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Open Access Publications from the University of California

A Caring Class: Labor Conflict and the Moral Economy of Care in California Hospitals

  • Author(s): Gaston, Pablo Uriarte
  • Advisor(s): Voss, Kim
  • et al.

This dissertation examines the connections between the moral evaluation of caring labor and the patterns, practices, and potential effectiveness of hospital workers’ collective economic conflict in California hospitals over the latter 20th century. The study begins in the post-war years, where many found the notion of hospital workers joining unions and striking as a violation of their sacred duty to care. While hospitals and their workers self- sacrificially cared for the sick, hospital managers, professional associations, and policy- makers successfully painted unions as uncaring and instrumental. My goal is to explain how, by the late 1980s and early 1990s, unions came to adopt a common, powerful framework in which care workers and their organizations understood the exercise of coercive economic power in the workplace not as a violation of their calling to care, but rather as consistent with their moral obligations; one where care workers would strike because they cared, while capital was uncaring.

I argue that the cultural and moral meaning of caring labor for workers, managers and patients—the ‘moral economy of care’—acted as a powerful social force capable of both retarding and advancing unionization. At the heart of the ‘moral economy of care’ was the fundamental antinomy between a moral obligation to care and instrumental, economistic action. It was a cultural opposition that remained in place, often uneasily, even as healthcare delivery grew to be increasingly governed by market forces, and as unions and professional associations expanded their activities to increase material rewards for their members. This moral opposition helped people define the meaning of work, identify violations of norms, and define the appropriate forms and targets of economic contention.

The study relies primarily on archival data, which is supplemented with key informant interviews. The empirical narrative is divided into three parts, roughly corresponding to three periods in which the moral economy of care work reshaped the practices and organizational forms of healthcare workers’ unions. Part 1 examines how the leaders and members of the California State Nurses’ Association, a professional association of nurses affiliated with the American Nurses’ Association, worked to reconcile the moral injunctions against economic action with an increasingly restive rank and file in the years 1946-1974. Empirically, I focus on explaining the moralization of the strike—the process through which advocates of collective bargaining for nurses came to frame collective economic action against hospital employers not as an abandonment of their caring obligation, but as an enactment of that obligation, as a defense of the moral obligation to care against uncaring capital. Part 2 takes as its backdrop the passage of the 1974 healthcare amendments to the Taft Hartley Act, which ended the 25-year old exclusion of workers in non-profit hospitals from the protections of the National Labor Relations Act. Part 2 introduces a comparison case: the Service Employees International Union (SEIU), the other major union that would come to dominate healthcare organizing in California. Comparing how the two organizations responded to the 1974 opening of new organizing opportunities, I argue that the key distinctions between the two organizations were the cultural boundaries they drew between different categories of healthcare workers. Part 3 follows the same cases into the 1980s and early 1990s, a period in which hospitals shifted decisively toward corporate control. Part 3 argues that this industrial turbulence triggered political crises in the organizations, allowing insurgent groups to draw upon culturally salient frames built around the moral economy of care. In both cases, this new form of care worker unionism was a pragmatic reaction to employer strategies and vulnerabilities. But its form was informed by the moral economy of care, and the cultural opposition of workers’ moral obligation to care against uncaring capital.

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