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How Nurses Prove the Power of Unions

In an anti-union era, nurses may have found a model for effectively organizing labor.

On a Tuesday night in mid-November, a week after the midterm elections, several of America’s most recognizable progressives joined a national strategy call to talk about “Medicare for All,” the vision of single-payer health care gaining traction in the Democratic Party. Vermont Sen. Bernie Sanders was on the line, along with former Ohio state Sen. Nina Turner, who heads Sanders’ political group, Our Revolution, and is a regular commentator on CNN.

But the first speaker on the call -- the woman who declared it was “time to give this movement some serious muscle” -- was neither a well-known elected official nor a prominent media personality. She was Bonnie Castillo, the registered nurse who early in 2018 became the executive director of the 150,000-member National Nurses United (NNU), the largest nurses union in the country.

Castillo didn’t pull any punches. She vowed that NNU would escalate its fight against the “very vicious profit-driven health-care system,” standing up for those “denied care in so many manipulative and deceptive ways so that the billionaires and the corporate few can add to their fortunes.” She said the fight would require them to do more than “simply rely on the electoral process.” It would require organizing all over the country.

NNU isn’t new to this fight. Breaking up the for-profit health-care system has been a defining mission of the union since its founding a decade ago. But now the group faces a new challenge. NNU is embarking on a revamped Medicare for All campaign not only at the federal level -- where the prospects of success are bleak, at least in the short term -- but in states across the country, especially those with Democratic governors, most notably California, Minnesota and New York. 

The effort flies in the face of history -- no state has ever enacted single-payer by itself. Vermont tried and failed in 2014, when Democratic Gov. Peter Shumlin concluded that state taxpayers couldn’t absorb the required revenue increases. In 2017, Anthony Rendon, the Democratic Assembly Speaker of California -- generally considered the nation’s most thoroughly liberal state -- shelved a single-payer proposal. But Castillo remains undeterred. “Where there are state-based efforts and we have the ability to engage, we are going to engage,” she says.

Success would require the building of broad coalitions that have proven elusive for the union in the past. It would require exceptional leadership from Castillo following the tenure of longtime Executive Director RoseAnn DeMoro, a transformative but polarizing leader whose hardline approach alienated some other unions and Democratic power players. But should NNU succeed in one or more states, or even take some well-publicized steps toward success, it will likely cement its reputation as a model for organizing, and as a remarkably strong union in an anti-union age.

NNU, which has members in all 50 states, was founded in 2009 when three longstanding state-based unions -- the California Nurses Association (CNA), the Maryland-based United American Nurses and the Massachusetts Nurses Association -- effectively merged. The California and Massachusetts branches continue to operate as NNU affiliates with 100,000 and 23,000 members, respectively. Through it all, the 116-year-old California group has been the powerhouse; DeMoro led CNA for 17 years before NNU’s founding, and she continued to lead the affiliate and the national umbrella group until Castillo took charge of both last year.

NNU’s most indisputable success is its remarkable growth. In 2014, The Atlantic dubbed the group “The Little Union That Could” -- “one of the smallest, but most powerful unions in the country” -- and noted that NNU was growing at the same time that other unions across the country were coming close to atrophy. CNA claims to have grown from 17,000 members in 1993 to about 100,000 in 2018. NNU organized 8,000 nurses after it gained national visibility for its early endorsement of Sanders’ presidential campaign in 2016. Jane Sanders, the senator’s wife, has called NNU “arguably the strongest union in the country.”

The California affiliate attracted national attention in 2004, when it took on a fight against Republican Gov. Arnold Schwarzenegger. The union had backed a law requiring minimum nurse-to-patient ratios at hospitals; Schwarzenegger sought to roll back the measure. CNA fought hard, waging a massive statewide campaign with more than 100 public demonstrations against Schwarzenegger at the peak of his popularity. The nurses won. 

In 2010, CNA helped defeat Schwarzenegger’s would-be Republican successor, former eBay CEO Meg Whitman. The union deployed an elaborate parody campaign that cast Whitman as the rich and entitled aspiring monarch “Queen Meg.” The campaign was meant to be funny, one union official said, “but what’s not funny is the idea that an ex-Goldman Sachs CEO billionaire can stroll into our state and buy the governorship.” Whitman was defeated easily by Democrat Jerry Brown.

Castillo believes her group is uniquely positioned to capture the energy of the present moment, when women are exerting new political power in Washington and at the state level. “This is a predominantly female workforce,” Castillo says of NNU, “which I believe has been inspired by the movement of women, whether in #MeToo or the teachers standing up. We are finding that even nurses who are not organized are contacting us and wanting to organize.”


