ME, MYSELF AND I: PROMOTING WORKPLACE VIOLENCE OVER PATIENT ABUSE

 

ME, MYSELF AND I: PROMOTING WORKPLACE VIOLENCE OVER PATIENT ABUSE

Unions are the bane of quality nursing care. Nursing unions are Marxism at work. The average and subpar nurses depend on the best to carve out profits and protect their employ.  Common complaints about nursing unions include mandatory dues, strikes causing lost pay and patient care disruption, prioritizing seniority over performance, internal disagreements on union stances (like mandates), and the potential for rigid contracts limiting individual skill use or career growth. Some nurses feel their fees fund political actions they oppose, while others dislike the ethical conflict of striking and potentially harming patients, or find unions protect poor performers while stifling high achievers. In 2025, corruption and ethical controversies in nursing and healthcare unions have been highlighted through leadership scandals, legal investigations, and internal dissent. While many nurses view unions as essential for safe staffing and fair wages, allegations of financial malpractice and systemic issues continue to surface. 

The overall scope of care is hospital, doctor, and nurse before patient. The profit is the insurance companies and governments before patient. In our current system, the patient is the product. Treatment protocol is the patient happens to be a person rather than a person happens to be a patient. The first way requires sympathy. The next requires empathy. In sympathy, patient abuse and workplace violence reign. In the latter, patient care is par excellence. The current system allows the caregiver to mask the perfprmance while rewarding the average and subpar on the level of excellence achieved by the best. Slighting patient care at the risk of placating nurses and unions. So much for quality care. In high pressure, stressful situations, nurses choose their safety over patient well-being.

What's done to nurses is eventually done to patients! "Therefore all things whatsoever ye would that men should do to you, do ye even so to them: for this is the law and the prophets. (Matthew 7:12)"

Some nurses oppose unions for reasons including reluctance to pay dues, belief unions don't add enough value, fear of striking and patient abandonment, negative past experiences, and ideological opposition, while some nurses feel management-backed "vote no" committees mislead them; however, many nurses support unions for better pay, staffing, and patient advocacy, highlighting a significant internal divide on the issue. Critics often respond, "But you need unions for the good of US healthcare!" Paul Neiman and Tammy Neiman in "Nurses on the outside, problems on the inside! The duty of nurses to support unions", write, "Nurses' unions use contract negotiations, legislative advocacy, and strikes to pressure other members of the healthcare community to address chronic short staffing, burnout, and retention. Nurses' unions in the US thus play a unique role in the system of competing interest as an organized group whose primary interest aligns with the community's obligation to provide access to quality healthcare. Nurses on the outside, problems on the inside! The duty of nurses to support unions."  

California is not a "right-to-work" state, meaning private employers (including hospitals) can require nurses to join a union or pay fees as a condition of employment, though federal law (_CWA v. Beck) allows opting out of political dues. The National Right to Work Legal Defense Foundation actively supports California nurses challenging mandatory dues and political spending by unions like the United Nurses Association of California (UNAC) and CNA/NNU, highlighting issues with forced unionism and political influence. The National Right to Work Legal Defense Foundation reported in "California Nurse Adds New Claim in Federal Labor Board Case Against United Nurses Association of California", "Sarah Warthemann, a nurse at Kaiser Permanente, has just filed new charges in her ongoing case against the United Nurses Association of California (UNAC) union challenging union officials’ illegal demands that she pay full union dues or be fired. Warthemann’s charges were filed at the National Labor Relations Board (NLRB) with free legal aid from National Right to Work Foundation staff attorneys."

Recent allegations and investigations into nursing and healthcare unions in 2024 and 2025 have centered on leadership scandals, financial mismanagement, and internal political rifts. In May 2025, George Gresham, the long-time president of 1199SEIU United Healthcare Workers East, was defeated in an election following a major corruption scandal. The House Committee on Education and the Workforce requested a federal investigation into revelations of "massive corruption" and lavish spending, with  some reports characterizing the union's funds as an "unlimited piggy bank" for leadership. In March 2024, the House Committee on Education and the Workforce launched a broad investigation into 12 private-sector unions, including those representing healthcare workers. The investigation focused on reports of fraud, embezzlement, and improper accounting, noting hundreds of federal indictments and convictions of union officials over the previous decade.

