Washington State Nurses Association

By Lauren Heitmann
(June 2002)

          The Washington State Nurses Association (WSNA) is a professional organization serving to protect and support nurses and the nursing profession.  It was founded almost a century ago as an alliance of individual nurses’ groups from all corners of Washington State.  The WSNA was created to support the standardization of nurses’ training, as that has been accomplished, today the WSNA acts to support nurses through legislative action.  The vision of the association is to be “the collective and leading voice, authority, and advocate for the nursing profession in the State of Washington.”[1]  Its membership consists exclusively of registered nurses; they maintain this focus to assure that the association provides the best possible representation for their members.  On the University of Washington campus, it represents some of the nurses at the University of Washington Medical Center; the WSNA is the only professional organization representing registered nurses at that location.[2]  This is primarily because, as the UWMC is state-owned and salaries and benefits are therefore non-negotiable, there is less room for a union to have impact.  The registered nurses’ needs are served sufficiently by a professional organization.

          The purpose of this paper is to attempt to describe the history of the organization that is the Washington State Nurses Association.  I will be addressing the history of the WSNA beginning with the incorporation of local groups and the development of a state organization.  Also, I will address briefly the creation of the American Nurses Association, the international organization that represents all the state nurses associations.  Next, I will describe the association at present: its structure, function, and basic working mechanisms. Finally, I will describe some of the goals of and issues facing this organization and its work today in promoting the profession of nursing. Included in this will be examining its manifestation here on the University of Washington campus.

The History of the Washington State Nurses Association

          The turn of the 20th century saw massive changes in Washington State.  The Gold Rush in Alaska, the arrival of the Great Northern Railroad, and the fishing and logging industries all attracted settlers to the area.  This swell in population increased communicable diseases, accidents and maternity cases.[3]  During this time, the population of nurses increased, but as their training was not regulated or centrally managed, it was hard to distinguish the poorly qualified nurses from those better prepared.[4]  To protect both the public and the well-qualified nurses from the less than adequate nurses, some central system of accrediting became necessary.  To create and administer these regulations, the organization of nurses was essential. 

          The American Nurses Association (ANA), the WSNA’s national affiliate, was created out of many of the same needs.  Across the nation one found nurses unqualified and unaccountable.  Isabel A. Hampton, the first president of what became the ANA, said in 1892, that “‘Trained Nurse’ meant anything, everything, or next to nothing.”[5]  To regulate nurses’ training, the American Society of Superintendents of Training Schools for Nurses of the United States was organized.  The name was changed to the National League of Nursing Education in 1912.  Out of this came the Nurses Associated Alumnae of the United States and Canada, an association of professional nurses, which was renamed the American Nurses Association in 1912.[6]

          Originally, the nurses of the East Coast schools organized by alma mater.  Many of these nurses traveled to Washington State to help with the organizing of nurses there, but it was difficult to separate the nurses by school, so they decided to associate by county.  To nurses across the nation, this was a new concept.[7]  On October 10, 1898, nine graduate nurses from the Spokane area formed the Spokane Graduate Nurses Association.  Other local groups sprouted in all corners of the state: Seattle in 1902, Tacoma in 1904, Whatcom County in 1906 and Walla Walla in 1907.

While these independent groups met annually beginning in 1906, they were isolated fiscally and geographically and could not be truly effective and supportive of each other. [8]  As their cause was the same, the promotion and support of nursing with the goal of fostering a healthy community, they decided to consolidate into one “compact” organization.  At the 1908 meeting, the “Articles of Incorporation of the Washington State Graduate Nurses Association” were accepted; they formally became an association, with a membership of 130.  Their goals in creating this association also included promoting friendship among the nurses, guarding the material interests of the nurse, enacting and enforcing just nursing laws, and shaping public opinion.[9]  As transportation was difficult and money was scarce, the association was divided into eastern and western divisions, not to be united until 1920­.[10]  At this time, the shortage of nurses prompted the association to begin its first formal membership drive.[11] 

Two leaders in this organization helped it get off to a strong start.  Etta B. Cummings was the first private duty nurse in America.  She came to Washington State in 1889 and helped create the Pierce County nurses’ association.  In 1905 she was elected the first treasurer of the WSGNA and held this position until retiring in 1921.[12]  At her death in 1922, she left her estate to the association.  In creating the Etta B. Cummings Memorial Fund, she decreed that its interest “be used for sick and worn out nurses in the state of Washington.”[13]  May S. Loomis was the association’s first president, and was vital to the successful passing of the Nurse Practice Act.  She was on the Board of Nurse Examiners for a number of years.[14] 

