Mission Health North Tower hospital in Asheville, NC, is owned by HCA.
Mission Health North Tower in Asheville. Colby Rabon / Carolina Public Press

In what the union hailed as a “landslide vote,” nurses at Mission Hospital in Asheville voted this week to approve a union — the first in North Carolina to do so and the largest hospital union win in the South since 1975.

National Nurses United, the labor group that now represents about 1,800 nurses at two addresses in Asheville, said in a statement Thursday morning it believes this is “the largest union election win in the South in a dozen years” for a union of any type.

“We’re all thrilled that we’ve finally won,” said Lesley Bruce, a registered nurse, who works in chest pain observation at Mission. In her statement, she added, “This victory means we can use our collective voice to advocate for patient safety and safer staffing.”

Nearly 1,400 people voted, and the ballots were counted from late Wednesday into early Thursday. Of those, more than 70%, or 965, voted in favor of a union.

A spokesman for the National Labor Relations Board said 100 ballots were challenged by one side or the other, but even if all of them voted against the union, the outcome would be the same.

HCA signals questioning results

In a statement sent midmorning Thursday, Mission Health/HCA Healthcare North Carolina Division spokeswoman Nancy Lindell said the company respects the nurses’ right to decide on a union but hinted the fight may not yet be over from its end.

“In the coming days, the hospital will thoroughly examine the election process and the manner in which the election was conducted,” Lindell said.

“The NLRB’s process allows both parties time to review the election and the conduct of the parties prior to the election; the hospital may utilize that process to ensure that all of our nurses had the fair election that they deserve.”

Bruce Nissen, a retired labor studies professor at Florida International University, said HCA’s language hints at months or even more than a year of “exploiting loopholes in labor law” to draw out the union organizing process as long as possible.

“They are talking about not accepting the results,” Nissen said of HCA’s statement.

But because of the large margin of victory, Nissen predicts that “further resistance by HCA is not going to be successful, and there probably will be a really strong union there because of the struggle the workers had to go through to establish a union.”

Once the dust settles, the nurses and HCA will hammer out a collective bargaining agreement, which outlines working conditions, pay and raises. NNU represents nurses at 19 other HCA hospitals across the country, the majority of which are in Florida.

The NNU vote count exceeded most others conducted recently by the NLRB, in which many efforts had only a handful or a few dozen votes involved.

Collective bargaining by public employees is banned in North Carolina, but Mission Hospital workers are not public employees. Workers in North Carolina don’t have to join a union and cannot be forced to pay union dues under the state’s “right to work” laws.

North Carolina has the second-lowest percentage of union-represented workers in the country, at 3.4%, according to Bureau of Labor Statistics data released last year. Only South Carolina has a lower percentage of its workforce unionized, at 2.7%.

According to its website, Mission Hospital is hiring dozens of nurses in a variety of fields. HCA bought nonprofit Mission and its suite of North Carolina hospitals and clinics for $1.5 billion in early 2019. It was then that many nurses started talking about forming a union.

Last fall the hospital raised its minimum wage to $12.50 per hour, with $15 for nursing support positions. Nurses may also qualify for tuition reimbursement of up to $5,250 per year. 

Contentious process

Asheville nurses ramped up their talk of forming a union in March, with new parent company HCA Healthcare pushing back against allegations of poor working conditions.

Around the same time, N.C. Attorney General Josh Stein sent HCA a list of questions prompted by consumer concerns, including those regarding the quality of health care and staffing at the Western North Carolina hospitals.

HCA in turn sought to delay the union vote, citing the pressures from the new coronavirus. At the time, in mid-March, hospitals around the region were bracing for a predicted influx of patients suffering from COVID-19.

Initial hearings with the NLRB were delayed again, in part due to the effects the coronavirus had on public life. Nurses were eventually able to cast ballots in mid-August.

Nurses have accused HCA of forcing them to attend anti-union briefings on the clock during the ongoing pandemic. HCA called the sessions “an important investment” to provide factual information and inform nurses of their legal rights under the National Labor Relations Act.

The vote count was conducted over streaming video, with some NLRB staff physically handling the envelopes and ballots while lawyers for both sides watched remotely. Normally, such a tally would be done in person, but COVID-19 has changed even this.

Game changer?

Nissen, the retired labor professor, said the resounding union vote at Mission could be contagious. Unions in the South have faced headwinds because of the history of slavery and racism, he said.

