The end of 2023 was a monumental time for the nurses of University Medical Center (UMC). Fed up with issues of short-staffing and scant supplies, UMC nurses began organizing to form a union with National Nurses United, the largest nurses’ union in the country. They filed with the National Labor Relations Board (NLRB) to hold an official union election on October 12, and held their election over a weekend in early December. At that point, LCMC, which runs UMC, had become one of only two hospital administrators in New Orleans, creating a so-called “duopoly” between LCMC and Ochsner. Despite needing hundreds of votes to win their union, and working against a strong anti-union campaign from management, UMC’s nurses voted overwhelmingly in favor of their union, by a margin of over 80%. The win represents a sizable gain for union representation in Louisiana, where union membership hovers at about 4.3%, or a little less than half the national average. Unionized workers earn, on average, about 14% more than non-union workers, with some research suggesting the boost to wages is even greater for workers of color. I spoke with Heidi Tujague and Ifeoma Eweni, two UMC nurses who were vocal supporters of the union drive. Both native Louisianans, Eweni has worked at UMC since getting her license, while Tujague cut her teeth in Lafayette’s old Charity Hospital, starting 17 years ago when Louisiana still had a public hospital system. In a long-ranging chat over Zoom, we discussed what motivated them to join the union, and what excites them about the road ahead.
What are some issues that you and other nurses have been experiencing with UMC up to this point? What are the common grievances?
Heidi Tujague: One of our big grievances going into forming a union was the lack of transparency from management with changes to policy. Things like our paid time off, that was cut from a maximum of 300 hours to a maximum of 200 hours, and that was done without any input from the staff. They [just] said, “That’s a new policy.”
Ifeoma Eweni: For me, I would say being able to provide just the basic needs that we need on our units, like fully functional equipment. Some things that should be fully stocked, we don’t always have, so we have to stop what we’re doing and search throughout other units. That kind of slows down patient care, [it] can be hazardous.
HT: Yeah, the lack of supplies has been huge throughout the hospital, with always the excuse that “it’s been backordered.” But once we filed with the NLRB—supplies were copious.
Can you talk about the safe staffing issue? How has that affected you personally?
IE: I’ve been at the same department going on six years, I’ve seen the point where we were fully staffed with new-grad nurses, full-time nurses, to now, [where] we’re majority contract, travel nurses. And a lot of the complaints we’ve gotten from nurses who are leaving, they feel like their license is on the line. And that’s because maybe they have a difficult team where they have a lot of high-acuity patients [patients whose condition is severe] and they may not have a lot of staff to kind of disperse those patients around. And we have the resources. There’s thousands of nurses in Louisiana who are licensed, who are not working. And it’s because UMC will not provide things that they could provide.
HT: I’ve seen that high turnover rate throughout the other departments, where I walk into the ICU and I don’t recognize any of the faces. I know that with longer terms of employment, you get more experienced people who know the hospital better, and overall are able to deliver better patient care.
Can you talk about how management responded to the union drive?
HT: I can tell you that our management had a very heavy union busting campaign starting from the Saturday after we filed. They hired these high-priced alleged “educators” to come out. I could never get too [many] details about what firms—some of them were attorneys. And they all were independent contractors, is what management told us. They stayed with us from the weekend after we filed with the NLRB up until the last day of the election, on our units, interrupting patient care.
Photo courtesy NNU
What kind of things were they doing?
IE: A lot of union busting techniques, trying to convince us to vote no, to kind of just say anything like, “We hear you. We will make the changes that you need.” But these are things that we’ve been voicing with the administration for years. They were trying to make it seem like “we’re here to help you with whatever it is that you need.” So they did try to make their presence felt. Asking what needs we had, and trying to make those things happen. By then, we already made our decision that we wanted to go full-force with the union.
HT: They even brought in new administration, saying, “Hey, we’re here to listen, we’re here to make changes. We’re here for you! Here’s this nurse who used to work in this hospital. She’s here for you!” There was a new chief nursing officer, and new CEO brought in during the middle of the campaign. [They said] “We are just trying to bring back the spirit of the old hospital,” which was our predecessor, Big Charity. “We want to bring back the ‘spirit of Charity,’” which hadn’t been spoken about for years since LCMC took over. But all of a sudden they want to bring that spirit back.