• Financial Malpractice: Accusations include the use of member dues for "ideologically charged litigation" or organizing unrelated industries without proper notice or consent from members.
• Coercive Agreements: National Nurses United (NNU) has criticized "indentured servitude" schemes where hospitals use "Training Repayment Agreement Provisions" (TRAPs) to force new nurses into predatory debt if they leave before a set period.
• Suppression of Whistleblowers: Older reports (such as those involving SEIU-UHW) alleged that some labor contracts discouraged union members from informing regulators or the press about poor patient care.
• Impact on Care: Some studies suggest that hospitals with certain union affiliations may correlate with lower overall hospital ratings or worse patient outcomes due to strikes and resource diversion toward legal battles. 

Robert Milkowski in "US healthcare workers union president ousted by opposition slate following corruption scandal" writes, "On May 4, George Gresham, President of 1199SEIU United Healthcare Workers East (UHWE) was decisively defeated by Yvonne Armstrong, a longtime and high-ranking member of his staff. Gresham, president since 2007, was ousted following the eruption of a scandal triggered by revelations of massive corruption, which prompted the House Committee on Education and the Workforce to request a federal investigation.

The scandal, triggered by an extensive exposé in Politico, lifts the lid on how the union bureaucracy as a whole lives—its corrupt appetites, its essentially parasitic and hostile relationship to the workers they claim to represent and their deep ties to management and the capitalist parties. It underscores that the bureaucracy cannot be reformed, but must be overthrown, and replaced with rank-and-file committees which give workers themselves real democratic control."

Effective August 2025, the Department of Veterans Affairs severed ties with several federal unions, including the National Nurses Organizing Committee (NNOC/NNU), voiding contracts for roughly 80% of its workforce.

Ann Fenny in NurseJournal's "What Are the Pros and Cons of Joining a Nursing Union?" weites,

"Do unions benefit or harm healthcare and nursing industries?

The pros and cons of unions in healthcare often spark debate. While unions protect and advocate for workers, they represent only one part of the healthcare ecosystem. Unions may fight for their members at the expense of patients and other stakeholders.

Cons

• Union fees
• Unpaid strikes
• Not all members support all collective action
• Seniority more rewarded than performance
• Can protect nurses over patients"

You can trace the dissatisfaction of healthcare with the nursing unions and their malfeasance to Karl Marx. The unions live, work and worship for the revolution. Black nurses faced decades of segregation, forming their own groups like the National Association of Colored Graduate Nurses (NACGN) in 1908, before major integration with the American Nurses Association (ANA) in the early 1950s, spurred by WWII efforts, the Nurse Training Act of 1943, and civil rights advancements like the Civil Rights Act of 1964, which finally opened most segregated nursing schools and unions. While specific, recent data on Black nurses within unions isn't readily available in these snippets, studies show Black workers are generally overrepresented in unions, and Black nurses are a significant, growing part of the overall nursing workforce (around 6-10% of RNs), with some data suggesting ~25.6% of unionized direct care staff were Black in one study, compared to 21.6% non-unionized, showing higher union presence. Marx saw Black liberation and working-class unity as inseparable, famously stating, "Labor in the white skin can never free itself as long as labor in the black skin is branded," viewing slavery and racism as core to capitalist exploitation, a belief that inspired Black socialists and activists, though the practical implementation in unions often lagged, creating tension between Marxist ideals of cross-racial solidarity and persistent racial division within labor movements. Tom Crean of the Socialist Alternative in "Marxism and the Fight for Black Freedom" writes, "Like Marx in his day we need to win people to the understanding of the complete interdependence of the fight for black freedom and the fight of the whole American working class for a socialist future. There will be no socialist revolution in the U.S. without the black working class and youth playing a central and leading role. Likewise the black freedom struggle cannot be victorious if it is isolated and not thoroughly integrated into the fight of all working people for freedom." He would like you to remember, "Socialist Alternative is a revolutionary organization working to build a movement for a democratic, socialist society. We are campaigning for a new party of working people and fighting for an end to all capitalist oppression and exploitation." Unions. Screwing over Blacks since 1943!

