Dive Brief:

• Some 1,800 nurses at HCA’s Mission Hospital in Asheville, North Carolina will now be represented by a union, following a successful election with the National Labor Relations Board completed Thursday. They voted to join the National Nurses Organizing Committee — an affiliate of National Nurses United — the country’s largest nurses union with more than 155,000 members.
• This will be NNU’s first union in North Carolina and its largest at any HCA-affiliated hospital, according to a release. HCA, the largest for-profit hospital chain, mounted heavily-funded anti-union campaigns against the nurses who waited six months for the election since filing their initial petition, the union said.
• "As divisive as this election has been over the last few months, we respect the right of nurses to decide for themselves whether or not they supported NNU," an HCA spokesperson said in an email statement. Still, the hospital will examine the election process and results as allowed under NLRB rules, the spokesperson said. 

Dive Insight: 

The vote marks the first private sector hospital union election win in North Carolina and the largest at any nonunion hospital in the South since 1975, according to NNU.

It also happened in a state with the second lowest unionization rate in the country, according to the U.S. Bureau of Labor Statistics.

"Winning a union representation election in the South is extremely challenging because the odds are so stacked in favor of the employer, and then to win it, essentially by a landslide, is a huge breakthrough," Rebecca Givan, associate professor in the School of Management and Labor Relations at Rutgers University said.

Mission Health operates six hospitals across western North Carolina, and Mission Hospital in Asheville is its flagship facility. Nurses there voted 965 to 411 in a secret, mail-in ballot election, according to the union.

Nevertheless, the HCA spokesperson noted that the NLRB allows "both parties time to review the election and the conduct of the parties prior to the election; the hospital may utilize that process to ensure that all of our nurses had the fair election that they deserve."

The nurses will now elect a team to represent them in negotiations with hospital management for their first union contract.

While the pandemic has certainly spurred union activity among healthcare workers, Mission nurses began their push to collectively bargain following HCA’s buyout of the former community hospital in February 2019, the union said. 

HCA enjoys a dominant market position in the Asheville area thanks to the actions of state lawmakers years ago in which they allowed a merger of two close competitors — Memorial Mission Medical Center and St. Joseph Hospital. Lawmakers passed legislation shielding the deal from federal antitrust oversight in exchange for state oversight.  But decades later that oversight was rescinded and paved the way for the HCA buy. 

"Only a few months into the HCA buyout, we started to see dramatic decreases in the amount of staff and resources we had across the hospital," Sue Fischer, a float pool RN at Mission, said in an NNU release. 

Already-organized nurses at other HCA hospitals across the country have taken action throughout the pandemic, protesting inadequate staffing and access to personal protective equipment.

Healthcare workers at five HCA hospitals in Las Vegas, represented by Service Employees International Union Nevada Local 1107, dropped off almost 500 complaint forms to state hospital regulators in August alleging untenable working conditions due to inadequate staffing and PPE.

National Nurses United also filed a complaint with the Occupational Health and Safety Administration in August alleging workplace safety hazards at 17 HCA hospitals, one of them Mission Hospital in Asheville, that it wants the agency to inspect.