Bonnie Castillo, NNU's executive director, may be less antagonistic then previous leadership, "but you don't become the head of this powerful union unless you're tough," says Paul Song of Physicians for a National Health Program. (National Nurses United)

Through all these battles, CNA has acquired a reputation for headline-grabbing theatrics, protesting and picketing against Republicans and Democrats alike. At times, the group has taken this strategy to what many consider an extreme: After Rendon tabled the single-payer bill in California, for instance, DeMoro tweeted a graphic of a California grizzly bear with a knife in its back. Rendon’s name was clearly visible on the surface of the blade.

DeMoro believed in conflict as a strategy. She saw herself as fighting a class war. A San Francisco columnist once called her “Mother Teresa with brass knuckles.” She was happy with that. “I don’t know about the Mother Teresa stuff,” she told Mother Jones, “but I like the part about the brass knuckles.” 

Dr. Paul Song, who sits on the board of Physicians for a National Health Program and favors Medicare for All, expects a slightly less militant style of leadership from Castillo, who previously directed NNU’s nursing practice, its health and safety programs and its disaster relief initiative. DeMoro was “not afraid to offend or piss people off,” he says. “That was just her style. I think Bonnie is also a force to be reckoned with, but her style is different. She’s far less confrontational, but you don’t become the head of this massive, powerful union unless you’re tough.”

One longtime ally of NNU who sounds wary of its new leadership is Ralph Nader, the well-known consumer protection advocate who earned CNA’s endorsement for his Green Party presidential campaign in 2000. Nader took a bus tour with DeMoro pushing for single-payer in California decades ago, and he says “she and her union set the standard for unionism in America.” Nader understands Castillo to be less committed to the expansive vision of social unionism that has been an NNU hallmark. “There’s something lost,” he says, “because the new leader wants to focus on the nurses more -- the staffing issue, the pay issue, the benefits issue, the safety issue.” 

NNU does have a history of pushing for causes one might not typically associate with nurses, from consumer protection -- which caught Nader’s eye -- to fighting climate change. But CNA spokesman Charles Idelson flatly rejects the notion that the union is altering its approach. “The amount of social union activism under Bonnie’s leadership is unparalleled, certainly among labor unions,” he says. “It’s the lifeblood of this organization.” He notes that NNU has been heavily involved in recovery from California’s recent fires, part of the union’s ongoing work on climate change as a public health crisis.

Even if she does bring a new tone to NNU, Castillo is planning continuity on a key issue that sets the group apart from other unions. “What has distinguished us in the past and still distinguishes us is that we do not engage in labor-management partnerships,” she says. “That’s not something that we do or will ever do, because the fundamental alliance with our patients is sacred.”

Not everyone is impressed with NNU’s approach -- or with its results. Steve Maviglio, a prominent Democratic consultant in California, says the nurses are the makers of their own misfortune when it comes to issues like single-payer. He calls them “masters of the political publicity stunt” who are ultimately ineffective advocates because they’re so radical. “It’s sort of ‘all or nothing,’ and [the result has been] nothing, because what they advocate never gets enacted. They put on a good show, but when it comes to results, they’re just not there. No one takes them seriously in Sacramento other than if you’re afraid of having people demonstrating.”

Idelson says the consultant’s criticisms are “word for word what the insurance industry would say about us, and what Wall Street would say about us. Trump and Maviglio are in line on this. That’s who he’s parroting.”

But even some of NNU’s allies in the fight for single-payer acknowledge a downside to the union’s approach. On the 2017 single-payer fight in California, says Song, “there are some critics I know who didn’t feel CNA had a really good inside game, meaning there was a great building of the grassroots but there was nobody inside the halls of Sacramento who really had an ear. They have lobbyists. They have political directors in there. But not to the point where they were able to build a real coalition of elected officials inside. I think there’s some truth to those criticisms.”

A new test of the union’s influence in California appears to be on the horizon. NNU endorsed new Democratic Gov. Gavin Newsom, who pledged his support for the concept of single-payer. Some question Newsom’s commitment, but Castillo promises her group will hold him accountable for his pledge. “The leadership of this union is not going to sit it out,” she says. “We’re counting on him being a firm ally on health care as a human right. He can’t be chicken on this one.”

If her rhetoric on this issue is any indication, Castillo won’t be shrinking from the union’s traditional goals, or the hardball tactics they have used in pursuing them. She refuses to believe single-payer at the state level is doomed by definition -- that only the federal government can achieve it. She says the primary problem is political will, and she’s steeling herself for more fights with politicians she considers lacking it. “At the end of the day,” Castillo says, “they have to fear us. If they don’t do the right thing, we need someone else in their place.” 

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