W.E.B. Du Bois and Marx provided foundational theoretical frameworks used in nursing and public health to understand how social structures, economic power, and racial hierarchies drive health inequities. Du Bois taught Marxism in the U.S., notably at the Communist Party-affiliated Jefferson School of Social Science in New York City starting in 1952, where he used Marxist theory to analyze capitalism, imperialism, and the Black experience, linking Pan-Africanism with global anti-colonial struggles for a socialist future, educating many Americans, particularly Black Americans, in these concepts before the school's forced closure in 1956. In health and social sciences, The Jefferson School of Social Science in NYC was forced to close in 1956 primarily due to intense federal pressure and investigations under the McCarran Act, which targeted alleged Communist organizations, creating impossible financial and operational conditions through legal battles, declining enrollment, and financial strain from defending itself, branding it a "subversive" front and making it impossible to continue. Du Bois exerted a profound influence on the "Howard Radicals," at Howard University, a circle of young scholars in the 1930s who integrated Marxist class analysis with the study of racial oppression. While writing his seminal Marxist-influenced work, Black Reconstruction (1935), Du Bois actively collaborated with Howard faculty members. In June 1930, Du Bois delivered a significant speech at Howard University where he directly questioned the capitalist system as the cause of the Great Depression. This address was widely reprinted in communist newspapers and signaled his "gradual move leftward," inspiring the younger Howard scholars to view race and class as "inextricably intertwined". He profoundly influenced both Marxism and nursing (public health) by integrating class analysis with systemic racism to explain social inequities. Du Bois was a pioneer in social epidemiology, directly influencing how nursing and public health professionals address health disparities.  In his 1935 work, Black Reconstruction, Du Bois explained why white workers often supported capital over their own class interests. He argued they were compensated by a "public and psychological wage" of social status, which divided the working class and prevented interracial labor solidarity. Become a Marxist and be a better nurse or share in collective bargaining. Power to the nurses!

The first US nurses' organization was the American Society of Superintendents of Training Schools for Nurses, formed in 1893 (later the National League for Nursing (NLN)), but for actual labor union action, the Alameda County Nurses' Association (ACNA) secured what's believed to be the first nurses' labor contract in 1947 with Kaiser Permanente, paving the way for modern nursing unionism, notes Kaiser Permanente. Screwing Anerica since 1893!

The American Society of Superintendents of Training Schools for Nurses (ASSTSN), founded in 1893 and now known as the National League for Nursing (NLN), has no direct historical connection to Karl Marx or his political activities. While the organization and the philosopher are historically distinct, contemporary scholars occasionally use Marxist theory as a lens to analyze the period in which the ASSTSN was founded. Modern academic papers (such as those by Sam Porter) apply Marxist concepts—like "surplus value" and "class antagonism"—to critique how the 19th-century nursing model evolved within a capitalist system. These analyses argue that the hospital-based training model championed by early superintendents created a hierarchical "caste system" that prioritized efficiency over nurse autonomy.

There is no formal historical or organizational connection between the Alameda County Nurses’ Association (ACNA), the California Nurses Association (CNA), and Karl Marx. References linking them often appear in academic labor histories or Marxist-humanist political analyses that discuss the evolution of nursing unions from professional associations into militant labor organizations. Academic works, such as those from UC Berkeley, often apply Marxist or social justice frameworks to analyze the "moral economy of care" within Alameda County hospitals. These studies use Marxist labor theory to describe the conflict between nurses' professional identity and the "industrialized" nature of modern healthcare. Michael Traynor in NIH's "Autonomy and caring: Towards a Marxist understanding of nursing work" writes, "The aim of this paper is to re-examine nursing work from a Marxist perspective by means of a critique of two key concepts within nursing: autonomy and caring. Although Marx wrote over 150 years ago, many see continuing relevance to his theories. His concepts of capital, ideology and class antagonism are employed in this paper. Nursing's historical insertion into the developing hospital system is seen in terms of a loss of autonomy covered over by the development of cults of loyalty toward those institutions, while the concept of emotional labour is used to re-examine nursing's high valuing of "caring" and to understand it as potentially exploitative of nurses. Raising awareness of this alternative way of understanding nursing work can become a first step toward change." Let's atop exploiting nurses by expectonj and demading quality care from them. We ask too much!

It's the politics not the patient. The union wants to build a big tent for the Socialist Democrats not the patient. Obamacare is failing. Good! We need Medicaid for All. Illegals don't have healthcare. Bad! Every Alien must have citizenship and healthcare. National Nurses United (NNU) reported:"Nurses represented by National Nurses United (NNU), the country’s largest nurses union, will be joined by allies including members of Congress for a protest..." Whay are they protesting? Better training to end Patient Abuse? Better Resource Allocation to reduce high stress periods on staff and improve patient care? NNU continues, "Nurses and congressional leaders will be joined by labor and community allies to stand together and demand that Congress first extend the Affordable Care Act (ACA) tax subsidies before the end of the year and then implement Medicare for All." Orange Man, Bad! Choosing a Ballroom over our affordability. NNU wants patients to remenber "All for the Revolution"! NNU reports, "Social Justice and Equity division works to build and deploy nurses’ collective power toward the transformation of systems, institutions, policies, and practices that perpetuate social, health, and workplace inequity and injustice. 