This is the biggest NLRB election in Louisiana in decades. Could you talk about how people with the union were able to connect with such a large group? Some of them were in different wings, at different shifts, maybe never met or interacted at all. What were some of the ways you got around that?
HT: I would say this has really opened my eyes up to the rest of the hospital. I do go to almost every department because I’m a consult for the emergency department. And I didn’t know a whole lot of faces and names, but I started talking to people. And one thing after we filed with the National Labor Relations Board was we all had our lanyards, our badge pulleys, and so you can see who was wearing the pulleys, and start a conversation with them, and that helped open up that topic for people. But leading up to that it was just: “Hey, we’re all frustrated with everything. There’s so many changes happening.” And then there were people who would talk to one person in the hallway, and that person would talk to the next person. It’s New Orleans, we talk.
IE: A lot of times some of the units interact, maybe we may get a patient from a different unit transferred to our unit. And in general, us nurses, we would communicate with each other around the complaints that we have. Talk about, “Let’s go ahead and do something about it.” So when we did decide together to form a union, the word slowly but surely spread throughout the nurses and everybody kind of banded together to make that happen.
Photo by Katie Sikora
Was there any sort of divide among people who have been working in hospitals for decades? What was that like organizing across all these different levels of experience and nursing backgrounds?
HT: I know some of the nurses who were program coordinators, they were pulled out of the units pretty early after we filed, by the alleged educators, and brought down to administration. So they had a lot of people in their ear from the beginning. But maybe [having] 17 years of experience, and seeing the changes throughout the years, versus someone who’s fresh out of school and seeing the struggles that they’re already having—I think that helped that we all came together on the same passions about [what’s] better for our patients.
IE: I agree. And interestingly enough, we did have a number of new grads that were very supportive of it. Just off the bat. We had support from ancillary staff, respiratory therapists, we had doctors, a large amount of support. That definitely helped a lot.
You’ve both mentioned changes that have come down that have been maybe for the worse. Can you talk a little bit more about that?
HT: The sudden policy changes, the lack of clear communication from the administration. Like instead of a certain dollar amount to pick up a bonus shift, they’d just decrease that without telling us, just: “By the way, we’re cutting that.” One of the huge things was closing down units. And shifting people around due to staffing, where that just slows down the whole hospital when you [have] a whole unit closed, backs things up all the way down to the waiting room where people are having to wait extended periods in the ER, because the beds are full in the ER, because the beds are full in the hospital. When things could have changed a little bit, where people could have been hired. More units could have been opened. And that offer just wasn’t there. [Hospitals contain multiple “units” for each patient care specialty; for instance, there are multiple medical-surgery, or med-surg, units where patients are preparing for or recovering from surgery.]
Were either of you targeted or pulled aside by these anti-union consultants?
HT: I voluntarily went to one of their education sessions and asked quite a few questions and then I was left alone after that. [laughs] My coordinator attempted to have a conversation with me, and I told her I was very much in support of the union. And if she has any questions, I would love to help answer questions for her. But I’m not interested in hearing anything on the other side.
Photo by Katie Sikora
We’ve talked a little bit about how the hospital could hire more people, that there’s short staffing. This is a choice that the administration is making. Do you think you can talk a bit more about this practice and why you think the hospital is choosing to run this way?
HT: I wish I could be inside the mind of an administrator when they’re making these decisions. Because more nurses would improve the ability to care for more patients.
IE: Yeah, and it doesn’t make too much sense to me, because a lot of our units are staffed with travel nurses, and they are paid significantly more than the staff nurses.
HT: We’re not just a number. As far as administration goes, we’re FTEs, full time equivalencies. They allow so many per unit. And what you need to look at is not just that number of the full time equivalencies, but how much that one number can do for the hospital. We’re people, we want to be able to care for our patients.
Have you seen a lot of people burn out?
HT: I wouldn’t say burn out. What we’re experiencing is that moral dilemma, where we want to be there to do more for our patients, [and] we just can’t, we don’t have the time. I know some of the med-surg units, it’s a 6-to-1 ratio [of patients per nurse], that limits you to 10 minutes per hour, per patient. There’s a lot of times it takes more than 10 minutes to do what you need to do with that patient. And then someone else needs you at the same time, there’s just not enough support staff to help with everything that needs to happen.
