This July, Heather Torrence was in the middle of a 12-hour shift in the ER at Iowa Lutheran Hospital in Des Moines, where she’s worked for 14 years. An intoxicated teenage patient was brought in, and it was Torrence’s job to initiate the treatment process—drawing blood, taking vitals, and speaking to the patient and their family. But before Torrence entered the room, she noticed something that she thinks saved her life: The lights were out.
She proceeded with caution, opening the door to ask why the patient had turned off the lights. But before she could do anything, she saw a movement to her left and heard the patient scream: “I’ll kill you. I’ll fucking kill you. I’m going to kill you!”
The patient attacked Torrence, stabbing and scratching at her with a pen and a pair of bent stainless steel forceps. Torrence shouted for security and wrestled with the patient. The entire ER stood still.
“My first thought was, who’s going to go home and tell my child that I was attacked and stabbed by someone his age?” Torrence said. “And then it was, as much as I don’t want this to happen to me, I need to stop her and keep her from doing this to someone else.”
Security guards came running from a different part of the ER and pulled the patient off of Torrence. It was toward the end of her shift, but she couldn’t leave: The ER was incredibly busy, not a rare occurrence. “I felt guilted because the department was busy, and so I ended up staying for another four hours [after the attack],” Torrence said.
She left the hospital at 1 a.m. that night. When she removed her clothes—which were torn, even through multiple layers of fabric—she discovered yet another deep scratch that she hadn’t even noticed.
Nurses have always been at a high risk of workplace violence. Eight in ten nurses have experienced some form of workplace violence in the last year, according to a 2024 report by National Nurses United. Half of the nurses they surveyed said that instances of violence are only increasing.
But Torrence thinks different workplace policies could have prevented her attack, or at least made it less likely. The hospital needs more security guards so they can respond to emergencies faster, more nursing staff so patients get proper care, more support from management when a nurse is attacked, more breaks during the day (read: any breaks at all), and more patient care technicians to assist the nurses.
Along with her colleagues and allies, Torrence hopes that unionization will give them the power to bargain for these asks. She is among thousands of nurses who are organizing across four hospitals in the Des Moines area owned by UnityPoint Health, after experiencing years of unsafe staffing ratios, minimal security, and mistreatment from management.
The nurses will vote in a union election on October 5, but until then, they’ll have to continue fighting an unprecedented union-busting campaign UnityPoint is waging against them. Union watchdog LaborLab has estimated that the hospital system has spent somewhere between $3.7 million and $6.1 million on anti-union activity, at a time when the company has resisted spending more on staff or safety measures.
The tally includes hiring attorneys and consultants, as well as estimated internal costs, including worker time lost to attending anti-union meetings and conversations with consultants. LaborLab estimates that UnityPoint is spending between $20,600 and $34,000 every day on the anti-union campaign.
LaborLab analyzed over 350 hospital disclosure forms and was able to find a handful of comparable spending estimates from other hospitals in the past, but UnityPoint is on track to outspend all of them before the early-October union vote. That would make this campaign the single most expensive anti-union effort ever undertaken by a hospital.
UnityPoint declined to comment.
IF FORMED, THE UNION WOULD WORK with Teamsters Local 90 and represent about 2,000 nurses across Iowa Methodist Medical Center, Blank Children’s Hospital, Methodist West Hospital, and Iowa Lutheran Hospital. Though nurses had been informally discussing their workplace concerns for years, the organizing effort took off late last year.
Sammi Ladd, an intensive care unit (ICU) nurse at Iowa Methodist, was added to a Facebook group called “United Nurses of Iowa” last fall, and couldn’t contain her joy. “Oh my gosh, they’re doing it. Somebody’s doing it,” she remembers thinking. “And I’m getting goose bumps right now just talking about it because I was so excited.”
Ladd had been waiting years for a union. “I actually can remember, in my first job on the med-surg [medical-surgical] floor, being so overwhelmed as a new grad,” she said. With six or seven patients under her watch and no help available, she was underwater. “I looked at one of my co-workers, who had been a nurse with UnityPoint for probably a decade. I said: ‘We need a union, because this isn’t sustainable.’ And he told me to shut up and not to mention that again.”
