National Nurses United

You are required to pay Fair Share ("Agency") fees to the California Nurses Association/National Nurses Organizing Committee ("CNA/NNOC") as a condition of your employment if you are employed by a private-sector employer that is a party to a collective bargaining agreement with CNA/NNOC con- taining an association security clause, and you work in a job classification included within a recognized bargaining unit for which the CNA/NNOC serves as your collective bargaining representative, and you are a non-member and have objected to paying for expenses that are not germane to CNA/NNOC's rep- resentational role. The purpose of the fair share/agency fee obligation is to prevent "free riders"—those employees who reap the professional practice protections, economic benefits, improved working conditions, and personal and workplace protections achieved through CNA/NNOC representation, but who refuse to share in the costs—"avoiding their fair share of the process from which they benefit." CNA/NNOC's Representational Role CNA/NNOC engages in representational activities addressing terms and conditions of employment com- mon to all workers such as wages, benefits, and job security. CNA/NNOC's representational role also includes responsibilities to the registered nurses it exclusively represents concerning terms and conditions of employment as well as terms and conditions of professional practice that are unique to registered nurs- es. Registered nurses represented by CNA/NNOC are required as conditions of employment to maintain their professional licenses in good standing, perform their work and professional practice responsibilities of providing patient care in accordance with standards of professional performance and competence man- dated by law, maintain clinical competency for particular patient care assignments through proper instruction and continuing education, and discharge their professional and legal responsibilities as patient advocates with a singular commitment to the interests of patients, a commitment that increasingly con- flicts with the financial and operational interests of their employers. Imperatives of RN Professional Licensure Registered nurses have professional obligations and ethical responsibilities as RN licensees independent of the job duties and responsibilities assigned by their employer. These responsibilities arise from statutory and regulatory mandates and the enforcement of those mandates through professional disciplinary action against licensees. Registered nurses are singularly responsible for providing safe and competent profes- sional nursing care for assigned patients. RN professional responsibility includes a duty as patient advo- cates to initiate actions which may be contrary to employer orders but necessary in the independent judg- ment of the RN to protect patient safety and health. A nurse may be subject to professional discipline and risk of suspension or revocation of license if the nurse engages in unprofessional conduct such as acts in breach of standards of competent performance in carrying out usual nursing functions. A nurse may also be exposed to professional malpractice liability for acts or omissions contrary to the obligations of licen- sure regardless of whether such acts or omissions are the product of employer incompetence, policy or direct order. Fear of employer discipline, contrary instructions from an employer, substandard facility conditions, deficient institutional clinical practices or excessive or unsafe patient assignments are no defense for professional liability arising out of failure to fulfill the obligations of RN licensure. Independent licensure obligations for nurses, such as the duty in appropriate circumstances to initiate actions contrary to employer directives, coupled with exposure to professional disciplinary action and malpractice liability for actions contrary to professional standards have a direct and substantial relation to the terms of employment and job security of nurses. As the exclusive collective bargaining representative for registered nurses, CNA/NNOC has a responsibil- ity to undertake all actions necessary for negotiation and enforcement of contract clinical practice stan- dards and conditions that enable nurses to comply with professional standards of safe and competent clin- ical practice and protect RN exercise of patient advocacy obligations. Negotiated contract clinical prac- tice standards are necessary because even though some statutory and regulatory protections exist, effec- tive enforcement of these protections is rare because of limited regulatory operations and resources, and increasing significant opposition and interference by well-financed health care and insurance industry lob- bying efforts. Unfortunately, decades of CNA/NNOC collective bargaining experience has clearly demon- strated the futility of seeking to negotiate meaningful RN clinical practice protections on a single facility or employer basis. Accordingly, CNA/NNOC collective bargaining strategy includes legislative and regu- latory advocacy to establish uniform standards of professional RN practice and safe nursing care con- ditions for the purpose of negotiating standards established by legislation and regulation into collective bargaining agreements for enforcement through the grievance/arbitration process and other contract enforcement methods. Health Care and Insurance Industry Conditions As a result of the radical restructuring, consolidation, and increasing commercialization of the healthcare industry over the past several years, the workplace pressures on registered nurses to evade, ignore, and abandon professional RN standards of competent performance and independent professional responsibil- ities of patient advocacy have become increasingly severe, resulting in greater risks to patients, and plac- ing nurses' licenses and ultimately their qualifications for continuing employment in jeopardy. The increasing conflict between the interests of direct-care registered nurses and their hospital/medical employers arises from the inevitable consequences of funding a healthcare delivery system based on profit from insurance risk. Today, hospital and physician services in this country are largely provided through group health plans and insurance exchanges. Health plan members are promised certain services by a health insurance company or HMO in exchange for a fixed monthly premium paid by health plan spon- sors, employers, and/or individual plan members. Health insurers and HMOs generate profits when the evasions of contractual, legal, and professional RN practice standards intended to generate surplus revenue by covering reductions of direct-care RN staff to unsafe levels. Fundamental Role as Exclusive RN Representative As an organization, CNA/NNOC's essential