On September 17, nurses at the Asheville, North Carolina–based Mission Hospital went union, with the final vote tally 965 to 411. The 1,800 nurses will be represented by National Nurses United (NNU).
Mission Hospital is owned by Tennessee-based HCA Healthcare, the country’s largest hospital corporation, and HCA Healthcare put up a serious fight to defeat unionization. As reported in the Intercept, HCA — which has 184 facilities in the United States and the United Kingdom — hired consultants from the Crossroads Group at $400 an hour to defeat the campaign. This union-busting took place even as staff were overwhelmed with COVID-19 patients, short on personal protective equipment (PPE), and staggering under the weight of HCA’s cuts in staff.
Mission’s nurses had filed for an election in March with 70 percent of the workforce signing union authorization cards, but HCA won delays from Trump’s National Labor Relations Board (NLRB), given the company more time to run its anti-union campaign. As the Intercept notes, HCA has already “received nearly $1.5 billion in coronavirus-related CARES Act grants.” As Jonathan Michels writes in Facing South, the Mission campaign was NNU’s largest labor campaign ever undertaken in North Carolina.
The successful campaign, waged in the midst of a pandemic against the leading hospital corporation, represents a huge victory not only for health care workers, but all workers. North Carolina is the second-least unionized state in the country, with only 2.2 percent of workers belonging to a union.
It’s no coincidence that HCA purchased a hospital in a state so bereft of unions. HCA is decidedly resistant to labor organizing, concentrating its facilities in right-to-work states. Given that North Carolina has been right-to-work since 1947, and outlawed public-sector bargaining in 1959, HCA executives saw it as a perfect addition to their portfolio. And they were right — except when they drastically underestimated the Mission nurses.
The South: A Low-Wage Haven for Industry
The South functions as a semi-periphery within the United States, a region where cheap labor and a lack of regulations lure unionized Northern industries to relocate in pursuit of higher profits. Even as manufacturing is on the decline, they still hold this position: in many regions, hospitals are the largest employers, filling the position factories once occupied. HCA is one such profiteer.
The US labor movement knows this is the South’s economic function, and the Mission victory vividly contrasts with the movement’s storied, tragic history of attempts to establish a beachhead in the region.
Operation Dixie is the most well-known of these efforts. The drive to organize the South, undertaken by the Congress of Industrial Organizations (CIO) in 1946, came at a time when the labor movement had been experiencing militancy and success. General strikes in San Francisco and Minneapolis in the 1930s were followed by FDR’s National Labor Relations Act. As World War II wound down, an unprecedented strike wave unfolded, with millions of workers in auto, steel, railroad, tobacco, and mining taking part. As a percentage of nonagricultural employment, union membership hit 35.4 percent in 1945.
In response to these victories, businesses in the North and Midwest began moving to the South, where racial division and an intensely anti-union economic establishment helped keep unions out of the region: bosses regularly played off the local racial hierarchy, using black workers to break strikes. Combined with the American Federation of Labor’s (AFL) traditional preference for organizing skilled rather than unskilled workers, which had left workers in the region’s key industries outside its purview, the South, home of reactionary rule, was welcoming to business.
The CIO, strong in the country’s ports and factories, hoped to change all this through industrial unionism, or wall-to-wall organizing of both skilled and unskilled workers, and prioritizing anti-racism. Then president of the CIO, Philip Murray, told the CIO executive board that he considered the Southern organizing campaign “the most important drive of its kind undertaken by any labor union in the history of this country.”
By February 1947, Operation Dixie had set up 324 new locals. CIO efforts to organize the unorganized ran through a range of industries such as woodworking, tobacco, and meatpacking, but with a focus on textiles. Almost every town in North Carolina had a textile mill, and Southern textile workers had struck in several states in 1929. When they struck again in 1934, it was the largest strike in US history, spreading across New England, the Mid-Atlantic, and the South. For these reasons, organizers saw textiles as the region’s strategic industry, like auto in the North.
Despite the ambitious vision, the CIO ultimately failed to overcome the obstacles to Southern unionism: anti-communism, violence against workers, and Jim Crow. By 1950, the federation, which had risen to prominence on the strength of the radicals leading its organizing, had expelled eleven unions for refusing to purge themselves of communists, bringing the era, and Operation Dixie, to an end.
A similar story took place in tobacco. In Winston-Salem, North Carolina, ten thousand tobacco workers, a majority of whom were black, used their union, Local 22 of the Food, Tobacco, Agricultural and Allied Workers of America-CIO (FTA), to challenge racial injustice along with economic and political oppression. For many black workers throughout the region, this “civil rights unionism” offered a path forward. Yet, as was the case with so many other CIO locals, the Communist-led union eventually collapsed under the weight of McCarthyism.
There are plenty of more examples of significant union drives in the South. Among them stands out the early twentieth-century struggle of wood processors, whose campaign to unite white and black labor organizations led to the Bogalusa sawmill killings, in which a white paramilitary group, backed by the owners of the Great Southern Lumber Company — the largest mill of its kind in the world at the time — killed four white labor organizers who were defending Sol Dacus, the head of the black union, along with two black workers. As Stephen Norwood writes of the massacre, “The gun battle in Bogalusa, when white union men took up arms and gave their lives to defend their Black comrade, represents probably the most dramatic display of interracial labor solidarity in the Deep South during the first half of the 20th century.”
There were nineteenth-century New Orleans longshoremen, the Depression-era Southern Tenant Farmers Union, the Appalachian coal miners, and, of course, the Memphis sanitation workers who Martin Luther King Jr joined in what would be his final days of his life.
And more recent examples exist, too. The International Association of Machinists (IAM) and United Auto Workers (UAW), following their industries to the South, have pursued organizing drives in the region. In 2017, IAM lost one such drive at a Boeing plant in South Carolina, while in 2019, UAW suffered defeat in a hard-fought campaign at a Volkswagen plant in Tennessee. On the flip side, there is the 2008 victory by the United Food and Commercial Workers (UFCW) at Smithfield Foods in North Carolina: there, the fight took fifteen years.
The labor movement is only as strong as its weakest members, and so long as the South remains a low-wage haven for industry, all workers in the United States will continue to suffer. Which is what makes the Mission nurses’ victory last week so significant. It was the largest union victory at a hospital in the South since 1975. May it serve to launch an offensive that is long overdue.