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Establishing healthy union relationships and the "best" unit in the hospital

Raso, Rosanne MS, RN, NEA-BC

Nursing Management (Springhouse): August 2010 - Volume 41 - Issue 8 - p 56
doi: 10.1097/01.NUMA.0000384002.01590.d9
Department: Leadership Q&A

Senior Vice President of Nursing, Lutheran Medical Center, Brooklyn, N.Y.

QThe organization for which I previously worked appeared to have a good relationship with the union; however, my current employer has an adversarial relationship. How is this possible?

There are multiple factors that determine whether your organization will have a good or adversarial union relationship, and sometimes you can have both within a short period in the same organization!

Some of these factors include the union's philosophy and the main beliefs of your administration and the human resource department. Is it inclined (or even declared) as a labor-management partnership model? In a partnership model, there's a commitment to inclusively seeking solutions using an interest-based method, rather than standing on fixed positions. A nursing labor-management partnership has positive effects on turnover and satisfaction.1

Relationship building is hard work and takes nurturing and attention. There has to be consistent application of both communication principles and contract language at all levels to achieve positive outcomes. Basics such as mutual respect and genuine recognition of the value of employees are the bedrock. Engaging union and staff input into departmental initiatives and projects is valuable. Demonstrated actions speak louder than words. At the very least, no matter how adversarial the relationship is, you should share the common ground of the best interests of staff and patients.



Another suggestion is to know the collective-bargaining agreement or contract and consistently follow it. If the contract is silent to an issue, then that's a good opportunity for interest-based problem solving to achieve mutual goals. Don't say negative things about the union to staff because it's counterproductive. Reach out to human resources for guidance and don't act independently, especially in highly charged or controversial situations. And, finally, act like a partner even if at first you don't feel it—it goes a long way in building a good relationship.

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1. Porter CA, Kolcaba K, McNulty SR, Fitzpatrick JJ. The effect of a nursing labor management partnership on nurse turnover and satisfaction. J Nurs Adm. 2010;40(5):205–210.

QI've been given the responsibility of opening a new medical-surgical unit at my facility. I want to have the best unit in the hospital. Do you have any advice on key first steps for achieving this goal?

Your definition of the best unit may be different than someone else's, but I'm assuming you're looking for top-notch patient, family, staff, and physician satisfaction coupled with extraordinary clinical outcomes. A tall order!

First, I would use the principles of a healthy work environment as a guide.1 Choosing the right staff with the right competencies to meet patient needs is essential (including communication competencies), along with aligning values and "fit" with anticipated unit goals and culture. You'll support best practice by establishing a collaborative environment with a shared decision-making infrastructure. Let staff members help—they'll thrive and you'll love the engagement. Your leadership effectiveness is critical in bringing out the best, holding everyone accountable, and making sure staff members have everything they need to do the job.

Secondly, I would emphasize building working relationships—up, down, and sideways. Meet regularly with your unit's medical director and all ancillary services that support the unit. You should also take time to set unit goals, share them, and communicate results frequently and clearly. Keep your boss in the loop and always make sure your actions are in line with organizational expectations. Give and receive feedback often. Be clear on what you expect. Celebrate accomplishments and recognize staff members individually and collectively. Focus on patient safety and quality in a healthy practice environment and you can't go wrong.

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1. American Association of Critical-Care Nurses. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence .
    © 2010 by Lippincott Williams & Wilkins, Inc.