California Nurses Association/National Nurses Organizing Committee

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California Nurses Association/National Nurses Organizing Committee
California Nurses Association logo
Founded 1903
Members 80,000[1]
Affiliation AFL-CIO, Maine State Nurses Association
Key people Executive director, RoseAnn DeMoro;
Presidents: Deborah Burger, RN
Zenei Cortez, RN
Cokie Giles, RN
Malinda Markowitz, RN
Office location Oakland, California, U.S.
Country United States

The California Nurses Association/National Nurses Organizing Committee (CNA/NNOC), is a labor union and professional association of registered nurses in the United States. CNA/NNOC has a four-member Council of Presidents, currently including Deborah Burger, RN; Zenei Cortez, RN; DeAnn McEwen, RN; and Malinda Markowitz, RN. The executive director of the CNA/NNOC is long-time labor leader RoseAnn DeMoro.

Policies and activities[edit]

Patient safety[edit]

The California Nurses Association is well known for its long history of advocacy for direct care registered nurses and patient care protections.[citation needed]

Under DeMoro's leadership, CNA gained attention for its sponsorship of landmark legislative and regulatory reforms, including the nation's first mandated registered nurse-to-patient ratios in California which were sponsored by CNA. The ratio law, which requires hospitals to maintain a minimum number of nurses in all hospital units at all times to assure patient safety, was signed in 1999 by then-California Gov. Gray Davis. The ratios were implemented in 2004. When California Gov. Arnold Schwarzenegger sought to roll back key portions of the law in late 2004, at the request of the California hospital industry, CNA led a successful year-long campaign to challenge Schwarzegger and protect the law.

In April 2010, a study by the University of Pennsylvania School of Nursing, comparing the ratios in California to New Jersey and Pennsylvania, found that if New Jersey had the same ratios as California it would have 14 percent fewer deaths in surgical units, and Pennsylvania would have 11 percent fewer deaths (Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., ... Smith, H. L. (2010). Implications of the California nurse staffing mandate for other states. Health Services Research, 45(4), 904-921. doi: 10.1111/j.1475-6773.2010.01114.x).

CNA was also the principal sponsor of numerous other legislation promoting patient safety, including laws requiring whistle-blower protection for hospital employees who report unsafe conditions, barring discrimination based on medical conditions or genetic characteristics, safeguards on who can provide telephone medical advice, and expanded legal protections for patients harmed by HMO abuses.

Additionally, CNA won changes in state regulations to assure that every patient be assessed by a registered nurse and limiting unsafe assignment of RNs to work in hospital areas for which they do not have clinical expertise.

National health care reform[edit]

CNA/NNOC has drawn national attention for campaigns on behalf of patients denied medical treatment recommended by their physicians.[citation needed]

The CNA/NNOC is a primary national organizational advocate of the United States National Health Care Act (HR 676). The bill would establish a single-payer national public health care insurance plan, essentially an improved equal-treatment Medicare for all Americans.

On June 19, 2008, CNA/NNOC joined with other health care, labor, and community activists, and patients in sponsoring a day of protest against the insurance industry in 19 cities across the U.S. calling for enactment of HR 676.

Public profile[edit]

A California Field Poll in April 2008 found that CNA has the highest favorable rating among all groups, politicians, and institutions involved in public policy debates over health care reform in the state.[2]

On May 9, 2008, the Public Broadcasting Service television show with Bill Moyers featured a segment on CNA/NNOC describing a campaign conducted by the organization saying all Americans should be entitled to the same level of care available to Vice President Dick Cheney and members of Congress. The program may be viewed at or

The growing achievements of CNA and NNU received much national attention in 2010. A profile of CNA and DeMoro in Business Week, July 22, 2010, noted, "Under DeMoro, the union threw itself into the broader fight for patients' rights in the face of consolidation in hospital chains and insurers. The NNU simply takes that fight national, says DeMoro." The Washington Post, November 20, 2010 described "an aggressive strategy by a national nurses union, experts say: Its members are growing in numbers, and they have not been afraid to walk picket lines." The San Francisco Chronicle, in an article headlined, "Nurses union becomes potent political force," November 24, 2010, wrote, "The Oakland-based California Nurses Association has made its mark by delivering some powerful political punches with a combination of entertaining theater and savvy strategizing."


The California Nurses Association was formed in 1903 as the California State Nurses Association.

CNA was the first nurses union in the U.S. to win collective bargaining contracts for nurses when Shirley Carew Titus[3]advocated for agreements with the East Bay Hospital Conference for minimum salaries, time-and-a-half pay for overtime, shift differentials for night and weekend work, a 40-hour work week, paid holidays, vacations, and sick leave, and employer-paid health insurance.

In 1976, California established the first in the nation requirements for safe RN staffing by adopting a CNA-sponsored law requiring no more than two patients per RN in intensive care units.

In 1992-1993, CNA established a new model for nursing organizations and unions in response to corporate hospital industry changes that resulted in reduced patient care standards and growing replacement of RNs with unlicensed staff, and the domination of most nursing organizations by nursing executives. Responding to growing demands for forceful protections for nurses and patients by the 90 percent of CNA members who were provided direct patient care, the CNA administration fired 13 CNA staff, including then-collective bargaining director Rose Ann DeMoro, and suspended four top leaders of the elected union arm of CNA. In response, CNA nurses staged a staff nurse revolt, building broad support among California nurses, winning a legal challenge to re-instate the fired staff and suspended leaders, and electing the first staff nurse majority on the CNA board. In September, 1993, the new staff nurse majority took office, and hired DeMoro as CNA Executive Director.[citation needed]

In 1994, CNA began an aggressive challenge to hospital restructuring plans by opposing reductions in care standards, holding educational workshops for nurses across the state, and establishing a national "Patient Watch" program to assist patients harmed by unsafe hospital practices.

