Who exactly does the American Nurses Association represent?

By Jerold Duquette

Nurses unions are split on the initiative. The Massachusetts Nurses Association has endorsed it. The larger American Nurses Association opposes it.”

This line in a recent news story about Senator Warren’s support of nurse staffing ratios and Question One caught my eye. To me, this was an incredibly counter-intuitive claim. Are nurse’s unions really “split” on Question One? Is the American Nurses Association “larger” than the Mass Nurses Association? Is it even a union? The reporter who wrote the story clearly came to share my confusion and, after a conversation with me about it, corrected the record in his online piece to the following:

“Nurses disagree on the initiative. The Massachusetts Nurses Association has endorsed it. The American Nurses Association of Massachusetts opposes it.”

The corrected formulation is certainly accurate, but it doesn’t help clear up at least two implicit mischaracterizations. First, unlike the Massachusetts Nurses Association (MNA), neither the American Nurses Association (ANA) nor its Massachusetts chapter (i.e. the nurse’s organization that opposes Question One) are unions. They do not represent members in collective bargaining. Also, the ANA-Massachusetts (ANA-M) is not larger than the Massachusetts Nurses Association. It appears to have 1000-2000 members, while the MNA has more than 20,000 dues paying members. Of the nurses that would be impacted directly by Question One, more than 70% are represented by labor unions that have endorsed Question One. So the above claim, despite correction, still leaves readers to assume that the two organizations both represent the nurses impacted by Question One and that the “American” organization is larger than the “Massachusetts” organization.

Am I splitting hairs? Maybe, but given the fact that opponents of Question One are portraying themselves as representing the interests and opinions of laborers in what looks to me like a pretty conventional labor – management disagreement, I think some clarity on the exact role, function, and membership of the American Nurses Association of Massachusetts, which bills itself as “the voice” of Massachusetts nurses, is called for.  I think such clarity would go a long way toward understanding just how “split” the state’s nurses are on Question One. Voters deserve to know which nurses are for it and which are against it, and why. It also seems to me that an important detail about the two nurse’s associations making headlines on both sides of this issue is not getting enough press attention, namely that the MNA, the state’s largest nurse’s union, separated itself years ago from the American Nurses Association (which was and is NOT a union) because of the ANA’s perceived anti-labor and pro-management posture.

When you cut through the opponents’ efforts to muddy the water, the “split” among the state’s nurses on this issue looks pretty unsurprising. Unionized bedside nurses appear to be solidly supportive of Question One. Others, such as nurse-managers and nurse educators, and non-unionized bedside nurses may very well be split on the issue, but to date no one has adequately probed that divide. In other words, the nurses most impacted by Question One who are protected by their unions from management coercion are, just as one would expect, supportive of a law that would prevent their employers from assigning them too many patients at one time, while some unclear number or proportion of non-unionized and/or non-bedside nurses are not supportive of Question One.

This simple, logical assessment of the interests and identities of the two sides on Question One is bolstered by simply “following the money!” Only a tiny fraction of the money behind the “No on One” campaign comes from working nurses. The lion’s share comes from the Massachusetts Hospital Association, individual hospitals, and other pro-management groups. The organization claiming to be the voice of the state’s nurses, the ANA-Massachusetts has put up less than 500 bucks of the $10 million plus raised by opponents. By contrast, the State’s leading nurse’s union, the MNA, has provided more than $2 million of the $5 million plus raised by the “Yes on One” committee.

The substantive merits of nurse staffing ratios are well above my pay grade, but the ways and means of ballot initiative campaigns are right up my alley. The opponents of Question One (understandably) do not think average voters would agree with them on the substance of the matter and (also understandably) expect average Massachusetts voters would side with with nurses if proponents of Question One succeed in framing the issue as a David versus Goliath battle between overworked bedside nurses and profit hungry hospitals and well-financed trade associations.  Therefore, the tactic of confusing voters into thinking that the nurses who know best and who have the power to make their voices heard are opposed or are at least “split” on Question One is a “no brainer” for the hired guns working for the Mass Hospital Association’s cause this fall. Will it work? Hard to say. Should it work? Hell no!

Creating substantive confusion for political gain is not noble, though it’s also not easy to resist when complex policy issues are put to a public vote, but intentionally trying to distort voters’ understanding of who is for and who is against a proposed ballot measure, crosses an important line in my book.

Jerold Duquette is an associate professor of political science at Central Connecticut State University. This piece was originally published on the MassPoliticsProfs blog.

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