in reality, we all are volunteering, everyone who’s involved in the union, who volunteers to be part of the union, who spends their own free time to be part of the union – they do it because they think the union is important. When the union kind of takes advantage of that willingness to spend your free time doing union work, then it abuses people, and it shows people how little they actually care about their time commitment. As you know, I have plenty of co-workers and friends who are in the union who have spent many years many of their evenings in the union, trying to get things done, getting more and more upset as they watch the union – how the staff have been conducting themselves around this election, in particular – because it’s almost like insulting to them that they can’t be trusted to make a choice that’s in the best interest of everybody. And that’s kind of what the union is all about. It’s like, we all have to make choices that are fundamentally in the best interest of all of us, or in the best interests of the as big a majority of us as we can, right? And if you can’t trust people to make those decisions, what are you even doing? What’s the union for, right? 

I’ve had co-workers come up to me who have never really talked about the union that much being like, “John, tell me what’s going on,” and getting really interested in it. Because when you feel like you know what’s going on, you can actually speak to it and you feel like you want to understand what’s going on. And then you actually have stakes and you have an interest and you have the capacity to speak about it intelligently. That’s a huge hurdle that we’ve got, just getting people up to speed people on our call with the VA nurses. Last week, we had a nurse who is the director of the VA in Georgia, in Atlanta. And she was like, “the national union work has just always been up in the clouds – until we started having this campaign and we started talking with you all, from Shift Change, it’s like you’re bringing it down to earth so we can actually see it, so I expect that we’re going to have it’s a real opportunity for us.” 

And we will keep building, regardless of how the election goes. And if we get elected, we expect that other nurses will continue to fight. We want to create the space for other nurses to do what we’re doing, and to keep pressure on us. Because we understand that once you get elected to those positions, your perspective changes and you always need people from the rank and file pushing to keep the union honest.

INTERVIEWER  

Because of all the grievances you’ve brought up against upper-level staff – their ability to impose their will upon nurses, usually against the labor interests of the latter – your opponents might find find themselves in a position to easily make an argument that your slate is anti-staff, that Shift Change is against rights of the union staff to self-govern their own affairs. However, you’ve also both expressed a lot of interest in the way that rank-and-file staffers have had their labor rights violated by some kind of upper union management.

So I guess it’s kind of two questions. One is, how do you reconcile your critique of the upper-level staff and union management (so to speak) with your sympathy for rank-and-file staff? And second, if there’s a staff member for the NNU out there reading this who finds themselves sort of in the mushy middle – because, say, they agree with some of your critiques, but they’re afraid that if the slate is gets into power they’ll just clean house, and they’re going to be caught in the middle, particularly if they’re already struggling with their labor rights – what would you tell them as reassurance? Like, what are you going to do on their behalf?

KOCH  

I can tell you, I wouldn’t be here talking to you, or be partnered with John, if it weren’t for a lot of ethical rank-and-file staff members texting me on their own phones, or calling me on their own phones, to encourage me to continue to fight. Because they openly said: “The reason I’m calling you on my phone, and not the usual number you see me on, is because I’m worried that you know that I’m going to get fired, and I can’t afford to be fired. But I want you to know that what you’re doing is right, that they’re frightened of you. They don’t want the changes you want.” 

So I reconcile these facts just like I do when John and I fight hospital management. Many of this rank-and-file staff are fighting union management, who have basically been the bane of both our existences. And as for possible fears: are we going to go in and have some kind of Night of the Long Knives where everybody’s going to be purged? No, no, not at all. In fact, we’re hoping to offer whistleblower protection, so that people can come forward and say, “Look, these are the things that went wrong. These are the things that we can’t let this happen again, we were in fear, but now we get to speak out about what was right.” That’s the stuff we need to protect. 

Now there are some people that – to be frank with you – have worked against the interest of nurses, that quite possibly, looking at where they are, may have to be asked to step down. But most of them, I’d say 99% of the staff are very secure in their jobs. I think that we need to have people have a come to Jesus moment where people come forward and can say, “Oh, now I can actually speak.” And just like nurses need to be able to do that, the labor reps need to be able to do that. 

HIERONYMUS  

Yeah, I would just say that, currently, the labor reps effectively don’t have a collective bargaining agreement. Labor reps are fired for practically anything that is deemed to be – I think they call it anti-organizational? – and that’s kind of just determined by the people who are the directors in our union. And, you know, there’s a few people in our union who are basically considered management, in every sense of the word. And those people will – we’ll have to have case-by-case discussions with everyone and figure out where their loyalties lie, in terms of are they loyal to building the power of nurses, or are they in it for themselves?

And we’re going to – but the vast majority of our staff are people who wanted to start working for a union because they care. No one becomes a nurse to get rich – well, at least, you don’t last as a nurse very long, if you’re in it for the money. You certainly aren’t going to be in it for the long haul. Similarly, you don’t become a labor rep because you’re looking to get rich. Those people who become labor reps who do so because they have commitments to building the power of the workers they represent. 

