Many nurses want to be able to unionize. The Employee Free Choice Act, which would allow unionization, is moving through the Senate, but it’s looking like there are going to be some roadblocks as the idea of nurses being represented by unions seeps through to government and industry.

However, the situation for the profession is too complex for purely polarized, pro and con simplifications about the principle of unionization. There’s a lot more at stake here. The entire nursing profession has daily representation issues across the health care spectrum. The degree of difficulty ranges from national issues to infuriating local nuisances.

Any union has to be able to operate in real time with issues, represent its members effectively and must above all be able to deliver credible results. The nursing profession needs ultra-functional performance levels.

Nursing is a unique profession. It needs a unique methodology to make its unions work. The Employee Free Choice Act offers  some very positive possibilities here, if the union can do the job:

1. Giving nurses a working legal ability to deal collectively with issues, on site and elsewhere.
2. The chance to be represented effectively regarding health care policies and issues.
3. A problem solving mechanism where nurses don’t have to fight every battle that comes along individually on an ad hoc basis when they’ve got five minutes.

Representation is the major problem underpinning all nursing issues in the health care industry mainstream. The American Nurses Association, which is a national body with an affiliate structure, represents registered nurses, a total of 2.9 million members. The ANA is usually off the public radar, and not on the political screen at all. The ANA apparently has nothing to say about Employee Free Choice Act, or unionization, for example.

The question is, can unions fill the representation gap for nurses? Every other major profession has effective national representation at policy level in the government, and a strong public profile. Unionization does provide at least a partial fix to local issues. How these unions are organized, and the nature of their membership representation, is going to decide whether they can get nursing issues on the national radar.

Whatever happens with the Employee Free Choice Act, please let’s not assume that enough local band aids will equate to a national body cast. Representation is the issue that won’t go away.