IE: I think we need more nurses. Like even sometimes we feel like, “If we just have one more nurse…” It would just help us so much. We could spend more time with patients, do what we really want to do for the patients. Before the next shift comes along.
Can you talk about the need for strong patient care in New Orleans specifically?
HT: I know one of the big pushes now is preventative care, and trying to get education into the public about preventative medicine. Getting your blood pressure checked so that you can keep an eye on it and get medication for it, or watching your sugar, getting a little extra two steps in, a little extra cardio, get that heartbeat a little bit better. [With] higher rates of cardiac disease and, unfortunately, the high trauma rates we have here in New Orleans… I’m grateful that we have a hospital like UMC where the trauma surgeons are always there, and have done so much, and the burn unit that we have is now getting nationally recognized. The hospital has done some amazing things.
IE: We have nurses who can educate patients at the bedside. A lot of times they don’t have a primary care doctor to follow up on [them] so we’re their first point of care, just trying to get as much as you can with a short visit for the patient to help them.
Do you remember when you first became aware of the union drive, when you first started hearing those conversations?
HT: I got involved right before we filed with the National Labor Relations Board. And I got involved as we’re getting all the cards filled out [and] filed with the board. It was great to be there when the fire started moving.
IE: I would say I was there when the fire started moving as well, and we were able to file for elections October 12 with the National Labor Relations Board, and then from there just kept pushing forward. It was publicized to UMC and then it just kind of started growing.
HT: It was nice to see support from our ancillary departments, cheering us on and encouraging us to keep going, especially with such a heavy union busting campaign.
Were they also sending you emails, giving out fliers, things like that?
HT: Oh yeah. Emails coming in all over the place, text messages. There were fliers posted, one of the fliers even said, “We thought you were smarter than this.” It was very insulting.
IE: Very much so.
What are the things you were hoping to gain from negotiating collectively? What are you hoping to change?
HT: One thing definitely is transparency with policies. We would really also like to work on our benefit package. Nurses would appreciate things like bariatric care and infertility care which aren’t covered under our current benefits. And, of course, lower cost of insurance out-of-pocket or better coverage for insurance, so that we can take care of ourselves while we’re taking care of patients.
IE: Better staffed units, equipment, fully functional equipment—fully stocked supplies.
In terms of your compensation, do you feel like it has kept pace with rising costs of living?
HT: I would definitely say that our annual increases are not meeting the demands of cost of living. The skyrocketing price of houses, and even renting in New Orleans is extraordinary and with the even higher rates of student loan repayment with interest rates on those—the cost of everything. Goods and services, groceries, gas, everything has just gone up.
Is there anything else that you want people to understand about why you organized, and how you were able to pull it off?
HT: It was always drilled into us that this [union] would never be an option and just opening our minds, going, wait, there’s other unions of Louisiana. Why couldn’t we do a nursing union?
IE: A lot of people don’t know that we do have a legally protected right to form a union. So I think if that’s the basis of the campaign that kind of helps draw people in as well. From there, just kind of gaining support along the way, because a lot of times most people want it! It’s something that’s needed, to get our voices heard from management, to be able to get the things that we need.
HT: I have friends in other states reaching out to me, just so excited that we were able to do this. They were nurses here in Louisiana. They were working with me both in Lafayette and here in New Orleans and they’re actually talking about coming back now and rejoining the system because they know that they’ll have that voice and be able to do better for their patients.
Have you heard from other hospitals here, locally, that have taken an interest and maybe are starting union drives there?
IE: I don’t know but I hope they do! [laughs] We do hope it inspires other nurses as well. I know there was a traveler [nurse] based in a different state, and after she found out we won, she started gaining interest, like, “I wonder if I can bring this to my state, which is a Southern state as well.” So I think people are inspired. And it seems more tangible to them, now that we did it. The power lies in our hands. Of course the administration will try to stop it. But as long as the nurses keep pushing forward, they can get a victory.
Top photo: UMC nurses celebrate on the evening of December 9 after voting overwhelmingly in favor of joining National Nurses United. Photo courtesy NNU.