Safe Staffing Buttons OK in Health Care Institutions

In the fall of 2003, the Sacred Heart Medical Center in Spokane began negotiating a new collective bargaining agreement with the Washington State Nurses Association (WSNA). Negotiations did not go smoothly and continued for several months past the then-current agreement's expiration.

Nurses began to wear a number of union buttons. The buttons read: "Together Everyone Achieves More";  "Staffing Crisis – Nursing Shortage – Medical Errors – Real Solutions";  and "RNs Demand Safe Staffing."

In February 2004, Sacred Heart issued a memorandum banning the nurses from wearing the "RNs Demand Safe Staffing" buttons "in any areas on our campus where they may encounter patients or family members." The memo claimed the button "disparages Sacred Heart by giving the impression that we do not have safe staffing." Although no one had complained, the hospital said it banned the button "because patients and family members may fear that the Medical Center is not able to provide adequate care."

After several nurses were ordered to remove their buttons, the WSNA filed an unfair labor practice charge with the National Labor Relations Board (NLRB). Although the NLRB upheld the button ban, the Court overturned the NLRB's finding and ruled in favor of the nurses.

"Union members have a protected right to wear union insignia in the workplace," the Court said. "In the healthcare context, restrictions on the wearing of union insignia in 'immediate patient care' areas are presumptively valid; by contrast, restrictions on union insignia in other areas of a hospital are presumptively invalid."

Because Sacred Heart banned buttons outside immediate patient areas, it needed "special circumstances" to justify its rule. "Special circumstances exist where the restriction is necessary to avoid disruption of health-care operations or disturbance of patients," the Court explained.

"Sacred Heart claims that the button's message would disturb patients. That assertion is speculative at best," the Court wrote. "Moreover, Sacred Heart's speculative concern is contradicted by actual evidence in the record that there was never any disturbance involving the button."

"Nurses wore both the 'RNs Demand Safe Staffing' button and the 'Staffing Crisis – Medical Errors' button for months without incident," the Court observed. "There were no patient complaints. Indeed, there were not even any patient questions about the button's message."

"The speculation as to potential harm in this case is far outweighed by the record evidence establishing that there was no actual harm or likelihood of harm," the Court stated. "Evidence of what actually occurred is far more telling than unsubstantiated conjecture about what might occur."

The Court ruled Sacred Heart's button ban was an unfair labor practice and violated federal labor law. [WSNA v. NLRB (9th Cir. 2008).