Other Titles
PechaKucha Presentation
Abstract
Purpose: Advocacy for the inherent value, dignity, and well-being of patients is a fundamental nursing duty (American Nurses Association, 2015). However, not all nurses are empowered to act as patient advocates. Nurses who work in cost-constrained environments undertake greater patient loads, experience greater burnout, and have poorer access to opportunities to improve patient care (Harvey et al., 2018; Tubbs-Cooley et al., 2019). Union formation and participation is an intervention that nurses worldwide may employ to advocate for patient care needs and equitable working conditions (Dube et al., 2016; Johnson & Billingsley, 2014). The purpose of this study is to describe the lived experiences of nurses undergoing unionization in a large urban United States hospital and how unionization supported nurses’ capacity for patient advocacy.
Methods: This study utilized ethnography, a qualitative method to understand the lived experiences and cultural context of people and how they interact with the world around them (Ravitch & Carl, 2021). Data included individual interviews with 25 bargaining unit members at multiple time points throughout the union’s first collective bargaining process, union communications, and observational data from union meetings and collective bargaining sessions. Interviews were unstructured, but commenced with the question: “How do you feel about the nursing union?” Data were collected after the union was recognized and collective bargaining efforts were underway. All nurses who belonged to the collective bargaining unit, regardless of personal support for the union, were eligible to participate.
Results: Study participants described their desire to advocate for patient care. Most participants described barriers to effective patient advocacy as their primary reason for becoming active in the union. Participants described the union as a tool they employed to demand inclusion in workplace decision-making and described union activity as an advocacy method that held administrators accountable in an enforceable manner. Throughout the union campaign some members described changes in the collegial environment such as increased interpersonal and interdepartmental civility, a greater perception of unity within the hospital, and solidarity from the community at-large. Some participants felt empowered to advocate for their patients through their union activity. At the same time, they reported feelings of personal exhaustion due to the challenges of the advocacy work they were engaged in.
Conclusions: Effective advocacy efforts require the capability and authority to participate in decision-making processes. Unionization may be a tool to increase capability and authority to engage in patient advocacy when other potential venues for advocacy are limited or ineffective. While many nurses found union advocacy to be challenging and sometimes emotionally exhausting, the sense of empowerment gained through their efforts gave them motivation to continue. Union participation may be an effective tool for nurses to promote advocacy for patients and create a mutually supportive, collaborative work environment. Future research is needed on the utility and limitations of union activity as a method to advance nurse’s capacity for patient advocacy and increase workplace empowerment.
Notes
References:
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association.
Dube, A., Kaplan, E., & Thompson, O. (2016). Nurse unions and patient outcomes. IRL Review, 69(4), 803-833. DOI: 10.1177/0019793916644251
Harvey, C., Baret, C., Rochefort, C., Meyer, A., Ausserhofer, D., Ciutene, R., & Schubert, M. (2018). Discursive practice – lean thinking, nurses’ responsibilities and the cost to care. Journal of Health Organization and Management, 32(6), 762-778. DOI: 10.1108/JHOM-12-2017-0316
Johnson, J., & Billingsley, M. (2014). Convergence: How nursing unions and Magnet are advancing nursing. Nursing Forum, 49(4), 225-32. DOI: 10.1111/nuf.12074
Ravitch, S. & Carl, N. (2021). Qualitative research: Bridging the conceptual, theoretical, and methodological. Sage Publications.
Tubbs-Cooley, H., Mara, C., Carle, A., Mark, B. & Pickler, R. (2019). Association of nurse workload with missed nursing care in the neonatal intensive care unit. JAMA Pediatrics, 173(1), 44-51. DOI: 0.1001/jamapediatrics.2018.3619
Sigma Membership
Delta Gamma at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Ethnography
Research Approach
Qualitative Research
Keywords:
Patient Advocacy, Workplace Culture, Unions
Recommended Citation
Christianson, Jacqueline; Fox, Cathleen; Camelio, Carmen; Johnson, Norah; and Haglund, Kristin, "Claiming a Seat at the Table: An Ethnography on a Unionizing Urban United States Hospital" (2026). Creating Healthy Work Environments (CHWE). 8.
https://www.sigmarepository.org/chwe/2024/presentations_2024/8
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2024
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-02-10
Claiming a Seat at the Table: An Ethnography on a Unionizing Urban United States Hospital
Washington, DC, USA
Purpose: Advocacy for the inherent value, dignity, and well-being of patients is a fundamental nursing duty (American Nurses Association, 2015). However, not all nurses are empowered to act as patient advocates. Nurses who work in cost-constrained environments undertake greater patient loads, experience greater burnout, and have poorer access to opportunities to improve patient care (Harvey et al., 2018; Tubbs-Cooley et al., 2019). Union formation and participation is an intervention that nurses worldwide may employ to advocate for patient care needs and equitable working conditions (Dube et al., 2016; Johnson & Billingsley, 2014). The purpose of this study is to describe the lived experiences of nurses undergoing unionization in a large urban United States hospital and how unionization supported nurses’ capacity for patient advocacy.
Methods: This study utilized ethnography, a qualitative method to understand the lived experiences and cultural context of people and how they interact with the world around them (Ravitch & Carl, 2021). Data included individual interviews with 25 bargaining unit members at multiple time points throughout the union’s first collective bargaining process, union communications, and observational data from union meetings and collective bargaining sessions. Interviews were unstructured, but commenced with the question: “How do you feel about the nursing union?” Data were collected after the union was recognized and collective bargaining efforts were underway. All nurses who belonged to the collective bargaining unit, regardless of personal support for the union, were eligible to participate.
Results: Study participants described their desire to advocate for patient care. Most participants described barriers to effective patient advocacy as their primary reason for becoming active in the union. Participants described the union as a tool they employed to demand inclusion in workplace decision-making and described union activity as an advocacy method that held administrators accountable in an enforceable manner. Throughout the union campaign some members described changes in the collegial environment such as increased interpersonal and interdepartmental civility, a greater perception of unity within the hospital, and solidarity from the community at-large. Some participants felt empowered to advocate for their patients through their union activity. At the same time, they reported feelings of personal exhaustion due to the challenges of the advocacy work they were engaged in.
Conclusions: Effective advocacy efforts require the capability and authority to participate in decision-making processes. Unionization may be a tool to increase capability and authority to engage in patient advocacy when other potential venues for advocacy are limited or ineffective. While many nurses found union advocacy to be challenging and sometimes emotionally exhausting, the sense of empowerment gained through their efforts gave them motivation to continue. Union participation may be an effective tool for nurses to promote advocacy for patients and create a mutually supportive, collaborative work environment. Future research is needed on the utility and limitations of union activity as a method to advance nurse’s capacity for patient advocacy and increase workplace empowerment.
Description
Patient advocacy is a core component of nursing practice; however, not all nurses are empowered to engage in advocacy efforts. This ethnographic study describes institutional cultural changes for nurses undergoing new union formation in an urban United States hospital and how unionization strengthens nurses’ capacity for patient advocacy.