After Historic Strike, Massachusetts Nurses Face Fight to Remove Union

Nurses at Worcester’s St. Vincent Hospital finished their 10-month stand in victory — but a decertification push backed by National Right to Work seeks to strip them of representation.

Registered Nurses and supporters stand in a picket line and wave to cars as they drive by outside St. Vincent Hospital in Worcester, Massachusetts on February 24, 2021. - 800 Nurses voted to go on strike starting March 8 after giving the hospital a ten day notice. During the pandemic the nurses have cited more than 500 reports of safety issues for both themselves and patients and had more than 100 co-workers leave.  Nurses are asking for increased staffing levels and a new contract. (Photo by Joseph Prezioso / AFP) (Photo by JOSEPH PREZIOSO/AFP via Getty Images)
Striking nurses and supporters stand in a picket line and wave to cars as they drive past St. Vincent Hospital in Worcester, Mass., on Feb. 24, 2021. Photo: Joseph Prezioso/AFP via Getty Images

Striking nurses at St. Vincent Hospital in Worcester, Massachusetts, ratified their new contract last month, winning added patient and staff protections after 301 days on the picket line. The four-year agreement, which represents roughly 700 nurses, promises pay increases, added workplace safety measures, and reduced staffing ratios, limiting the number of patients that can be assigned to a nurse at a given time. Out of almost 500 nurses who voted, only nine opposed the contract. The longest nurses’ strike in state history was over.

But while the union and management prepared to ratify, a new proposal appeared before the nurses: a decertification petition, which asked them to cast off the union that led them through the strike. Garnering 254 total signatures, the petition successfully triggered a vote, starting Friday, before the National Labor Relations Board. If the nurses vote in favor, the Massachusetts Nurses Association, or MNA, will no longer represent the union; the contract they fought so long to win will become null and void; and the nurses will face at least a year without any union protection at all.

“This seems bizarre to me,” said Steve Striffler, director of the Labor Resource Center at the University of Massachusetts, Boston. “Historically, of course, there are legitimate decertification attempts, you know, when workers are unhappy with their union and they want a different one and they go through this process. But this clearly isn’t.”

Over the course of the strike, the hospital hired “permanent replacement” nurses, scaled back services, and launched a public relations campaign to shame the striking nurses, leaning on the increased stakes brought by the Covid-19 pandemic. Now the dark-money anti-union National Right to Work Legal Defense Foundation is representing the replacement nurses leading the fight for decertification. Taken together, observers point to an obvious and deliberate goal: break the union.

“It really is just about draining resources and trying to undermine the union at a time when the union is clearly pretty strong,” said Striffler.

Nurses Strike In Worcester

Paul Stuart, a tech at St. Vincent, and Betty Ann Warner, a 40-year veteran registered nurse at the hospital, hold signs as the union nurses announce a strike in Worcester, Mass., on March 7, 2021.

Photo: Matthew J. Lee/The Boston Globe via Getty Images

Last March, St. Vincent nurses walked off the job after a year of laboring under crisis conditions and months of failed contract negotiations with Tenet Healthcare, the hospital’s for-profit owners. Tenet, a Fortune 500 company valued at around $5.5 billion, had offered a contract with better pay and benefits but refused to capitulate to the union’s demand for safe staffing ratios. The nurses’ association wanted it enshrined in the contract that nurses would never be assigned more than four patients at a given time, contending that their higher workloads put patients in dangerous situations and ran nurses ragged. Conditions were only made worse by the ongoing pandemic, which demanded higher ratios and turned the hospital into a more perilous workplace.

The hospital’s owner, meanwhile, was one of the many multinational companies that profited immensely over the course of the pandemic, reporting $414 million in profits in the final quarter of 2020 and $448 million in the third quarter of 2021. More than $1 billion in Covid relief subsidies from the federal government bolstered Tenet’s profits.

While nurses were agitated, shareholders were happy. Over the course of the pandemic, the company’s stock has risen: from a low of $11.89 per share in April 2020 to a high of $81.69 per share in December 2021.

But you wouldn’t know that from the company’s public statements. Management argued that a 4-to-1 ratio would be “inflexible” and claimed that the hospital’s staffing level met industry standards. In statements and press releases, hospital leaders decried the strike as irresponsible in a time of such great need for health care workers.

Over the course of the strike, as the company’s stock continued to climb, management at St. Vincent offered contract after contract without once budging on patient ratios. They installed security cameras along the picket line. And they accused the striking nurses of bullying their fill-in replacements and colleagues who crossed the picket line. Hospital leadership announced an anti-bullying campaign, which included T-shirts that read “Support Colleagues Above Bullying,” an attempt to reclaim the word “scab.”


