Health care is among the few sectors of the national economy where unionization is actually increasing. One local sign: nurses at St. Louis University Hospital and Des Peres Hospital recently pulled off rare votes to organize workers at local health institutions.

Collective bargaining talks have begun, and may not be easy. Nurses want not only increased pay and benefits, but also improved staffing ratios they say will enhance the quality of patient care.

We expect the tenor of the discussions to be professional as nurses put forward their proposals for improvement to patient care, said Andrew Prediletto, principal negotiator for the nurses at SLU Hospital. We hope to reach agreement as soon as possible, but there is no set timetable.

The votes came against a backdrop of setbacks for unionization efforts at local hospitals in recent years. Nurses at Mercy Hospital St. Louis in Creve Coeur voted to decertify their union affiliation in 2007. Nurses at St. Louis Childrens Hospital voted down an attempt to unionize in 2003.

SLU Hospital nurses voted by a 3-to1 margin in early June to join the National Nurses Organizing Committee-Missouri, an affiliate of the 175,000 member National Nurses United, the nations largest union and professional association of registered nurses. Des Peres Hospital nurses voted by 2-to-1 margin three weeks later to unionize.

The bargaining agent will represent about 600 registered nurses at SLU and 250 nurses at Des Peres Hospital.

Nurses see this process as an opportunity to make improvements in staffing, said Prediletto, whose union is headquartered in suburban Washington. We anticipate discussing an improvement of wages benefits and working conditions Weve had meetings at both hospitals, and weve issued proposals.

Phillip Sowa, the chief executive of SLU Hospital, said in a written statement that additional days of bargaining are being scheduled for the coming months. We will continue to negotiate with them in good faith, he said, and we remain focused on our ultimate goal of providing high-quality health care to this community.

The hospital maintains that it offers competitive wages and benefits, and that its management promotes a positive work environment.

Walter Kopp, an independent hospital consultant based in San Anselmo, CA., said the nurses union likely will face tough talks.

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Hospital unions votes in St. Louis set stage for tense talks