Abstract
This article explores various labor relations strategies and tactics used by hospitals in union elections. Union avoidance and union substitution were the two most widely used, with union avoidance being the best way to fight unions. Regardless of the strategy used, unions won a majority of the elections, most often using a neutral or accommodative strategy. Some widely used management tactics during an election included: hiring a labor lawyer, using a consultant known for breaking unions, and prohibiting distribution of union literature in non-working areas of hospitals.