Very promptly the women created and lobbied the first Nurse Practice Act of Washington State. The goal of this act was and continues to be the improvement and regulation of the standards of nursing care.  The first bill, drafted in 1907, was presented to the state Legislature on January 18, 1908, but was voted down.  A new bill was drafted that year, and was scheduled to be read March 3, 1909.  It came up as the session neared lunch, and the legislators seemed to keep one eye on the clock.  “This time [the nurses] used more than smiles to influence the men,” wrote Evelyn Skooglun, who researched the history of the WSNA.  “As the thought of luncheon was uppermost on their minds, a box of candy was promptly produced by one of the lobbyists and circulated among the legislators.”[15]  The bill passed.[16] 

The creation of the first State Board of Nurse Examiners was another victory for the WSGNA.  It consisted of five nurses appointed by Governor Marion E. Hay in April of 1909.  These nurses discussed and began the process of certification.  At this time, nurses could register without being tested as long as they: were at least twenty years of age; had graduated from a two-year program at a “reputable, general hospital with a minimum of thirty beds;” and were of “good moral character and free from habits liable to interfere with [their] services as a nurse.”[17]  The president of this board, Mary Keating, was the first nurse to register in Washington State.[18]  The first examination was held for one nurse in September of 1909.[19]  At this time the Board undertook the examination and evaluation of nursing schools, with twenty schools being inspected in the spring of 1910.[20]

          The First World War saw both a nursing shortage and, in response to it, a nursing boom.  In the beginning, there were only 400 nurses in Army service and 160 in the Navy Corps.  But as nursing offered women a way to support their country and gain new skills, many women became nurses and went overseas.  By the end of the war, it is estimated that 24,000 nurses had served.[21]  At home, the Influenza epidemic of 1918 was met with a shortage of nurses.  Married nurses ineligible for the service worked alongside anyone able to lend a hand, regardless of their qualifications.  The situation was dire: working conditions were difficult, nurses themselves fell ill, and hospitals were severely crowded.[22]  Nevertheless, nursing fervor peaked during the first World War, which lead to an overabundance of nurses.  By the end of the 1920s, it was difficult for nurses to find employment.  An insurance program was instituted by WSGNA, the Nurses Protective Policy, which was “designed to protect the earning ability of nurses.”  Eight-hour days were also used to spread the work amongst a greater number of nurses.[23]

The Great Depression had numerous effects on the nursing profession.  The WSGNA undertook several fund-raising projects designed to aid their unemployed members.[24]  The Depression also caused state associations to become increasingly dependent on the national organization for support.  This lead to a greater camaraderie amongst nurses of the ANA, and all felt a greater appreciation for unity.[25]  Out of this newfound sense of unity, there was a push for nurses to join labor unions as the depression ended.  The president of the state nurses’ association at that time, Edna Mason, visited every district in the state to distribute pamphlets titled, “The A.N.A. and You.”[26]  This document explained the ANA and the benefits it gives its membership.  The WSGNA adopted the standing that “the affiliation of our members with trade unions or other similar organization is incompatible with the obligations of professional men and women, and hence detrimental to the care of the sick and the public health.”[27]  In 1940 the association changed its name from the Washington State Graduate Nurses Association to the Washington State Nurses Association.  This was done with emphasis that the organization would remain exclusive to registered nurses.[28]

          To protect the economic welfare of nurses, the ANA adopted an Economic Security Program at its annual convention September 23-27, 1946.[29]  It advocated increasing salaries, decreasing hours, and having the ANA assist more frequently the state nurses associations.[30] This resolution also recommended every state nurses association become the exclusive bargaining agent for their members in matters concerning economic security and collective bargaining. [31]   The WSNA House of Delegates adopted this program in 1948, and dues were raised to provide funds for it.[32]  It was the first step in representation for members.

The Structure of the Washington State Nurses Association

          The Washington State Nurses Association is managed by a Board of Directors, consisting today of eleven WSNA members.  There is a President, Vice-President, Secretary/Treasurer, three Directors-at-Large, two Staff Nurses, and three Cabinet/Council chairs.  The cabinets or council chairs include the Legislative and Health Policy council, the Professional Nursing and Health Care council, and the council on Economic and General Welfare. 