So, like Eric said, we’re just gonna have discussions, and we’ll work through it. We believe that there are [staff] people who probably are very, very committed to building like our power as nurses – and those people are I think probably pretty marginal in the union, probably because they’re afraid for their jobs if they step out of line or you know, get themselves too committed or too out there in terms of connecting nurses to each other and building our power. So we’ll see how it goes.

KOCH  

And before you think that we’re the ones that would undertake this bloody massacre of firing: I can tell you this right now, our former labor rep at Alta Bates Summit, she moved on, was at another hospital, Sutter Solano. And she was fired, because they suspected that she was the one that was feeding me information. And I’ll swear to you on a stack of Bibles, take a lie detector test – and I’m not criticizing her, either, but – she never reached out to me, or said boo to me, neither supported or against, but she was fired. Guilt by association! They felt that that had to be my inside [connection]. And she noticed herself later on, she talked to me after she was fired and said, “It was like I was getting pushed out – nobody would talk to me, little by little.” And she goes, “It corresponded with your guys’ militancy at the table against the union.” She felt she was being pushed further and further away as a labor rep, in the union at this other hospital. And it was because they thought she was the one feeding me information. And of course, I swear to God, I’m telling you it was not. 

So they fired this woman just because she had an association with me. At a certain point, this is what we’re dealing with. That’s where we are talking about just cause [firings] and things like that. Our union talks about just cause when it turns to firing, but they sure don’t practice it when it comes to their own staff.

INTERVIEWER  

So would you be willing to commit to a better collective bargaining agreement for the NNU staff union? You mentioned burnout, the golden handcuffs, etc before. So is that something that Shift Change would push for?

HIERONYMUS  

Just so we’re clear: there are [individual] people who are in the collective [bargaining unit], who are represented by the staff union, who make far in excess of what, like, every other person in the union [staff] are making. And so when we’re talking about collective bargaining agreements, having negotiations, and figuring out, like, what it is that the relationship between the unionized staff and the nurses – that’s all  definitely going to be a thing we’re discussing. But our goal is for them [the NNU staff] to have more security, more understanding, more transparency, so that they don’t feel like they are constantly walking on eggshells, when they’re out trying to just do their job, right? 

But there are people who we know are taking advantage of the situation, have negotiated personal side deals with hospital management – and they have a different relationship to the rank-and-file nurses than their coworkers, to the rest of their own [staff] union even. And so, yeah, we’re gonna have an open, regular, normal relationship with the staff union. And we’ll figure it out, but we don’t expect that they’re going to be, you know – we want our relationship to be cordial and collaborative, not something that’s hostile. 

And currently, the way it is right now is very much like a climate of fear and hostility. For the staff, Zoom calls are notorious, where you have 400 people who all have to be on Zoom with their cameras on and they have to toe the line inside the staff. Because if they don’t, they’ll lose their job. And so I think that hurts us as a union. I think dissent provokes discussion, and discussion is how we get better solutions to the problems that we’re trying to face. And if staff feel like they can’t dissent then we’re gonna get poor decisions, we’re gonna get poor representation. So I guess that’s my kind of orientation towards our existing staff union and what I hope that our relationship is going to be with them. I’m totally fine with them having elected their own elected leaders without us interfering in their own staff union elections. That’s so absurd!

KOCH  

We can’t have the management of the union, however, interfering with those elections or continuing to intimidate staffers, just like we would never stand for management intimidating us when we vote for a contract. We shouldn’t allow the union management to intimidate the rank-and-file labor reps. They are a vital part of our union, they are central to our union. And if they’re miserable, we’re going to be miserable.

HIERONYMUS  

It’s a descending pyramid of abuse. You hear stories about the staffers being trashed by their bosses, the directors, treated in really toxic and disgusting ways. And then we hear about an insane story where a staffer body checks a nurse in the middle of negotiations. And so there’s going to be accountability for things like that, but at the same time, it’s going to be fair, and it’s going to be within the bounds of the collective bargaining agreement. And that’s just because that’s what we believe in, we don’t believe in union-busting anybody!

KOCH  

And if a labor rep talks to me, in the strike line – you know, we had one of the labor reps speak to us. And, they were saying, “Wow, I really can’t believe this is happening to you guys. You know, I can’t believe they’re reacting this way.” She was talking about CNA management. And then three hours later, she comes up to us, and she’s weeping. And she goes, “Please don’t tell them I talked to you about that, oh please, I’m gonna lose my job. Just say that we were talking about the strike turnout or something.” And that – you know, somebody who’s that fearful – that is fucking ridiculous, that somebody has to be fearful to just speak their mind to me and another nurse-negotiator.

What kind of union has that kind of draconian malevolence towards its own workers? If we faced a hospital management team like that, our union would have marches on the bosses every other day! Yet our union management runs that way.

