The union movement: legislative and regulatory issues in California

In the late 1980s, hospitals began to identify that patient care services needed to be restructured to deliver services in a more cost-effective and efficient way. As more and more hospitals adopted this philosophy, unions began to take an increasingly aggressive role advocating against the strategies that hospitals employed, which often put unlicensed assistive personnel in a role that more appropriately used the professional training of a registered nurse. The strategies taken by the unions took several forms: regulatory and legislative, which sought to preserve nurses' jobs through mandatory staffing ratios; a public relations campaign aimed at discrediting hospitals that have restructured and informing the public that the changes jeopardize patient welfare; and targeted organizing. This article addresses the impact the union strategies have had on hospitals and the changing health care market.