By John Commins, for HealthLeaders Media, January 3, 2012

Lost for many observers in last month's end-of-the-year hullabaloo was the annual Gallup Honesty and Ethics Survey which by a wide margin again ranked nursing as the most honest and ethical profession.

The survey found that 81% of Americans believe that nurses have "very high" or "high" honesty and ethical standards. It marks the 11th straight year—and the 12th time in 13 years—that nursing led all professions in the survey. Gallup says the only time nurses haven't top the list since they were included in 1999 was in 2001 after the 9/11 terror attacks, when firefighters were ranked No. 1.

Not surprisingly, National Nurses United is well aware of the survey results and appears poised to capitalize on that hard-earned public regard.

"We hold that trust as a sacred bond with our patients and our communities," Karen Higgins, RN, co-president of National Nurses United, said in a media release. "Patients and their families expect nurses to fight for them at the bedside, even when it conflicts with the profit motive of far too many hospital managers, insurance companies, and others in the healthcare industry who put the bottom line above patient interest."

"For nurses, that obligation also goes beyond the bedside," Higgins continued, citing the NNU campaign for "sweeping changes to heal our communities and nation, with a program for a Main Street Contract for America premised on jobs with dignity, healthcare for all, a safe environment, and support for public education."

The union is also pushing for a Robin Hood tax on financial transactions to be levied against "Wall Street banks and other financial firms who created the current pain and suffering in our communities…."

NNU has smart, tough leaders and compelling "us-versus-them" and "patient-first" messages that resonate not only with the nurses they hope to organize, but with tens of millions of Americans who play by the rules and still feel like they're getting a raw deal.

The union has gained considerable success and notice since it consolidated the California Nurses Association/National Nurses Organizing Committee, United American Nurses, and Massachusetts Nurses Association in December 2009. The "super union" now boasts more than 150,000 members within a national network and has won most —if not all—of the organizing efforts it has undertaken.  

Savvy leadership and a compelling message—while important—are not the only keys to NNU's success. Seasoned and tough leaders can be found in other unions that have not fared as well. In 2010, only 11.9% of the U.S. workforce was unionized, down from 12.3% in 2009. Unions have seen a mostly steady decline in membership since 1954, when about 28% of the workforce was organized, according to the Bureau of Labor Statistics.  

Union supporters believe that more U.S. workers would join unions if they could. They don't, the explanation goes, because these workers haven't the leverage to bargain with management, especially in a weak economy plagued by high unemployment.

The frustrations and pressures that nurses encounter on the job can be shared with workers in other sectors from agriculture to retail to heavy industry.  Bad bosses, declining wages, and benefits, job instability and lousy hours are not unique to a particular sector.

Nurses, however, know they are in high demand. They know they are not easily replaced. They know their skills—for the most part—cannot be outsourced.  Because of all that, they know they don't have to tolerate a dysfunctional workplace. They can vote with their feet and find a new job elsewhere, or they can vote to organize.   

NNU's success suggests that when workers are given the chance to organize, usually they will. That annoys a lot of people who want to believe that unions are no longer needed in this era of enlightened management.

Instead, union successes are dismissed as some sort of trickery such as heavy-handed organizing efforts that pressure non-affiliated workers to join. How else to explain the failure of management to contain NNU's organizing efforts, other than to acknowledge the failure of management?

If NNU's only purpose were to increase dues-paying membership, as some critics suggest, that is not necessarily a grand deception on its part, and it does not explain their success. Nor is it explained by the suggestion that unions now hold some momentary advantage thanks to a temporarily pro-labor tilt on the National Labor Relations Board.

The explanation is simple. NNU is succeeding because many nurses—like many workers in many sectors—believe that nobody else in a position of power and influence is looking out for them. The only difference is that nurses are in a position to do something about it.

John Commins is an editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.