Neither Drudges nor Doctors: The Political Development of the US Nurse Workforce

• In Event: Labor Politics, Class, and Inequality

Abstract

As late as the 1960s, American nurses occupied a relatively marginalized position within the American health care system and political-economy more broadly. Pointing to the low wages and grueling working conditions, one academic study, for example, concluded that prospective nurses would be better off pursuing a career in stenography (Yett 1966). Yet on the eve of the COVID-19 pandemic, registered nurses (RNs) held significant levels of economic and political power–at least relative to the U.S. workforce more broadly. RNs were the second largest occupation within the health care industry, and the fifth largest in the United States (Department of Labor 2021). While still facing tough and at times life-threatening working conditions, they command average salaries well above the national average; are unionized at nearly twice the rate of the US workforce more broadly; and in recent decades, have gained significant power and autonomy on the job by liberalizing state-level “scope of practice” laws–despite the opposition of organized physicians, an incredibly powerful force in the health system (Starr 1982). At the state and national level, furthermore, nurses are highly influential in establishing standards of practice more broadly as well as setting the terms of entry into the nursing labor market.

As American workers have suffered significant setbacks in recent decades, including wage stagnation (Hacker and Pierson 2010), union decline (Galvin 2019), and greater vulnerability to “precarity” more broaldy (Thelen 2020; Hacker 2002), how have nurses secured relatively high levels of security and status? What are the limitations of nurses’ political and economic power? What can the answers to these questions tell us, theoretically, about race, class, and gender formation in post-industrial, service-oriented liberal market economies (LMEs) (Hall and Soskice 2001; Iversen and Wren 1998)?

To answer these questions, I deploy a mixed-methods approach. Qualitatively, I process trace how nurses, through labor unions and voluntary professional associations, have used state and national legislation to expand the size of their workforce, upgrade its educational requirements, and increase the purview of their job responsibilities. Quantitatively, I analyze data on union membership, salaries, and workplace rules to chart the growing political and economic influence of nurses. I conclude by considering how the COVID-19 pandemic has shed light on the limitations of the economic security and political power of nurses.

Author

• Trevor Brown, Cornell University