“An offer to return to work has been brokered with the governor, the speaker, the chair of the County Commission, the mayor …”

I didn’t even get to the details before everyone began screaming and clapping. I called for silence and insisted they let me explain the rest, because we needed to call the political leaders right away—they were holding the bosses hostage. Someone made a motion and it was all over. Then D Taylor whispered to me that he wanted to speak. I introduced him with a great deal of affection and acknowledged the crucial role he had been playing. The workers gave him a standing ovation.

“I have run a lot of strikes in Nevada over the past twenty years. A few of them went on for more than one year, one of them lasted seven years, and, never, ever did the governor of the state even call me, let alone broker a settlement. You are nurses, and I hope you understand now that when you choose to exercise it, you have a lot of power.”

The house came down.

The same holds true for quality of patient care. The best patient outcomes require a seamless health-care team, and the best way to get there is to have all the workers in one organization where they can sit side by side and bargain for new and better work systems as well as fair pay. Here is a concrete example that goes straight to the heart of the difference between the CNA approach and what we were doing in Nevada. In 2004, California became the only state in the nation to implement legally guaranteed minimum nurse-to-patient ratios.¶ That victory is one of the CNA’s main claims to fame. And they deserve plenty of credit—it took a huge political fight to win, which the CNA is capable of waging. And, it’s an incredibly important law. Years later, they successfully defended the ratios when Governor Arnold Schwarzenegger made a concerted attempt to roll the law back. In 2006, our local also won minimum nurse-to-patient ratios in our contract with the CHW hospitals in Las Vegas—it had been one of our top demands. But in our CHW contracts, we also won language prohibiting management, as they implemented our new nurse-to-patient ratios, from cutting non-nurse positions. This difference is crucial. Because the CNA was only fighting for the elite workers, the intent of the California law, when it took effect, was grossly undermined by hospital bosses, who gutted their ancillary staffs to pay for the additional nurses they were required to hire. Nurses in California now have many additional tasks that were formerly performed by aids, housekeepers, techs, phlebotomists, and others. In Nevada, when the CHW hospitals began to implement the new nurse-patient ratios stipulated in our contracts, they had to keep all existing positions on the ancillary staff.