In a press release distributed by St. Vincent Hospital, active working nurses wear shirts that read “Supporting Colleagues Above Bullying,” as “a positive variation of the word ‘scab.'”

Photo: Saint Vincent Hospital

The tension came to a bitter head in August, when the hospital publicly announced that it would be cutting back inpatient beds and services, blaming the nurses. “Their irresponsible decisions are now putting healthcare access for Central Massachusetts residents in jeopardy,” St. Vincent CEO Carolyn Jackson said in a statement.

Shortly after, the hospital announced that it would hire more than 100 “permanent replacement” nurses, and as the strike stretched from summer into fall, negotiations disintegrated around a return-to-work agreement. For several months, Jackson would not agree to allow striking nurses to return to their previous jobs if those jobs had been filled by permanent replacements.

“Literally, I’ve never heard of that before,” said Striffler. “They say, ‘Oh yeah, we’re going to agree to all the terms, but you’re not going to get your jobs back.’”

The eventual resolution, brought on by an all-day arbitration session with Labor Secretary Marty Walsh, held that all striking nurses would have jobs to return to but that all the permanent replacements would remain as well — including one crucial replacement nurse named Cederic Richard Avola.

On December 20, just three days after management and the MNA bargaining unit settled on the contract, Avola filed a petition with the National Labor Relations Board to decertify the union. He gathered 254 signatures from nurses at the hospital, passing the 30 percent threshold required to trigger a process that will culminate in the vote that starts Friday. A win for Avola’s campaign would remove the MNA, which represents nurses in 51 hospitals across Massachusetts, from St. Vincent, leaving its 700 nurses without a contract — or a union to bargain one.

Quoted in local outlets as C. Richard Avola, the replacement nurse told the press repeatedly that the MNA “did not have our patients’ or community’s interest in mind.”

In a December 22 article that ran in the Telegram & Gazette, Worcester’s daily newspaper, Avola said of the union: “They just did what they wanted and did not see the damage that they have done to our community over the past nine months.” In an October 12 story for the same outlet, titled “Nurses working at St. Vincent Hospital say they want to be ‘respected’ for their decision,” Avola and another replacement nurse “pushed back on reports the hospital was unsafe.”

“This hospital runs just as every other hospital in this country runs; sometimes there’s a 4-to-1 ratio (of patients to nurses), sometimes there’s not, and when there’s not it’s because we’re with patients,” Avola told the paper. “The issues are known; now it’s time to go back to work and let the management and administration work on those issues and move forward. … Please end the strike and come back. Please.”

Avola appeared with five other nurses “who crossed the picket line,” in the paper’s words, “to tell their side of the story.” Weeks later, when he introduced his decertification petition, Avola told the local outlet MassLive that he had gotten the “verbal support” of another union, the American Federation of State, County and Municipal Employees, to take the MNA’s place. But reached by MassLive, the second union denied Avola’s claim. In fact, AFSCME had sent a letter of support to the MNA just a few days before the report. While Avola told MassLive that the union backed out “at the eleventh hour,” AFSCME contends that it would never swoop in on a shop that already had representation.

Tenet Healthcare, meanwhile, is legally barred from supporting a union decertification effort, and its public statements show the company carefully toeing the line.

A spokesperson for St. Vincent told The Intercept that the hospital respects “the legal right of our nurses to choose whether or not they wish to be represented by a union.”

Reached by Facebook Messenger, Avola declined to comment on the decertification effort and instead offered his attorney, Glenn Taubman, of the National Right to Work Legal Defense Foundation. Taubman did not respond to The Intercept’s requests for comment.

“They’ve fought tooth and nail so that they do not have to have their funding disclosed.”

The National Right to Work Legal Defense Foundation, a branch of the National Right to Work Foundation, confirmed its involvement in a January 4 statement, saying it was the result of a legal notice issued to the nurses at the onset of the strike. The notice offered free legal aid to nurses “who encountered union pushback in the exercise of their individual rights.”

The National Right to Work Legal Defense Foundation is staffed by a dozen or so lawyers, many of whom are members of the Federalist Society. A 501(c)(3) nonprofit organization, it exists off donations, and since it’s a private charity, the donors are mostly anonymous.

“They’re incredibly well financed. They don’t have to disclose their funding, and they’ve fought tooth and nail so that they do not have to have their funding disclosed,” said John Logan, a labor relations professor at San Francisco State University specializing in the anti-labor industry. “They claim that they’re supported by a lot of individual employees, but, like, c’mon.”