“The South has always been the Achilles heel of the U.S. labor movement,” Nissen said.

“There’s been very few victories for unions in the South, and very, very few of them of this comparable size. It could have a major impact on the fate of organized labor and unions in the South.”

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Kate Martin is lead investigative reporter for Carolina Public Press. Email her at kmartin@carolinapublicpress.org.

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  1. It gladdens my heart that a NNU has a fighting chance to serve the nurses at HCA’s Mission Hospital. Years ago in my brief tenure at an HCA mental health facility I saw firsthand the “bottom line mentality” of this corporation and the resulting impacts on patient care and staff morale. In the early 90s HCA nickle-and-dimed its way toward higher profit margins, closing other mental health facilities and relocating many patients across two states to our then still-open facility, applying reduction-in-force strategies to avoid paying the deserved higher salaries of experienced employees with years of service to the corporation (particularly the “letting go” of an iconic medical records supervisor who had established an industry-renowned level of efficiency and quality in HCA’s records division and was instrumental in training medical records staff across HCA’s large network of hospitals–when she was suddenly gone the continued quality of those departments suffered corporation-wide.) I hope HCA relinquishes its continued attempts to thwart the unionization of nurses (and of other employees). This unionization will benefit the workers, the patients, and the State of North Carolina.

  2. I worked in a union environment most of my career. I have participated in several organizing drives so I know the courage it took for the nurses at Mission to cast their vote. Best of luck as you move forward with this process. This is your Union and one thing you should always remember “The strength of the union is its members.”

  3. Thank God for the nurses at mission.
    They will not only help they help themselves but they will save the patients (as they already do hundreds of times each day). ❤️

  4. I am proud of the nurses, and thrilled with the result. Congratulations to the National Nurses Union for waging such a successful campaign in the teeth of strong resistance by a deep-pocketed corporation. Any HCA challenge to this 70-30 outcome would be a monument to bad faith, and begging for a tough-as-nails negotiating approach by this newest NNU chapter.

  5. NC is both a “right-to-work” and “tort-reform” state. That generally translates into the right to be fired without any kind of recourse/due process, and the inability to find a lawyer willing to go up against one of these giant community-gobbling hospitals/monopolies when we/a loved one suffer malpractice (or retaliation for reporting malpractice). And how many of us (as doctors or nurses) have paid dues to organizations like the AMA and NC Medical Society and NC Nursing Association . . . only to be completely abandoned/have NO HELP when we face off against a multi-billion dollar healthcare conglomerate? Corporate ethics in healthcare is a contradiction in terms. It’s all/only about the money.

    With five medical schools in NC (Atrium/NCBH want a 6th), the MBA’s of medicine consider doctors “a dime a dozen” and nurses little more than chattel. The press (obliged to advertisers/major employers – i.e. hospitals) has long looked the other way. And in almost thirty years, neither the state legislature nor a long line of Governors has seen fit to do ANYTHING legislatively to protect clinicians from bad corporate behavior. Clinicians in NC are lambs to slaughter – even in the wake of a pandemic where so many of us flocked to social media to BEG for help.

    And it’s a surprise when clinicians finally decide we’ve HAD ENOUGH and invite the unions in? What’s truly embarrassing to me as a physician is that nurses had to lead the way. But don’t they always?

    Given decades of apathy and determined inaction to preserve the rights of doctors and nurses in the face of “the corporate beast”, I sincerely hope the union-bug spreads faster than COVID-19.

  6. Very thankful to hear this news, better conditions for both patients and nurses will be a positive result of this outstanding vote

  7. Hooray and bravissimo!

    I was born in Memorial Mission Hospital in 1953; I watched as the hospital merged with St. Joseph’s, and as Mission evolved into a political and industry elephant in the WNC region, and finally as the former CEO sold out a 100+year institution to the for-profit, corrupt HCA — a chain founded by the political Frist family and which, under CEO Rick Scott, now senator (and former governor) from Florida, had the pay the highest fine in American history– over $1 billion — for cheating Medicare and Medicaid.
    Seeing them get their comeuppance with a 70%-30% vote in favor of a union, despite their spending hundreds of thousands of dollars to quash the attempt, feels good indeed. However, knowing that they will continue to fight against their own nurses, the right to unionize, and the needs of their patients, solely to maintain the billions in profit they garner each quarter, disgusts me.
    What is even more fear-inducing is that if the Trump regime clings to power, the NLRB will be abolished and the union will never be allowed to be instated.