Our union, like our communities, is a very diverse place and we do not all experience injustice in the same way. Yet, as union nurses, we all have a duty to build a just and inclusive democratic society in which all people can be healthy and free. This requires that we address inequity in our workplaces, by demanding safe and respectful environments free from discrimination, harassment and other policies and forms of behavior that compromise well-being and dignity. Workplace justice includes fighting for opportunities, resources and support for nurses who have been historically marginalized, disenfranchised and oppressed. Social justice at work also means organizing, winning contracts, and advancing campaigns that change oppressive institutional policies and practices." Long live the Revolution!

"We fight patient abuse with collective bargaining. All for the Revolution!"

Nursing unions and Marxism intersect as Marxist theory provides a framework to critique capitalism's negative impacts on healthcare, revealing how profit motives undervalue nurses, create poor working conditions, and worsen health inequities, prompting calls for unions to adopt radical approaches for genuine social change beyond mere wage increases, focusing on systemic reform, worker control, and social justice. While traditional unions focus on economic gains, Marxist-influenced nursing movements see unionization as a tool for challenging the exploitative structures of capitalism, linking nursing's struggles to broader class conflict and social reproduction. Sam Porter in the National Institutes of Health (NIH)'s "Why nurses should be Marxists" writes, "The argument that nurses should be Marxists is made by looking at the primary areas of nursing activity in turn, giving an example of how capitalist economic relations negatively impact upon that activity, and providing a Marxist explanation of the reasons why it has that impact. In relation to the nursing activity of health promotion, it is argued that capitalism's generation of social inequality undermines the health of the population. In relation to curative activities, the focus is on how capitalism's reckless pursuit of profit has subverted the sustainability of bactericidal interventions. The argument in relation to comforting and assistive care is that the ownership and control of health services by capitalist corporations undermines therapeutic relationships. Finally, in relation to supportive care, it is contended that capitalism's requirement for a disciplined workforce can compromise healthcare professionals' support of employees. It is concluded that if nurses aspire to have some control over their activities, then it is a good idea for them to avail of Marxism's capacity to identify the socio-economic mechanisms by which capitalism affects nursing care."

Patient abuse is any act or omission by a caregiver causing unreasonable suffering, harm, or misery to a vulnerable patient, encompassing physical (hitting, restraint), sexual, emotional (insults, threats, isolation), and neglect (withholding food, care, medication) mistreatment, often seen in vulnerable groups like the elderly, manifesting as unexplained injuries, poor hygiene, behavioral changes, or untreated needs, and should be reported to authorities like Adult Protective Services. A significant amount of patient abuse goes unreported in U.S. hospitals, with estimates suggesting over half of medical errors and a large portion of elder abuse cases are missed, often due to narrow definitions of harm, fear, systemic gaps, or complex reporting; studies show hospitals fail to capture many patient harm events, and high percentages of violence against staff also go unreported, indicating pervasive undercounting of abuse. In July 2024, the US Department of Health and Human Services (DHS) Office of Inspector General (OIG) in "Hospitals Reported Few Captured Patient Harm Events to CMS and States" reported, "Our results show a significant discrepancy between the events that CMS and States expected hospitals to report and the events that hospitals actually reported. Nationwide, we determined that 16 percent (15 of 94) of harm events that hospitals identified and captured in their incident reporting or other surveillance systems were required to be reported externally per CMS and/or State requirements. Yet, in our sample, hospitals reported only 5 of 15 captured events per these requirements. For the remaining 79 events not required to be reported externally, hospitals voluntarily reported 7 of those events for learning purposes." Can you feel the collusion? Collusion (n.) is "secret agreement for fraudulent or harmful purposes," late 14c., from Old French collusion and directly from Latin collusionem (nominative collusio) "act of colluding," from colludere, from assimilated form of com "with, together" (see com-) + ludere "to play" (see ludicrous). "The notion of fraud or underhandedness is essential to collusion" [Fowler]. Yes, collusion in healthcare between hospitals, doctors, and even insurers happens, not always as overt conspiracy but through anti-competitive practices like price-fixing, wage suppression, and steering patients, leading to higher costs, plus ethical "collusions" (blind spots) in patient care, though many professionals strive for collaboration and face immense pressure. The U.S. Department of Justice (DOJ) actively investigates such monopolistic behavior, while professional dynamics can involve power imbalances or silence that harms patient care. While there is no evidence of a universal "collusion" conspiracy among all medical professionals to abuse patients, investigative reports and legal actions in 2025 highlight systemic issues where staff cover-ups and organizational failures have occurred. 

