Click the questions below to see the answers.
Technology
We have not conducted a cost-benefit analysis because that is not the focus for these projects. Virtual nursing has been deployed to address nursing shortages and improve patient and nurse experiences, not to reduce costs or workforce.
In the hospitals with virtual nursing programs, all virtual nurses are employed by the hospital.
In other hospitals, the virtual nurse uses a TC 50 device; some are experimenting with Teams. In an emergent situation, the virtual nurse is part of the discussion/care plan to support, but if/when they can no longer contribute, the tablets are removed from the room.
There are no confirmed workflows for ambient documentation technology for nurses, and any future state would be defined with nurse input. Currently, this is used only by providers and is episodic. There is no continuous listening. Audio is temporary and encounter-specific.
Good question, and that’s why we need to be thoughtful about how we’re mitigating risk or errors. We need to continue gathering information, monitoring, building, and ensuring the tool provides accurate answers. It’s a space we need to be aware of and concerned about, and MSH GPT allows us to have control over the data we are sharing and providing. There is a GPT governance committee to ensure that we are ethical in our development of the tool.
There are RNs and Physicians on the review board, but the Hospital bargaining team encouraged early collaboration with our nurses on technology, and discussions are ongoing.
Union Dues and Agency Fees
Associates who work in a unionized unit cannot be required to join the union—but they are required to pay the union whether or not they are members. Union dues are the fees paid to the union by members of the union for the union to spend how they choose. Agency fees are the amounts a union can charge nonmembers to cover the cost of representation services they receive by virtue of being employed in a job covered in the bargaining unit represented by the union.
Unfortunately, once a union is voted in, all associates within that bargaining unit are unionized. You can choose not to be a member, but the union may still require you to pay agency fees to cover activities limited to collective bargaining, contract administration, and grievance handling. The current contract between the Hospital and NNU requires that these fees be paid.
They should be. The law limits what unions can charge non-member employees covered by union-security clauses. However, the Union has put forth a proposal that would require agency fees “be equal to the full member dues rate.” As we told the Union in bargaining, the Hospital does not agree with raising agency fees to the same level as full membership dues, and we will stand up for our nurses.
Maybe. The current collective bargaining agreement allows the Union to demand nurses who don’t pay dues or agency fees be fired. The Union has not exercised that right lately, but in discussing their new proposal the Union has suggested it intends to do so going forward. As we told the Union in bargaining, the Hospital will not agree to any proposal that includes firing our nurses who have a valid objection pending to the increased agency fees.
That’s a good question. Only the Union can answer this, but it could be because more nurses are choosing not to pay member dues. Full member dues subsidize the business of the Union and political or ideological activities unrelated to workplace representation. Instead, nurses may only want to pay only the mandatory fees directly related to representation.
General ("Collective Bargaining" or "Negotiations")
Collective bargaining is a back-and-forth negotiation process between a union and an employer aimed at reaching an agreement on a labor contract, also known as a collective bargaining agreement.
A union is an organization that serves as a collective bargaining agent for the groups of associates it represents (i.e., the union speaks on behalf of employees with their employer on all things related to wages, benefits, and working conditions). A union is a business that is supported primarily through dues, fees, fines, and assessments charged to its members.
During union contract talks, the employer meets with union representatives to discuss pay, benefits, scheduling, and other terms and conditions of employment. The employer listens, shares information, and negotiates in good faith to reach a fair agreement. The contract takes effect when both sides approve and sign it.
There are no guarantees in collective bargaining. Associates could get the same, more, or less than they currently have through the bargaining process.
No. As long as the employer bargains in good faith, there is no obligation to agree to any specific union request. The law requires that employers and unions negotiate in “good faith” to reach an agreement. This includes meeting at reasonable times and conferring in good faith, bringing proposals to the bargaining table, responding to the other party’s proposals, and working toward consensus.
Yes, a union can refuse to accept a contract proposal even if its members want the union to agree to it. Sometimes, members might have the chance to vote on the proposed contract and share their opinions directly. However, the ultimate decision to accept or reject a contract proposal is made by the union leadership.
No, once a union has been voted in and a labor contract has been negotiated, you cannot opt out of the contract, even if you don’t like the terms, never supported the union, voted “no” in the election, or no longer want the union here.