So Ladd kept quiet, and continued to shoulder a heavy patient burden. Sometimes she returned home crying or, once, hid in the bathroom mid-shift to sob after a doctor berated her for missing something. She had been too overwhelmed with patients, and one order had slipped through the cracks. Eventually, the pressure became too much, and she left bedside nursing, like many other nurses have done to protect themselves from burnout or out of fear for their safety.
LaborLab estimates that UnityPoint is spending between $20,600 and $34,000 every day on the anti-union campaign.
After a three-year stint as a hospitalist nurse, Ladd felt the calling to return to bedside nursing, and started working in the ICU. There, she faced unsafe conditions—for both herself and her patients. There was the time when, 32 weeks pregnant, she had to dodge remotes and phones that a patient was hurling at her. Or the day that she had to manage a patient in airborne isolation, on continuous dialysis, a ventilator, and three different blood pressure medications, alongside caring for a second patient with cancer. Or just a few months ago, when a patient suddenly gripped her wrist and refused to let go, then kicked her in the chest.
“Our public safety does a good job when they are there,” she said. “It just does seem that sometimes it’s hard to get them there, and we’ve had issues with panic buttons not working.”
In addition to concerns about their personal safety, the nurses I spoke to consistently brought up patient safety as one of their main motivations for organizing a union. Ladd described having to juggle multiple critically ill patients, when each of them needed her full attention. “I’m completely unfortunately used to having to take care of those two critical care patients at the same time,” she said. “It’s become second nature, and it doesn’t feel like it should.”
Sometimes, caring for too many patients at once can lead to actual medical issues. But more often than not, what falls to the wayside are the “care” aspects of the job.
During the COVID-19 pandemic, Torrence was responsible for two critically ill patients, both of whom had the virus. One, a woman, refused ventilation and was transitioning to comfort care. The other, a younger man, was soon to be put on a ventilator. Torrence helped both of them have Zoom calls with their families, knowing that they might be their last conversations with their loved ones. After helping put the male patient on the ventilator, there was a knock on the door. Another nurse told Torrence that her female patient had died while she was caring for the male patient.
“I remember just feeling so unbelievably defeated and heartbroken because I wasn’t in the room with that patient at that time,” she said. “One of the other nurses that I was working with went in and held her hand and talked to her, so she wasn’t alone. But to not be the one to be there and care for them in that moment because your attention is being divided between two incredibly ill people is heartbreaking.”
Alex Wilken, an ICU nurse at Iowa Methodist, described how these nonmedical ways of caring for patients and their families are what has kept him in the nursing profession, and particularly in the ICU. “In the ICU, often the patient is not going to be conscious,” he explained. “So at that point you get to know the family really well, and it’s not just getting to know the family and the patient, it’s educating them. Like, ‘This is what the process looks like. This is what you can expect while you’re here. This is what your loved one might be experiencing.’”
It’s those conversations and relationships that make all the difference when caring for the critically ill. “That’s what brings me joy in this job,” he said.
But Wilken described simply not having the time to engage with patients and their families as he’d like to when he’s juggling too many patients. “That part of the job that I said brings me joy? I [don’t] have time to do that part. And by the way, it’s not just about me and my joy,” he added. Sometimes caring for multiple patients means that he doesn’t have time to do the easily overlooked but still important parts of the job, like brushing a patient’s teeth to make sure their mouth doesn’t get uncomfortably dry.
“Nobody believes that just because we unionize, that suddenly all these nurses are going to be hired, and we’re not going to have these staffing issues anymore,” Wilken said. But he knows that a union would offer nurses a number of ways to address those issues, like an official grievance process that could lead to UnityPoint being penalized for unsafe staffing assignments and thereafter hiring more staff. Nurses could file “assignment despite objection” forms, which give nurses some legal protection for any issues that arise due to unsafe staffing ratios. And staff could be retained through competitive pay and a safe work environment.
But instead of putting money toward metal detectors or pay raises or more staff, UnityPoint has gone in a different direction—spending millions of dollars to bust the nurses’ union.
THE NURSES I SPOKE TO ATTESTED to the scale of the union busting. Nicole Ledger, a maternity nurse at Methodist West, described anti-union consultants showing up at the end of unit meeting group calls, in their nursery and on the maternity unit.
