California Nurses Association/National Nurses Organizing Committee

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

Under RoseAnn 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.[2] 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.

A subsequent study evaluated the effect on outcomes for nurses and patients by comparing outcomes in California in the subsequent two years with those of New Jersey and Pennsylvania — two similar states without such mandates.[2] There was substantial compliance with the mandate in California, with over 80% compliance rates reported across several different units of surveyed hospitals; equivalent levels of non-mandated compliance in the comparator states were considerably lower, at 19%, 52%, and 63% compliance in medical/surgical, pediatric, and intensive care units (ICUs) in New Jersey and 33%, 66%, and 71% in Pennsylvania.[2] After extensive adjustment for patient and hospital characteristics, the study revealed statistically significant relationships between the nurse-to-patient ratio and 30-day mortality and failure to rescue (FTR — that is, failure to prevent a clinically-important deterioration, such as death or permanent disability, from a complication of an underlying illness or of medical care) in all three states.[2] In particular, for every additional patient added to a nurse's workload, the odds of patient death increased by in 13% California, 10% in New Jersey, and by a factor of 6% in Pennsylvania after adjusting for these factors. Across all three states, facilities with nurse-to-patient ratios consistent with those mandated in California were associated with lower rates of nursing burnout, and nurses reported consistently better quality of care.[2]

CNA was also the principal sponsor of numerous other items of 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 health maintenance organization (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.

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

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.

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.[3]

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 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."

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[7] 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.[8]

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.[9]

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.[10][11][12]