In 1995, CNA withdrew from the nurse executive dominated American Nurses Association, a pattern later followed by other state nurses associations.[citation needed]

From 1997-1998, CNA waged a major battle with HMO giant Kaiser Permanente over its efforts to force sweeping contract concessions on RNs with strikes by 7,500 RNs at 47 Kaiser hospitals and clinics in Northern and Central California, and a successful campaign to oppose Kaiser hospital closures in Oakland, Richmond, and Martinez.

In 1999, CNA culminated a long campaign by winning passage of a landmark law, the first in the nation, requiring minimum RN-to-patient staffing ratios in all hospital units.

From 2001-2003, CNA won numerous union elections, especially in large hospital chains run by Catholic Healthcare West and Tenet Healthcare.

In 2004, CNA founded the National Nurses Organizing Committee in response to the requests of direct care RNs across the nation for a stronger voice to improve RN and patient care standards. The CNA website [May 10, 2008] claims the group is the fastest-growing union in the United States, adding that 80,000 RNs are currently members of CNA/NNOC.

In April 2008, the CNA/NNOC clashed with SEIU over an agreement between SEIU and Catholic Healthcare Partners of Ohio. CNA/NNOC labeled the election a "sham." SEIU and Catholic Healthcare Partners cancelled the election for 8,000 workers in 9 Ohio hospitals on whether to have SEIU representation. NNOC contends that the agreement fits SEIU's pattern of forging controversial agreements with employers that sacrifice public protections and workplace standards in exchange for more members.[4] The conflict continued until March, 2009, when CNA/NNOC and SEIU announced that the unions would cooperate to organize hospital employees, with nurses joining the nurses union and other hospital staff joining the SEIU.[5]

National Nurses United established

On February 18, 2009, CNA/NNOC announced that it is joining with two other nurses unions, the Massachusetts Nurses Association and the United American Nurses, to create a 150,000-member union. The organization is called National Nurses United[6] and is affiliated with the AFL-CIO. Deborah Burger, co-president of CNA/NNOC said that the new group is intended to give registered nurses a national voice and more organizing strength.[7]

On December 7, 2009, CNA joined with the Massachusetts Nurses Association and United American Nurses to found National Nurses United, the largest union and professional association of registered nurses in U.S. history. In its founding convention in Phoenix, NNU delegates pledged to:

  • Advance the interests of direct care nurses and patients across the U.S.
  • Organize all direct care RNs "into a single organization capable of exercising influence over the healthcare industry, governments, and employers."
  • Promote effective collective bargaining representation to all NNU affiliates to promote the economic and professional interests of all direct care RNs.
  • Expand the voice of direct care RNs and patients in public policy, including the enactment of safe nurse to patient ratios and patient advocacy rights in Congress and every state.
  • Win "healthcare justice, accessible, quality healthcare for all, as a human right."

In its first year, NNU cited many accomplishments, including:

  • Organizing more than 8,000 RNs in Florida, Illinois, Iowa, Missouri, Nevada, Texas, and Washington, DC.
  • Playing a key role in election campaigns, especially in California where CNA members were influential in helping defeat billionaire Republican gubernatorial candidate Meg Whitman and Nevada where CNA and NNU helped defeat Sharron Angle and re-elect Senate Majority leader Harry Reid. The California campaign garnered national attention, especially with the street theater protests featuring a mock Queen Meg to critique Whitman's unprecedented spending and campaign style.

On January 3, 2013, the CNA joined forces with the National Union Of Healthcare Workers (NUHW) to form a new union, NUHW-CNA. Part of the motivation regarding the affiliation was the 2013 election for 43.000 Kaiser service and tech workers represented at the time by CNA rival, SEIU-UHW. Despite CNA support, SEIU-UHW won the election and the partnership between CNA and NUHW eventually ended.[8]

CNA supports he Inclusive Prosperity Act (H.R. 1144/S. 434 Ellison) otherwise known as the Robin Hood Tax, which would place a tax on the sale of stocks,bonds and derivatives, and the single payer bill HR676 (Conyers) which would set up a government-run, non-profit health insurance system covering all US residents. CNA was also the first labor union to endorse Senator Bernie Sanders' presidential run in 2016/17.

[9] Jan 24, 2017 ... Summary of H.R.676 - 115th Congress (2017-2018): Expanded & Improved Medicare For All Act.

See also[edit]


  1. ^ About Us Index Page
  2. ^ California Field Poll, Release #2267, Release date: Monday, April 28, 2008 By Mark DiCamillo and Mervin Field
  3. ^ "Titus, Shirley Carew (1892–1967)". 2007-01-01.
  4. ^ Labor's Growing Pains
  5. ^ Greenhouse, Steven (2009-03-19). "S.E.I.U. and Nurses Union End Bitter Rivalry". The New York Times. Retrieved 2009-03-19.
  6. ^ "It's Official: Three Unions Merge to Form Nurses 'Super Union'". 2009-12-08. Retrieved 2010-08-30.
  7. ^ Raine, George (2009-02-19). "Nurses unions to combine". The San Francisco Chronicle. Retrieved 2009-02-19.
  8. ^ Hananel, Sam. "Health Care Alliance Could threaten larger rival". SF Gate/AP. Retrieved 1-4-13. Check date values in: |accessdate= (help)
  9. ^

External links[edit]