On January 3, 2013, the California Nurses Association/National Nurses United (CNA/NNU) and the National Union of Healthcare Workers (NUHW), two of the healthcare industry's most aggressive unions, announced a new alliance designed to organize employees in non-union hospitals, impose their agenda on already unionized hospitals and target the members of rival union Service Employees International Union (SEIU).

CNA/NNU is the largest union exclusively representing registered nurses (RNs). The CNA has had considerable success in California organizing over 85,000 RNs and using its political clout to force through the first in the nation patient staffing ratios in 2004. The success emboldened CNA to expand nationally and create NNU, now representing an additional 100,000 RNs. CNA/NNU is known for extreme tactics, public pressure and strikes taken under the guise of patient care but with the actual goal of achieving typical labor objectives such as pay increases or union rights. In fact, CNA/NNU has called strikes at over 100 facilities in the last two years.

NUHW is a relatively new union, formed in 2009 by ousted leaders from the SEIU after the SEIU's national leadership imposed control over the California local union covering healthcare workers. Since the schism, the NUHW leadership has embarked on an impressive campaign to poach SEIU members and otherwise organize healthcare workers. The NUHW already represents over 10,000 employees and has a pending NLRB petition to represent an additional 43,000 members currently represented by SEIU. NUHW is also known for aggressive tactics and is equally not shy about using strikes and other economic weapons to achieve its goals.

The announcement put an exclamation point on the official end of a four year truce between CNA/NNU and SEIU, under which the  two healthcare union giants had agreed to "bury the hatchet." The formal truce, which was reached after the two unions publically attacked each other and sought to organize each other’s members in 2009, officially ended by its terms on December 31, 2012. The January 3rd announced alliance, which directly attacked SEIU and its leaders, makes it clear the hatchet has been dug up.

The alliance will provide both the CNA/NNU and NUHW additional resources to pursue their agendas. Since 2009 CNA/NNU has provided NUHW $2 million in loans or grants help the new union and the alliance will continue the financial support with NUHW's access to CNA/NNU resources and CNA/NNU receiving per capita payments from NUHW members, the NUHW will remain technically an independent union. Additionally, the organizers, business representatives, lobbyists and other resources of each union can be utilized to support each other, not to mention the use of the membership to support picketing, strikes or other protest activity. The result is likely to be more hospital and healthcare organizing, more protests and more strikes in 2013

Management Missives

  • Non-union hospitals and other healthcare employers should evaluate their union avoidance strategies, appropriately train management and otherwise be prepared to respond it targeted;
  • Hospitals and other healthcare employers with relationships with either CNA/NNU and/or NUHW should anticipate an even more aggressive 2013, including potential organizing by the alliance of unrepresented areas of the employers' operations, and develop appropriate contingent strategies;
  • Hospitals and other healthcare employers with SEIU contracts expiring in 2013 should be prepared for their facilities to become battlegrounds as CNA/NNU and NUHW look to capitalize on the alliance; and
  • The SEIU affiliated unions in healthcare are not likely to be passive and roll-over for the CNA/NNU and NUHW.   Expect the SEIU unions to develop and pursue aggressive counterstrategies to protect and expand their turf in this nasty street fight.
Back to Management Memo Blog

Search This Blog

Blog Editors

Related Services



Jump to Page


Sign up to receive an email notification when new Management Memo posts are published:

Privacy Preference Center

When you visit any website, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalized web experience. Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.

Strictly Necessary Cookies

These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms. You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.

Performance Cookies

These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site. All information these cookies collect is aggregated and therefore anonymous. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.