Physician strikes.

Throughout medical history, physicians have rarely formed unions and/or carried out strikes. In a profession faced with the turmoil of health reform and increasing pressure to change their practices and lifestyles, will physicians resort to unionization for collective bargaining, and will a strike weapon be used to fight back against the array of corporate and government powers involved in the transformation of the American health-care system? This article examines the question of whether there could be such a thing as an ethical physician strike. Although physicians have not historically used collective bargaining or the strike weapon, the rapidly changing practice environment in the United States might push physicians and other health-care professionals toward unionization. This article considers the ethical questions that would arise if physicians started taking advantage of labor laws, and it lays out criteria for an ethical strike.

Traditional and non-traditional collective bargaining: strategies to improve the patient care environment.

Acquiring organizational autonomy and control over nursing practice, through a combination of traditional and non-traditional collective bargaining (CB) strategies, is emerging as an important solution to the nursing shortage crisis. For the past 60 years, nurses have improved their economic and general welfare by organizing through traditional CB, particularly during periods of nursing shortages. During the past decade, however, the downsizing of nursing staffs, systems redesign, and oppressive management practices have created such poor nursing practice environments that improvement in wages no longer is viewed as the primary purpose of CB. Much more essential to nurses is assuring they have a safe practice environment free of mandatory overtime and other work issues, and a voice in the resource allocation decisions that affect their ability to achieve quality health outcomes for patients. The thesis presented in this article is that traditional and non-traditional CB strategies empower nurses to find such a voice and gain control over nursing practice. This article describes the current shortage; discusses how CB can be used to help nurses find a voice to effect change; reviews the American Nurses Association's (ANA's) history of collective action activities; explains differences between traditional and non-traditional CB strategies; and presents a case study in which both strategies were used to improve the present patient care environment.