Key Evidence of Systemic Issues

• The "Code of Silence": Investigations by the Office of Inspector General (OIG) have documented a "code of silence" where staff protect one another from the consequences of misconduct by remaining silent or lying to investigators.
• Failure to Report Harm: A 2025 HHS OIG report found that hospitals failed to capture half of all patient harm events among Medicare patients, often because staff did not consider the events to be "harm" or applied narrow definitions to avoid reporting.
• Systemic Neglect in Psychiatric Facilities: A 2025 class action lawsuit against the Psychiatric Institute of Washington alleges a years-long pattern of systemic abuse, including the falsification of medical records and unlawful involuntary hospitalizations.
• Medical Fraud and Unnecessary Procedures: Federal authorities have indicted hospitals for allegedly enabling and benefiting from criminal activity. For instance, a hospital was indicted in early 2025 for enabling a physician who performed decades of medically unnecessary procedures. 

Hospitals and nursing unions have a dynamic relationship: unions advocate for nurses through collective bargaining for better pay, benefits, staffing, and working conditions, which studies show often leads to improved patient care, safety, and nurse retention, while hospitals balance union demands with operational needs, sometimes leading to conflicts but also to collaborative committees for safety and policy. Major unions like NNU, CNA, and SEIU focus on patient-staff ratios and ensuring nurses have a voice, impacting hospital quality and nurse satisfaction. Paul Neiman and Tammy Neiman in NIH's "Nurses on the outside, problems on the inside! The duty of nurses to support unions" write, "This article argues that nurses' professional duty to care for patients includes a duty to support nurses' unions as an important way to address the factors outside of nurses' direct practice that impacts the quality and accessibility of the care that nurses provide to patients. This duty to support unions applies to unionized and non-unionized nurses in the US, and includes duties to participate in union activities, to not cross picket lines, and to avoid work for strikebreaking nurse agencies." Are your Spidey Senses tingling yet?

Collective bargaining is the negotiation process where employees, usually through a union, bargain with their employer as a group to set terms of employment like pay, benefits, hours, safety, and other working conditions, resulting in a legally binding contract known as a collective bargaining agreement (CBA). Its purpose is to empower workers by giving them a collective voice, balancing power with management, and improving wages, benefits, and workplace fairness, with key US legislation like the National Labor Relations Act (NLRA) protecting this right. Ever notice you, the patient, are never at the table?! Patients aren't typically directly at the bargaining table because nurses' unions bargain for nurses' conditions (pay, staffing, safety) which indirectly benefits patients by ensuring quality care, but patients are often represented by nurses advocating for staffing ratios that protect patients from understaffing, creating a partnership where nurses fight for patient safety through better work environments. Patients' non-involvement stems from traditional labor models, nurse reluctance to strike (due to patient care duty), and legal/logistical hurdles, though patient advocacy is a core union goal. This is why workplace violence over patient abuse. No direct accountabikity.

Hospitals and nursing unions have a complex, often adversarial but increasingly collaborative relationship, where unions like the National Nurses United (NNU), SEIU, and CNA negotiate for better pay, staffing, benefits, and patient safety, directly impacting working conditions, while hospitals manage these demands, leading to improved nurse retention, patient care (through staffing ratios), and security, but sometimes creating friction over management control, flexibility, and the effectiveness of union power in different settings. Patient Care and its negligence, Patient Abuse, should not be a secondary consideration but a primary. Patient abuse statistics highlight a significant public health challenge, particularly affecting elderly and vulnerable populations. These statistics often reflect two distinct directions: abuse of patients by staff/caregivers and abuse perpetrated by patients against healthcare workers. Patient abuse in U.S. hospitals is a significant issue, with high rates of verbal abuse (over 90% for some staff) and physical threats, particularly in emergency departments, though statistics vary by study and focus (staff vs. patient abuse). Key findings show nurses and clinicians are frequent targets, often by patients with altered mental status, pain, or dissatisfaction, leading to substantial financial costs (over $18 billion in 2023) and impacting staff retention, with physical violence rates often higher in EDs and general floors than critical access hospitals, according to reports from the National Nurses United (NNU) and American Hospital Association (AHA). You can tell by the statistics, it isn't!

Complaints about nursing unions often center on mandatory dues, unpaid strikes, seniority-based rewards over performance, and internal disagreements with union stances, leading to ethical dilemmas like striking during patient care or using fees for politics. Nurses worry about loss of individual merit recognition, potential for job loss during strikes, reduced autonomy in some union contracts, and the financial burden of dues, while some feel unions don't always truly represent all nurses' diverse needs or protect patient care effectively. Why should we complain when it is all about me, myself and I!