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New Orleans Nurses Fight For A New Union As Hospitals Merge

Above photo: University Medical Center in New Orleans, LA. Photo from Wikimedia Commons from November 22, 2023.

And Revenues Soar.

Concerns over working conditions and patient care amidst hospital consolidation drove Louisiana’s largest union victory since 1993.

Heidi Tujague works 12-hour shifts as an emergency room nurse at New Orleans’ University Medical Center (UMC), just outside the Central Business District. The hospital is part of a massive nonprofit, LCMC Health — which held assets of $3.57 billion in 2022 and operated over half of New Orleans’ hospitals in 2023. But despite those resources, Tujague says nurses sometimes have to scramble for supplies to care for patients. Even wheelchairs can be scarce.

“You have to ask a patient, ‘Would you mind standing up and shifting to this chair so I can get this wheelchair — while you’re waiting for your X-ray — so I can get someone else to their X-ray? Having to make people uncomfortable just because we don’t have enough wheelchairs.”

Last fall, Tujague and her colleagues had finally had enough of what they described as persistent undersupplying and short-staffing. In October, nurses at University Medical Center filed for a union election. Two months later, on Dec. 9, over 80% voted to join the National Nurses Organizing Committee/National Nurses United (NNOC/NNU), the country’s largest nurses’ union. The election was Louisiana’s largest National Labor Relations Board election in nearly 30 years. With the vote, University Medical Center became Louisiana’s first unionized private-sector hospital. About 4% of Louisiana’s workers are unionized, compared to about 10% nationwide.

Tujague and others who voted to unionize said that not only pay and benefits were at issue. They also believed their hospital’s policies prevented them from giving quality care, and potentially put patients at risk. And they noted, too, that as hospital mergers have reduced competition, it has empowered hospital giants to raise prices and squeeze workers.

From 1998 to 2021, there were 1,887 hospital mergers in the U.S. The American Medical Association (AMA) reported that 92% of American hospital “markets” were highly concentrated as of 2017. Meanwhile, the percentage of publicly owned hospitals fell from 24% in 1999 to 18% in 2021.

Research has shown that both nonprofit and for-profit hospitals engage in anticompetitive behavior, using their increased market power as they grow ever larger. Nonprofits, including New Orleans’ LCMC Health, make up the majority of hospital “administrators” (the entity running the hospital), but a 2016 study reported seven of the 10 most profitable hospitals in the country were designated nonprofits. A 2023 study reported that when nonprofit hospitals increased their revenue, they invested less in “charity care” than their for-profit counterparts.

“A pretty substantial body of research has found specifically that when hospitals merge, it raises prices. But there’s less clear evidence of hospital mergers leading to improvements in the quality of care,” says Zachary Levinson, a project director at the Kaiser Family Foundation, who researches the impact of hospital mergers.

In 2022, LCMC Health purchased three hospitals from for-profit juggernaut HCA Healthcare, paying $150 million and creating a hospital “duopoly” in New Orleans. This left the New Orleans region with just two hospital systems — LCMC and Ochsner Health — running its eight acute-care hospitals. After the merger, LCMC proposed closing Tulane Hospital in downtown New Orleans and relocating most of its staff to other hospitals.

Although the nurses’ union NNOC/NNU had previously opposed HCA’s expansions, the union was so concerned over the effects of consolidation that it lobbied Louisiana’s attorney general to block the sale. The letter from National Nurses United Southern Regional Director Bradley Van Waus explained: “Creating a two-system duopoly [creates] unrestrained leverage over patients and health care workers… against the public interest, by leading to further consolidation, higher healthcare prices, and cuts to vital services.” When the merger went ahead despite the union’s efforts (and a lawsuit filed by the Federal Trade Commission), LCMC was running five of the city’s hospitals. Meanwhile, LCMC CEO Greg Feirn had posted an annual salary of $2.5 million in 2021. The implication was clear, says UMC observation unit nurse Tatiana Mukhtar. “Our focus as nurses is taking care of patients, and their focus is making a profit.”

Indeed, a 2021 study found that health care workers’ wages stagnate when hospital mergers increase market concentration. “Over a few years, it adds up,” said Elena Prager, one of the study’s authors and a professor at the University of Rochester. She added that stagnation is typically worst in the communities with the highest levels of concentration — such as New Orleans with its newly minted duopoly.

Nurses at University Medical Center New Orleans say that their pay has not kept pace with the rising cost of living, and that their health care premiums and co-pays are expensive, with insufficient coverage. According to Tujague and other nurses interviewed by Capital & Main, unionizing was the way for them to have a voice in hospital policy. In recent years, they say, the hospital has cut paid time off by more than one-third, from an annual maximum of over 300 hours to 200 hours; cut bonuses for extra shifts; and had nurses “float” to other departments without their input.

Nurses say the hospital has also refused to hire more nurses despite a staffing shortage. The result, say nurses, is less time with each patient. The workers report this creates more stress for them — and worry that it lowers the quality of care for patients. A ratio of six patients to one nurse — which Mukhtar says is standard in University Medical Center’s medical-surgical units — leaves 10 minutes per hour with each patient.

“It’s difficult to take care of that many patients, but we make it happen. We do the best that we can,” said Mukhtar. She worries about losing her license if something goes wrong. Nurses at University Medical Center also say that increased staffing keeps patient frustrations at bay and gives nurses more confidence in the quality of care. Indeed, one 2021 study showed that each additional patient in a nurse’s workload increased the odds of 30-day mortality by 16%.

Tujague stressed that patient care is at the center of the organizing effort, calling the current ratio a “moral dilemma” in which nurses who want to provide the best care for their patients don’t have the time to provide it. “That’s why we’re doing this,” said Tujague. “We want to be able to give more time back to the patients.”

The hospital did not react positively to the union drive. After University Medical Center nurses announced their intent to form a union in mid-October, nurses say they began to receive a steady flow of anti-union material from consultants hired by LCMC. Workers reported receiving texts, signage and emails that argued — among other things — that the hospital would listen to their needs, and a union was unnecessary. Nurses say the consultants also sought nurses for anti-union meetings. On the day of the election, LCMC CEO Greg Fairn sent UMC nurses an email observing that a union “may put itself before our patients or our community.” Fairn then forwarded the same email to workers at East Jefferson Hospital later that day, in an apparent attempt to quash organizing elsewhere. A web page on LCMC’s main site dedicated to the National Labor Relations Board-supervised election still included links to anti-union sites and in early February.

LCMC declined Capital & Main’s repeated requests for comment.

“They are so used to holding on to all the power, and making all the decisions,” said Mukhtar.

“These decisions do not benefit the patients or the nurses. They have nothing to gain from us unionizing. But the patients gain, and the nurses gain.”

The data backs her up: If nurses want to fight the negative effects of consolidation, research suggests that their successful union election may help. The same 2021 study that found health care workers’ wages stagnated post-consolidation also found that labor unions can be an effective “countervailing” force, keeping wages from falling behind.

So far, the election results have been certified by the National Labor Relations Board, and the workers have elected a bargaining committee to negotiate their contract with LCMC. They sent out a survey to collect answers from the nurses that they’ll be representing about each worker’s priorities in a contract, and Tujague said other employees at UMC have been extremely supportive.

“They were very excited for us and we saw respiratory therapists, we saw the phlebotomists asking, can we have a union too?”

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