Nurses at Mission Hospital in N.C. make history with first union contract

Bonnie Castillo
4 min readJul 3, 2021

In the anti-union South, RNs show winning and building a strong union is possible

Mission RNs hold an action for safe staffing in August, 2020.

Union nurses go to great lengths to bargain a strong contract because it governs the conditions in which our patients receive care. Will there be safe limits on how many patients are assigned to each nurse, allowing us to focus, deliver pain medication on time, and notice changes in our patients’ condition? Will RNs have enough personal protective equipment to keep ourselves and our patients safe? Will we be allowed a break to rest, or will we be completely fatigued and more prone to medical errors?

The mighty RNs at Mission Hospital in Asheville, N.C. have spent the past nine months advancing their demands for a safe workplace, with six of those months at the bargaining table, and we are extremely proud to announce that this week, they voted yes on their very first contract. It’s significant that they won their first contract in that time period — a fairly record pace. A Bloomberg Law analysis found the typical time to settle health care worker first contracts was 528 days.

Mission nurses were fierce, and they got the job done!

Their contract win comes on the heels of their historic vote to join National Nurses Organizing Committee/National Nurses United (NNOC/NNU) in September, 2020. And they did all of this successful organizing and bargaining in the second-least unionized state in the country, and under one of the wealthiest and most anti-union hospital corporations in the world, HCA.

“We are proud of this agreement. It is a testament to the unity of the Mission nurses, and to the phenomenal support we have received from our neighbors, elected leaders, clergy, and friends across the greater Asheville community,” said Mission RN Kelly Graham. “Our pledge to all of you is to ensure you receive the highest standard of care when you are sick, injured, and in need of therapeutic, healing hospital care.”

On a list of what Mission nurses needed for Nurses Week: “Our contract.” This week, they got it!

What the Mission nurses accomplished will have a long-lasting positive impact on their patients and their community, and it should inspire RNs in non-union workplaces across the country about what they too can achieve, especially with the backing of National Nurses United. Mission RNs proved that winning and building a strong union in the South is not only possible, but that it can be done swiftly.

Under the new three-year contract, Mission RNs will receive wage increases of up to 7 percent the first year and up to 17 percent total, based on years of experience, over the life of the agreement, that includes a grid guaranteeing regular increases. Safe staffing, and health and safety protocols were also a top priority, and substantial gains were made throughout the new contract, including:

  • A staffing committee with equal participation of union nurses and management to review hospital staffing levels, with approval by the committee for any changes in staffing patterns. A separate 12-member Professional Practice Committee to review patient care conditions and make recommendations for improvements at the hospital.
  • Guaranteed meal and rest breaks for RNs, and a ban on mandatory overtime, both critical to avoid the fatigue that can lead to medical errors.
  • Requirement that the hospital will provide proper personal protective equipment (PPE) for nurses that meets the strictest federal, state, and local guidelines, and guaranteed HIV and Covid-19 testing for nurses at no cost following an exposure.
  • A hospital behavioral response team with added security for workplace violence prevention, with additional violence prevention training for nurses.
  • Patient handling lift teams and training to reduce musculoskeletal and other injuries to nurses, a major cause of nurse injuries typically linked to ambulating heavier patients.
  • Limits on unsafe floating — the assignment of nurses to units for which they do not have the clinical expertise or training — and assurance the hospital cannot float nurses from an assignment that leaves short staffing in their home unit.

Among other important provisions, the contract provides:

  • A hospital committee to promote diversity, equity, and inclusion on race, gender, age, and sexual orientation in hospital recruitment, retention, promotion, and training.
  • Limits on the ability of the hospital administration to make cuts in health coverage for the nurses.
  • Just cause protections, including grievance procedures for discipline and hospital harassment.
  • Seniority protection for longterm nurses in layoffs, recall, filling of vacancies, and transfers.
  • Additional pay for nurses who work nights, evenings, weekends, overtime, when transporting patients, and when called in for needed additional shifts.
  • Paid time off to vote in elections.

Even when it seems like the odds are stacked against us, registered nurses always have morality on our side. We are the guardians of care, and when we stand in unbreakable solidarity, we can move mountains for our patients and communities. Congratulations to Mission nurses for doing just that with all the strong protections in your historic, new contract!



Bonnie Castillo

Union Nurse Leader & Medicare For All Activist. Executive Director of @NationalNurses, the Largest U.S. Organization of Registered Nurses. #TIME100