Contribution data gathered by the American Bridge 21st Century database shows large donations from conservative and corporate interest groups: Since 2001, the Freedom Partners, a now-defunct Koch brothers project, donated $1 million. The John M. Olin Foundation, affiliated with munitions company Olin, donated $1.98 million. Other major funders include Alleghany Corp., Aimco, and Armstrong World Industries.

National Right to Work won what was arguably its biggest single victory with the Supreme Court’s 2018 decision in Janus v. AFSCME, a ruling that severely compromised the ability of unions to collect dues. Like with Avola and the MNA, Right to Work relied on one disgruntled anti-union employee, Mark Janus, to carry the case.

“They really seek out workers in labor disputes that will allow them to offer legal advice, to offer other help, that will have the end result of weakening the unions, either politically or financially,” said Logan.

Of late, Right to Work has taken a particular interest in the health care sector. Nurses at two Las Vegas hospitals voted to decertify their unions in 2017. In 2020, two Seattle nurses sued their union for making them pay full union dues, and they eventually won. Last year, technical workers at a Las Vegas hospital voted to oust their union. National Right to Work was involved in each case.

The health care industry is expanding rapidly, and so is union activity among hospital workers. Nurses have been especially successful in union organizing over the past several decades, Logan said — which makes them an obvious target for Right to Work.


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At St. Vincent, the decertification vote begins February 4, as agreed upon between the MNA, the hospital, and Right to Work vis-à-vis Avola. Ballots will be mailed to all nurses employed at St. Vincent, due back on February 25. On February 28, the NLRB will count the ballots.

Citing the overwhelming vote to ratify the contract, at 487 to 9, the MNA said in a statement that it was confident the union would defeat the measure, which it called an “unwelcome distraction” as nurses return to their jobs and “resume providing care to our patients and our community, supported by the vital protections and other benefits we secured through our hard fought strike.”

“[O]ur eyes are focused on the future, on returning to our home, to the hospital bedside to do what we love the most, which is to provide the high quality care our patients expect and deserve,” said Marlena Pellegrino, a St. Vincent nurse and member of the bargaining unit.

The MNA said it’s surprised that nurses would want to decertify the union, as they would lose the contract and all the protections that come with it, instead becoming “at-will” employees subject to firing for “any reason other than the limited protections of federal law.”

In a public Facebook group called “St. Vincent Nurses Unite!” Avola and other nurses involved in the decertification effort organize and share information.  One recent post from Avola quotes an email from St. Vincent management claiming that only 327 of 612 striking nurses have returned to work after wrapping up the recall process on January 22.

“This number includes multiple resignations since our last re-orientation session two days ago, so we believe the number of returning nurses will decrease further before it levels out,” read the email as reproduced by Avola. A hospital employee, who was not authorized to speak publicly, told The Intercept the email had been distributed widely and that Avola’s version was accurate.

Avola welcomed the email as “fantastic news.”

“If my math is correct, we are equal in numbers ( returning vs. replacement and those who crossed), thus giving us a fantastic opportunity to win the decertification,” he wrote in the post.

Indeed, 327 striking nurses is only around half the number of nurses who initially set out to strike, and Avola’s initial petition gathered some 250 signatures. The MNA, however, disputes the figure, putting it closer to 400 returning nurses, according to a statement sent to the Intercept.

The recall process, or the way in which the hospital reassimilates the striking nurses, followed strict timelines. In one recall letter shared with The Intercept, hospital management gave the nurse seven days to respond to the notice. Fail to respond and “you will no longer have the right to be recalled.”

For those who do respond, the letter assigns the nurse a mandatory reorientation session on five days’ notice. Miss the session and you won’t be put on the schedule, the letter says. Similarly, the hospital gives the same seven-day window to alert the hospital if the nurse can’t make the session.

Logan and Striffler observed that St. Vincent’s handling of the strike has been hostile to the point of union busting: reducing hospital services and blaming the union, hiring permanent replacement nurses, holding out on a return-to-work agreement, and muddying the recall process. And it was an expensive affair. The Boston Business Journal estimated that the strike cost the hospital upward of $40 million between staffing and police details — roughly $57,000 per nurse.

While the decertification effort is led, ostensibly, by nurses and not by management, it’s the latest in a pattern of stressors applied to the union. A successful vote to decertify would deal a tremendous blow to the MNA, but even an unsuccessful vote drains resources, time, and attention, said Striffler.

“I think it is part of a playbook generally to weaken and undermine unions,” he said. “Honestly, it should be illegal.”

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