Nursing Power: California Nurses' Collective Advocacy for Patients and Nurses: An Interview with Rose Ann DeMoro

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Rose Ann DeMoro is executive director of the California Nurses Association, the largest and fastest-growing professional association and union for registered nurses in the country. CNA membership has doubled in the past seven years. CNA today represents over 57,000 RNs in 164 facilities across California.

With CNA, California nurses have led the nation in ground-breaking patient advocacy legislation such as staffing ratios and whistle-blower protections.

Modern Healthcare, an industry trade publication, in 2004 ranked DeMoro the thirty-fifth most powerful person in healthcare in the United States.

Multinational Monitor: What proportion of nurses is organized in California or nationally? Rose Ann DeMoro: About 20 percent of hospital-based registered nurses are organized nationally. In California, I believe that number is closer to 60 percent.

MM: What changes for a nurse if they are a member of a union?

DeMoro: For one thing, they have the ability to engage in what we call collective patient advocacy, which is the ability to advocate for patients against hospital management collectively, rather than one-on-one. Nurses who are organized have higher retention rates; they are better compensated; their pensions are better; their health benefits are better. This translates directly into the quality of patient care, because an experienced RN workforce is going to provide better care.

Directly through their collective bargaining agreements, nurses are able to control nursing practice in their hospital. So the introduction of technology and other aspects of work arrangements that might undermine patient care are limited and prevented through the union contract.

MM: Is there a shortage of nurses in the United States?

DeMoro: Yes, primarily because of industry practices that have really undermined the ability of nurses to practice nursing the way they were educated and desire to practice.

It has made hospitals in particular a much less desirable place to work.

MM: Are the hospitals also cutting back on nursing levels?

DeMoro: In some cases, we are still seeing so-called hospital restructuring, which does substitute lesser skilled workers for registered nurses. We're also seeing registered nurse-displacing technologies becoming the new wave of restructuring, which also reduces the number of RNs. …