representational role is to: (1) empower registered nurses to act collectively in defense of their professional and license responsibilities to patients and healthcare con- sumers to practice nursing care under working and practice conditions which ensure safe, competent, and therapeutic patient care; and (2) to represent registered nurses in all appropriate forums and by all neces- sary means to ensure that their working and practice conditions satisfy the minimum standards necessary for faithful discharge of their professional and license responsibilities to provide safe, competent, and therapeutic patient care. This essential representational role includes activities to defeat health insurance and healthcare industry operations and initiatives which seek increased profits through elimination of hospital direct-care nurses and degradation of direct-care RN practice and patient care standards, as well as activities to organize and empower registered nurses that may ultimately inure to the benefit of all reg- istered nurse bargaining units represented by CNA/NNOC. CNA/NNOC engages in a broad range of activities to address these working and practice issues on behalf of registered nurses represented by CNA/NNOC and charges fair share fee rates that reflect the level of activity and expenditures directly related to these representational and organizational activities. CNA/NNOC's representational activities are outlined below along with those activities that are paid for by CNA/NNOC members, but not charged to non-member fee payers. Fair Share Fee Rate You have the right not to be a member of CNA/NNOC. If you are or become a non-member, you may object to paying for expenses that are not germane to CNA/NNOC'S representational role by notifying CNA/NNOC of your objection in writing at the following address: CNA/NNOC, Membership Services, 155 Grand Ave., Oakland, CA 94612. Non-members, who have notified CNA/NNOC of such objection are charged a fair share fee that is 13.65% less than the regular membership dues paid by CNA/NNOC members. Regular CNA/NNOC membership dues include amounts for political activities and certain benefits and member-supported activities that are not charged to non-members. Nurses who choose to be non-members of CNA/NNOC, and who have objected to paying for expenses that are not germane to CNA/NNOC's representational role, can protest CNA/NNOC's allocations of chargeable expenses included in the non-member fair share fee which a protestor believes are not germane to CNA/NNOC'S representational role. However, if you decline membership you must forfeit the many rights and benefits of CNA/NNOC mem- bership. The decision to decline CNA/NNOC membership should be carefully considered because of the rights and benefits that are forfeited by non-members. revenue they receive for group health plan premium payments is greater than the costs they incur in reim- bursing hospitals and physicians for providing services promised to group health plan members. However, this opportunity and potential for health insurer and HMO profits also presents a risk, the "insurance risk" of incurring costs for providing services promised to members of a group health plan in excess of the premium revenue received for the group. Today, hospital and physician reimbursement for providing promised services to health plan members is often not based on fees charged for the specific services provided, but instead is largely determined by "capitation" contracts and other forms of "at risk" arrangements with health insurers which limit reim- bursement to a preset amount of monthly premium revenue or other fixed amount. These "at risk" reim- bursement arrangements transfer to hospital and physician organizations the "insurance risk" of incur- ring costs for providing services promised to group health plan members in excess of the fixed premium revenue received for the group. "At risk" contracting arrangements for reimbursement of hospital and medical services have reversed the economic incentives of medical groups/physicians and hospitals in pro- viding care, aligning provider interests with HMO/insurer interests in maximizing provider revenue and insurer/HMO profit on insurance risk by limiting access to healthcare services, ignoring individual patient needs, denying necessary services, and disregarding minimum standards of safe, competent, and thera- peutic nursing care. This system has been complicated in certain respects by cost saving mandates in the Affordable Care Act. RN job security, RN professional practice, and RN staffing/safe patient care standards are in jeopardy as a consequence of hospital/healthcare provider mandates to generate surplus revenue under "at risk" reim- bursement contracts. Health insurance corporations and HMOs today generate immense profits under the prevailing method of financing the delivery of healthcare services in this country, "profit on insurance risk." Under the "at risk" reimbursement arrangements imposed on healthcare service providers, the health insurance/HMO industry has effectively transferred significant "insurance risk" to healthcare serv- ice providers while retaining control of premium revenue and directing provider implementation of new policies and operational changes to increase profit-taking, including: (1) initiatives to "restructure" nursing services which reduce RN staff and increase patient loads; (2) "clinical pathways" which severely and dan- gerously interfere with direct-care RNs' abilities and professional responsibilities to exercise independent judgment in making nursing diagnoses and formulating nursing care plans; (3) patient care policies and practices such as "charting by exception" which provide deceptive cover-up of the risks to patient health and safety by clinical pathway schemes to limit nursing care; (4) new technologies including RN "decision- support technologies" which effectively block RN exercise of independent professional judgment with respect to patient assessment and other key elements of the "nursing process"; and (5) imposition of employment policies which directly interfere with direct-care RN competent performance and proper dis- charge of the RN professional responsibility of patient advocacy, including (a) compelled "floating" to units and/or forced assignment of patients without possessing required clinical competencies, and (b) denial of meal and break periods, forced overtime, compelled uncompensated "after-shift" duties (such as "chart- ing" that are matters of individual RN professional responsibility) and other practices that are calculated O C T O B E R | N O V E M B E R | D E C E M B E R 2 0 1 9 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 33 NOTICE TO PRIVATE SECTOR EMPLOYEES REGARDING MEMBERSHIP AND DUES/SERVICE FEES

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