These board members are elected to two-year terms in democratic elections by the constituency of the association.  It is this group, the dues-paying members, who control the association and uphold its values.  Membership in the WSNA is defined by one’s status as a Registered Nurse, assuming one has paid one’s dues and has no outstanding restrictions.  In paying one’s dues, a member will receive the right to vote in association elections, a copy of The Washington Nurse (the official publication of the WSNA), and the ability to run for election in both WSNA and ANA elections.  Currently, there are over 12,000 members in the WSNA.  The association has recently organized two new facilities, which has added over 700 new members.  They continue to organize at their current facilities, to recruit new members.[33] 

Dues for the WSNA are formulated and collected on a county-by-county basis.  Each district, in observing a poll of the average pay scale of nurses at forty-seven Washington health care facilities represented by the WSNA, comes up with its own fee which is collected by the WSNA.  This fee consists of WSNA, ANA, and district operating expenses.  It can get relatively expensive and often inhibits non-members from joining.  The average monthly membership fee for nurses at the University of Washington Medical center is currently $46.[34]  This is dependent upon hours worked per week; part-time nurses pay less.     

Legislation is one of the primary means for the WSNA to enact change.  One of the oldest issues of legislative advocacy has been the Nurse Practice Act, which is the basis of all regulations of nursing in the state of Washington.  As the profession of nursing grew and changed over more than ninety years, the Nurse Practice Act has been amended by legislative action numerous times.  Originally, the act allowed nurses who had graduated before 1911 to register without being examined.  This exception was excluded by an amendment in 1922.  The appointment of a supervisor of nursing schools was added in 1933.  In 1949, Nurse Practice Acts for both professional and practical nurses were passed.  An amendment allowing registered nurses to pierce tissue was passed in 1955.  In 1961, the Nurse Practice Act was changed requiring that all registered nurses be licensed.  An improvement was made in 1963 wherein licensed practical nurses are, under certain circumstances, allowed to administer medications.  In 1973, the Act was again changed to redefine the profession of nursing and “provide for the expanding role of the nurse.”[35]   

          There are many ways in which the WSNA supports its members.  Their legislation in progress is called “Active Primary Support,” and currently includes seeking funding for data entry of the nurse workforce, as well as for scholarships, faculty salaries and the like.  Legislation the WSNA is pursuing in collaboration with other groups is called “Active Support,” and includes establishing bargaining rights and maintaining state health plans.  Issues of concern for the WSNA are called “Monitored Issues,” and currently consist of mental health, prescription drug, long-term care and insurance reform issues.  Issues the association feels may have a potential impact on the state of nursing are called “Review Issues,” and include assisted suicide, family planning and pain management.  Finally, issues relating to state agencies are those undergoing “Regulatory Monitoring,” and pertain to such issues as air quality, ergonomics, needle sticks and contraceptives.[36]  

          Through successful lobbying and advocacy, the WSNA has promoted the role of nurses in all realms.  In July of 1971, Governor Daniel Jackson Evans appointed the first nurse to the state Board of Health.  In July of 1974, the nurse member was appointed Chairperson of the Board.[37]  One important recent accomplishment of the WSNA has been lobbying for the Mandatory Overtime Bill, which protects nurses from excessive overtime and protects the patients from mistakes possibly caused by the fatigue of overworked nurses.[38]  In providing nurses with more comfortable and reasonable shifts, it may make the profession more attractive to potential nurses, thus potentially reducing the shortage of nurses.   

          The WSNA has the distinction of supporting the first nurse’s strike in the history of Washington State.  This strike, which pitted eighteen hundred Seattle nurses against fifteen Seattle hospitals, lasted sixty-eight days, ending on September 17, 1976.[39]  It was one of the nation’s longest strikes.[40]  It was in support of pay raises, staffing decisions and representation.  The WSNA wanted 13% wage increases the first year with 8% raises the next two years, while the Seattle Area Hospital Council (SAHC) wanted only 8% annual raises.  The WSNA also supported “nursing practice committees” which would influence the number of nurses needed for various wards and patients.  The issue of “agency shops” was also contested, which concerned the difference between joining the union or simply paying it for its work on one’s behalf.[41]  A three-year contract broke the strike, which consisted of an 8-12% pay raise the first year and 6% pay raises each of the following two years.  Seventy-four percent of the 2,200 affected nurses voted to ratify this contract.  It did not end happily, though, as over eighty of the striking nurses lost their jobs; the hospital council did not grant unconditional amnesty to all the striking nurses.  However, they did receive first priority for future openings.[42] Since then, the majority of actions taken by the WSNA have consisted of informational pickets.  The nurses have been aided in their success by positive press coverage and amicable relationships with the employers.[43]   