The duty of fair representation is a legal obligation that requires labor unions to represent all members of the bargaining unit in a fair and impartial manner. This obligation is established by the National Labor Relations Act (NLRA).
Under the duty of fair representation, a union must not discriminate against any of its members and must act in the best interests of all members when negotiating and administering collective bargaining agreements. This means that the union must make decisions in a non-arbitrary, non-discriminatory, and non-partisan manner, taking into account the interests of all members.
If a union breaches its duty of fair representation, a member may file a complaint, or unfair labor practice charge, with the National Labor Relations Board (NLRB). The complaint may result in legal action to remedy the breach and restore the rights of the affected member.
The employer and the union can agree to extend the agreement’s effective date while they continue bargaining.
The union has the authority to call a vote to approve a strike, a common tactic employed by unions. This year, we have seen unions call numerous strikes, including NNU taking its unionized members at St. Agnes in July of this year.
If management and/or the union believe they won’t reach an agreement (called a stalemate or impasse), either side can request mediation, arbitration, or management can enforce its last and final offer.
A last and final offer is the point in negotiations when one side presents its best and final proposal. It indicates that no further changes will be made unless both parties agree to reopen the discussions.
Simply put, it makes sense. A three-year contract provides security with guaranteed increases during uncertain times. You get the increases now and throughout, avoiding delays, disruptions, and the emotional toll of traditional negotiations, plus the risk of strikes.
Strike FAQs
This is an important question members should ask their union representatives. The union has not specified how long it intends the strike to last, so it could continue indefinitely.
When nurses leave the bedside to strike, it can disrupt patient care and jeopardize the wellbeing and safety of both patients and staff.
The nurses themselves, not the union, face the risks and consequences of a strike.
Yes. Hospitals have the right to hire replacement workers to ensure uninterrupted patient care.
No. Striking employees do not receive wages from the hospital during a strike.
No. NNU does not use member dues to financially support nurses on strike. In fact, during the four strikes called in the first half of 2025, striking members received $0 in financial assistance from the union.
If a strike lasts for an extended period, associates may have to pay the full cost of their medical benefits out of pocket.
In Washington, D.C., striking employees are not eligible for unemployment benefits.
Make sure you secure medical coverage during any strike, whether through COBRA or other options like your spouse’s employer or an individual policy. Whether you keep any scheduled appointments or procedures is up to you.
Other FAQs
There’s no way to predict the outcome of contract negotiations. Bargaining is a give-and-take process, and the hospital must consider many factors, including the current hiring market, any economic demands the union might make, the hospital’s financial condition, and costs the hospital could face if the union plans a strike.
The union contract authorizes NNU to appoint the bargaining team and gives that team the power to decide whether to accept a proposal and whether to put it to a vote. This is why it’s important for nurses to keep sharing their views with the union so they hear from all nurses, not just a few making decisions for everyone.
If you feel your rights, or the rights of your co-workers, have been violated, you can file a complaint against the union on the National Labor Relations Board’s website. You can also call the regional office of the NLRB for help filing the complaint. This is their contact information.
Regional Office 05 – Baltimore, MD
Edward A. Garmatz U.S. Courthouse
101 W. Lombard Street, Suite 700
BALTIMORE, MD 21201
United States
Tel: (410) 962-2822
Fax: (410) 962-2198
It is true that we have some right to make unilateral adjustments to pay under the contract. However, we cannot accomplish the goal of assuring that every nurse’s pay is competitive without implementing the full package we have proposed, and that requires the union’s agreement. For example, the pay increases for OR nurses, preceptor pay, and resource pay could not be achieved without negotiations with the union.
We believe everyone deserves competitive pay based on their skills and experience. Our pay structure aims to bring each nurse’s salary in line with the market, considering their individual expertise. Some nurses may receive a higher percentage increase than others, but the goal remains the same – for every nurse to be paid near or at the top of the market for their role. Additionally, to be fair and respectful to all nurses, we understand that offering competitive rates at every level helps us attract new nurses at those levels.
We can’t predict what your union will do, but we continue to believe they should listen to you and represent your interests. We encourage you to keep pressing them to act in your favor.