Nurses respond to healthcare restructuring: the transformation of the Massachusetts Nurses Association.

The most recent period of Massachusetts healthcare system reorganization began in the early 1980s. In part, this has been a response to soaring healthcare costs, countering them with diminished reimbursements. To decrease labor costs and survive in an increasingly competitive and market-driven healthcare environment, hospitals downsized and laid off nursing staff. Patient care and safety has concomitantly suffered. These efforts severely challenged nurses' status. Radicalized rank and file members of the Massachusetts Nurses Association mobilized against the association leadership's weak efforts to protect nurses' social and economic interests and the deteriorating quality of care. They transformed an association whose main focus was supporting nursing's professional image to one which became an activist labor union of professional workers. The history of this often contentious transformation is presented here within the context of these healthcare system changes. The MNA's successes and pending challenges within the Massachusetts healthcare system are also discussed.