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RNs in Motion » 23 Collective Advocacy PATIENT ADVOCACY— OUR GUIDING PRINCIPLE A BIT OF HISTORY AND PERSPECTIVE In 1966 the mass resignations of 1,979 RNs from 33 hospitals in the Bay Area resulted in salary increases of 40 percent, to $700 a month for all CNA RNs. Paid holidays were also increased to eight per year with time and a half for holidays worked. The CNA Board of Directors, under pressure from the membership, repealed its no-strike pledge. In 1969, after months of unsuccessful bargaining, CNA nurses went on strike at eight Bay Area hospitals: Saint Francis, French, Alameda, Herrick, Peralta, Providence, Alta Bates, and Children's Hospital Oakland. A major issue in the strike was the establishment of Professional Practice Committees (PPCs) to meet once a month and recommend to management ways to improve patient care. After an 18-day strike, the hospi- tals agreed to the PPC language as well as provisions for paid educational leave, a guarantee of every fourth weekend off, and salary increases up to $840 per month. In the 1980s, responding to the deepening nursing shortage and the leverage of market conditions in favor of direct-care RNs, CNA nurses showed our collective strength through successful negotiations and strikes. The results were gains in salaries, tenure steps, benefits, and the establishment of clinical ladders and improvements in working conditions that advanced nursing as a career. Prior to 1993, the CNA Board of Directors consisted primarily of nursing supervisors and educators. Because of the inherent conflict of interest, a second board, the Congress of Economic and General Welfare, was created with no real authority. In 1997, four years after the staff RN takeover, the CNA House of Delegates (now the CNA/NNOC Convention) voted to discontinue the past practice of having two policy-making boards and merged the boards into one. Since that time, the bylaws prohibit supervisors from holding a board seat. The CNA/NNOC board now has overall responsibility for the direction of the organization and all its pro- grams, including collective bargaining. The Union and Patient Advocacy RNs have independent ethical and professional obli- gations and therefore a right as patient advocates to initiate actions that, in our independent judgment, are necessary to protect patient safety and health — even if these actions might be contrary to our employer's directives. Having a union gives you the workplace and political power you need and also provides the founda- tion for engaging in patient advocacy on a collective basis with a unified union voice. The Right to Bargain on Patient Care Issues There are many examples of management decisions to restructure or redesign patient care delivery methods, including changes in staffing skill mix, abandonment or modification of acuity systems, and imposing new responsibilities for RN clinical supervision of unlicensed personnel. All of these decisions can severely burden RNs and pose significant risks of harm to patients. These same decisions are mandatory subjects of bargaining under the National Labor Relations Act and public employment labor laws. The reason they are mandatory is because they directly affect RN workload and job responsibilities, and may actually jeopardize an RN's license because the increased responsibilities and job speed-up prevent competent performance of professional responsibilities.