“They’re showing up onto the unit just giving their spiel to whoever will listen, and then also hopping on at the end of a lot of these meetings,” Ledger said. “[They’re] forcing everybody to be on, forcing cameras to be on and saying it’s required for our job.”
These meetings might violate current federal labor law. In 2024, the National Labor Relations Board announced that requiring employees to attend meetings where anti-union views are shared violates the National Labor Relations Act. Employers are allowed to host such meetings if they give employees “reasonable advance notice” of “the subject of any such meeting,” a rule that the spontaneous consultant appearances don’t seem to follow.
All told, the Teamsters has filed at least seven unfair labor practice complaints against UnityPoint, alleging that the hospital system and its consultants are engaging in illegal surveillance, discipline, and threats (among many other complaints). The NLRB lacks a quorum right now, which means that these complaints can go unaddressed if the company challenges them.
Advocates at LaborLab are concerned that the anti-union consultants UnityPoint has hired aren’t disclosing their intentions, as required by law. In early September, LaborLab filed a complaint with the Office of Labor-Management Standards, arguing that six labor consultants have potentially violated the Labor-Management Reporting and Disclosure Act by failing to file necessary disclosures about their anti-union activity. When consultants don’t follow disclosure law, said Bob Funk, executive director of LaborLab, they’re “thumbing their noses at the law, at the Department of Labor and at the public.”
The Prospect reviewed an email sent from UnityPoint management to one nursing department describing the consultants, who in some cases are paid upwards of $400 per hour to host “education sessions” and one-on-one conversations with nurses. The education sessions, the email reads, “are not intended to sway your decision, but solely for educational purposes.”
The email also introduces some of the anti-union consultants, emphasizing their personal backgrounds to paint them as sympathetic characters. Consultant Mico Penn’s dad “was a part of Teamsters,” they say. James Misercola “worked as a union organizer and now enjoys educating employees to make informed decisions.” Rian Wathen “was a union organizer director for 15 years.” Carina Hunt “was a nurse” who “has worked union and non-union,” the email reads.
This congenial way of describing anti-union consultants is part of a larger trend in contemporary union busting, said Funk. “Union busting has changed,” he said. “They’re not coming in there just yelling about a union or slamming people’s heads together like the old days. It’s much more insidious.”
According to Funk, many anti-union consultants portray themselves as experts on labor law, at times even posing as NLRB officials. They often come across as kind, or even supportive of the cause. Wilken, the ICU nurse, described a one-on-one meeting he had with Carina Hunt, the former nurse and now president of C Hunt Management Consulting, Inc. He went into the meeting prepared for a fight, but got something very different instead. According to Wilken, Hunt presents herself as a helpful educator who is just there to explain the unionization process.
“Other nurses that don’t know what’s going on, I can see how they would be totally swayed by somebody coming in and presenting themselves the way that Carina presented herself,” he said.
MOST OF THE NURSES I SPOKE TO are cautiously optimistic about their odds for the October vote. But if the union effort isn’t successful, some nurses say it could be the final nail in the coffin for their careers with UnityPoint.
Ledger, the labor and delivery nurse, has been at UnityPoint for almost 11 years, the majority of her nursing career. But seeing how much the hospital is paying consultants instead of actually addressing nurses’ concerns “feels like a slap in the face,” she said.
She loves her work, and chose labor and delivery because of its patient population. “Just being in the baby world and being a part of those moments for people is where I knew I wanted to be,” she said. It’s like that joy that Wilken feels caring for patients and their families in the ICU.
“I hate the idea that I potentially will have to leave if things don’t get better,” Ledger said. “One of the most crushing things about how we’re being treated and how all of this is going is knowing that if it doesn’t improve, a lot of us don’t want to keep doing this.”
Until then, the nurses will keep organizing. Pro-union nurses have been mobilizing on social media, setting up tables to share information, and having conversations with younger nurses. Wilken described a long conversation where he spoke to an early-career nurse who was anti-union and frustrated by the intense rhetoric coming from her pro-union colleagues. They started by talking about nursing, just chatting about the job and its stresses, and then moved on to the topic of the union. By the end of the conversation, Wilken said, the young nurse had become pro-union.
“I have this connection to my co-workers that the union-busters will never have,” he said.
Photos courtesy International Brotherhood of Teamsters