Labor Conflict and Moral Contention: Nurse Organizing and the Corporatization of Care

The contentious practices of American organized labor have changed dramatically in recent decades, with workers engaging in fewer, smaller and shorter strikes, while innovating new practices that rely on moral, rather than economic, contention. As unions’ ability to exercise workplace-centered economic coercion has become increasingly circumscribed by courts, legislatures, and custom (Getman 2010; Rhomberg 2010, 2012; Western and Rosenfeld 2011), many activists and organizers have made increasing efforts to extend labor contention beyond the workplace, to community and consumer fields, arenas where moral suasion becomes a more potent weapon than economic coercion (Chun 2009; Clawson 2003; Milkman 2006; Reich 2012). In this paper, I argue that many of these concrete practices can be traced to workers within hospitals, in particular nurses, and their long-term process of negotiating the boundaries between profession and class, between moral authority and economic action.

Professional nurse organizations have historically been broadly ambivalent toward the strike. Nurses’ early organization within professional associations shaped how they engaged in workplace-centered conflict; this organizational history and ongoing collective claims to professional status kept nurses from striking for their first two decades of collective bargaining, even as many nurses themselves were becoming increasingly militant. I argue that the tensions, contradictions and compromises of the early era of nurse organizing—particularly the tension between “professional” patient-care obligations and the use of economic coercion—helped produce a set of practices that would prove helpful in later conflicts, practices that would later spread to the more traditional core of the American labor movement. 

Using a broad variety of archival sources, this paper examines these processes by focusing on two organizations—the California Nurses Association and the American Nurses Association—during three key periods. First, 1944-7, when California nurses implemented the first collective bargaining program focused on professional nurses, which then spread to the national level. The second period is 1966-8, when California nurses first defied the Association’s strike ban, leading to a wave of nurses strikes. Culminating in the late 1980s, during the ascendance of managed care, I argue that the broader crisis of confidence in corporate healthcare at the time made these practices uniquely effective against hospital employers.