          In 1983, local SEIU 1199NW broke away from the WSNA.  It has been the primary competitor for the representation of nurses in the Northwest ever since.  During one battle for representation when contracts were up, the president of SEIU 1199NW, Diane Sosne, said, “the WSNA wears entirely too many hats to be an effective bargaining unit.”  In response to this, Steve Zuback, a labor specialist for the WSNA, responded that the WSNA meets the needs of its members: it is both a bargaining unit and a professional organization to support legislative action and provide educational opportunities.[44]

           The WSNA differs from the Local 1199NW (affiliated with the Service Employee’s International Union) in that it is strictly a professional organization, whereas SEIU 1199 NW is a union.  The line between ‘union’ and ‘professional organization’ is often blurred, and in the case of these two groups, it is difficult to distinguish.  Whereas the WSNA represents only registered nurses, 1199NW represents doctors, pharmacists, technicians, therapists and the maintenance staff of health care facilities.  As 1199NW represents around 9,800 members, only a percentage of its constituents are nurses, it must first look out for the overall well-being of its membership.[45]  Janet C. Parks, RN, a nursing representative for the WSNA, feels the relationship between the two unions is amicable.  “WSNA tries to collaborate with our sister unions as much as possible.  We all have strength in numbers and what one achieves the others benefit from as well.”[46]

Issues concerning the Washington State Nurses Association

The main issue affecting nursing and the WSNA has been and continues to be a shortage of nurses. The oversupply of nurses during the 1920s was tempered in the 1930s, when lack of funds limited the amount of nurses able to attend nursing school.  By the 1930s, nurses were again in short supply.[47]  Reasons for the nursing crisis include unsatisfactory economic status, frozen income, a climate of economic insecurity, and no control or power.[48]  In 1966, the average annual income of a staff nurse was $4,700.  At this time, secretaries and female factory workers received, on average, $5,325.[49]  Today’s average salary for a first-year nurse is approximately $35,000.  The current upper level of the salary scale is $60,000.[50]   The beginning salary and successive salary steps are not competitive with other professions, which makes the recruitment of nurses difficult.  Along these lines, as choices of occupation have increased for women, fewer of them are drawn to nursing.  With more choices, women who have profitable options will often take them.

Another issue concerning the effectiveness of the nurses’ professional organization is the low percentage of nurses represented by the group at any particular location.  In speaking with Ms. Parks, it seems the main reason why few nurses belong to the WSNA is because it misunderstood: the WSNA is, in fact, a professional organization, not to be confused with many stereotypes of unions in movies and the like.  Timing is also a factor: it is impossible to get all the nurses together at once, because some of them are always working.

          Finally, the profession of nursing, like other groups providing crucial service to the public, is often caught between expectations of selflessness and desire for personal security.  That nurses are seen as “wanting more” runs contrary to their jobs as public protectors.  As stated in an “Economic Fact Sheet” provided by the ANA in 1958, “in the past, nurses have often mistakenly believed that concern with their own economic welfare was incompatible with the high purpose of their work.  Today, they know that satisfactory working conditions are a prerequisite to quality nursing service.”[51]  The WSNA, as a professional organization, must “maintain a delicate balance between fulfilling its functions for the community and protecting its professional constituency from exploitation by the community.”[52]

          Nurses today are finding that their professional goals do not, in fact, run contrary to their positions as service employees; better working conditions often provide a better level of patient care.  Unity is being valued more and more as the Washington State Nurses Association continues to grow.  In the words of Ms. Parks, “I am a nurse.  And I want to have an equal voice in my workplace and how I do my job and what my benefits are.  I am hopeful that others will see the strength in numbers that collective bargaining represents and the gains that can be achieved when we all work together and stay united.”[53]

©2002 Lauren Heitmann