Nurse Perspectives on Labor Union Participation Prior to Implementation of a Collective Bargaining Agreement: A Qualitative Study

Background: Patient advocacy is a duty for professional nurses; however, not all nurses are empowered to advocate for meeting patients' needs. Participation in labor unions may serve as a venue for nurses with limited institutional decision-making authority to advocate for patient needs; however, unionization can be a time-intensive and fraught process. Purpose: This study examined how nurses participating in a new union in an urban United States hospital described their reasons for participating in a labor union during collective bargaining. Methods: Content analysis of participant's interviews that took place between January and March 2023, after the nurses voted to unionize and collective bargaining had commenced but progress had stalled, and before additional actions (e.g., informational picketing, labor strikes) were authorized by union members. Findings: Content analysis generated three themes: (a) systemic barriers to advocacy, (b) unionization as an advocacy method, and (c) professional empowerment through unionization. Nurses in this study perceived barriers to meeting patient care needs that were insufficiently addressed prior to unionization. They described their motivation to participate in the union due to their desire to advocate despite adversity and finding empowerment through union activities. Implications for Practice: This study highlights the need for equity in decision-making authority and greater opportunities for nurses to effect workplace changes.