INTERVIEWER  

This is my last question. You all find yourselves in a similar position to reformers in authoritarian systems. It’s promising because you might have an opportunity to change things, but also dangerous because of history and institutional inertia. Perhaps you’ll find that you’ll get there, but there’s very little that you can do from those commanding heights to change a system whose main problem is that it’s all run from those commanding heights. Do you think centralized control might be an insurmountable obstacle to reform? Or can your slate and rank and file overcome it if you get into power?

HIERONYMUS  

So we are in a fortunate position that our union is actually fairly small in terms of national size: it’s only 150,000 members. So we’re not talking about dealing with a union with several million members with a vast bureaucracy of thousands of paid staff that we would have to overcome and deal with. We’re dealing with hundreds of people, not thousands of people. And the union has centralized itself so much that there really is very little that can be done to stop us from making the kind of changes that we’re looking at. In fact, one of the reasons why we’re motivated to do this in the first place is because the union has become so centralized that under the wrong conditions it could be easily decapitated, even dismantled, by a hostile Attorney General, if they wanted to give him the right laws and Supreme Court rulings. 

Fortunately, our union still has people that turn out to meetings. And we think that most of our work is just going to be kind of like reinvigorating former structures that used to exist. So we don’t have to reinvent the wheel. We don’t have to come at this completely without any knowledge. We’ve got people involved in our reform effort who’ve been in the union for decades, who’ve been staff in the union. 

And also, this isn’t something that hasn’t happened before – other unions of comparable size, or a little smaller, have been able to pull off pretty dramatic turnarounds in terms of reasserting democratic control over the union, rebuilding the kind of internal culture of democracy inside the union. This isn’t like running for the President of the United States, and you get it, and then they sit you down for a meeting with the Defense Department and the CIA and they tell you how the government really works. [laughs grimly] It’ll be easier than that.

So, I feel that we have done a lot of the work shedding light on how the union operates, how the union became the way it is. And we have experienced people who have been guiding us this whole time. So our capacity for actually instituting the changes that we’re looking to institute, I think, are high. I’m much more confident now than I was when we started. 

KOCH  

You know, when John and Mark and Raina and I started, it was like: well, we have a puncher’s chance of winning the election, right? We have a puncher’s chance; if they ignore us, we could probably get enough votes, maybe from just our three hospitals and a few supporters we have elsewhere. And then as we started having the Zoom meetings, we actually started seeing that we have support in the VA, we have some Kaiser nurses supporting us, we now have Long Beach Memorial, we have all these other hospitals who’ve already told us, “Don’t worry about it. We’ve already voted for you.” And it was like, wow, I didn’t even realize it. 

You’re right, of course: is it easier to move and make decisions when you have a decision making body that’s just anywhere from one to ten people? Of course, it’s much easier to make decisions and get things done. But if you really want to have a long-lasting union, we need to decentralize and widen the base. If you’ve ever been into amateur wrestling, you know – you keep your base a little wide, and that gives you the most support. We needed to widen the base of the union. 

But we need to have one shared central principle: our value as a union needs to be to put the bedside nurse first. If we have that shared value, we cannot be separated. And if we have [decentralized] decision-making bodies, like John said, an attorney general or Supreme Court law might go against us – but as a union we’ll still be there. We’ll have enough people throughout the country that it would not cripple us. That is the important thing that we need to look at: all in all, if we have enough nurses participating across the country, our union is going to grow. And we’re going to have more voices, and more ideas, and more people willing to stand up and fight. 

As it is now, when the union comes calling, a lot of people are just not answering the call. Because it’s hard to answer the call of the union, when you pay your union dues and then your labor reps are going throughout the hospital supporting management’s last best and final to you. It’s hard for nurses at that hospital to feel that the union has their best interest at heart. That’s what happened at our facility at Alta Bates Summit. And of course, the labor reps worked against the nurses at the other 16 tables. That is not the path to having a growing and thriving union. The nurses at the bedside have to be your priority. And I don’t know what’s going to happen with the election. There are words back to us that they expect us to win and that they’re going to basically decentralize in October to try to pre-empt us. Who knows. Either way, the reform movement will not be stopped.

We are just the beginning. It’s basically a dying union, and unless we change it, it’s actually digging its own grave. We are the solution to this union bouncing back. Just like they have reforms and other unions. We’re not going to have success long term unless we follow through, unless we’re successful – if not this time, then the next time around. We are building a base now, as John can tell you.

My God, I can’t believe we’re here right now. It’s unthinkable from when we started just a few months ago. I just thought we were like the devil in Milton’s Paradise Lost – better to rule in hell than serve in heaven! – that it was better to be what we are, and shake our fist, and say, “we are going to change this union one way or another,” and maybe take a victorious, heroic loss, but help build the reform. 

Now, I think maybe now is the time that we are going to take this election. I don’t know if it’d be close one way or the other. But I think we have a chance. And I hope to God it happens because change can’t happen soon enough. ~

Strange Matters is a cooperative magazine of new and unconventional thinking in economics, politics, and culture.