An interview with Diane Sosne, RN, MN, President Emeritus, SEIU Healthcare 1199NW
WCN sat down with nurse leader Diane Sosne. In 1983, Sosne was instrumental in starting (what is now) Washington’s largest union of nurses and healthcare workers, SEIU Healthcare 1199NW. Sosne spent 39 years as the union’s president, advocating for improvements to healthcare and patient care through the collective empowerment of frontline nurses and healthcare workers. After a phenomenal career of action-based leadership, she retired in 2022. We asked Sosne about her career journey in nursing, and here is what she had to say.
WCN: What inspired you to pursue a career in nursing?
Sosne: I came of age during an interesting time in this country. It was a time when there were still a lot of stereotypes about jobs that women could do. Teaching and nursing were seen as womanly professions. No one was encouraging us to pursue careers in technology or STEM. I applied to a reputable nursing program at Simmons College in Boston, MA. It was also during a time of social justice movements happening across the country. There was the Civil Rights movement and the Anti-Vietnam War movement. Boston was the center of the Our Bodies, Ourselves movement, a movement that started open conversations about sexuality in ways that had been taboo to talk about. These movements spoke to me. I saw nursing as a way to combine my interest in political and social justice action with affecting the healthcare delivery system, which needed work then and still does.
WCN: Can you briefly share your journey into nursing leadership (career progression)?
Sosne: During the summer of my junior year at college, I traveled to Tanzania. I was interested in Tanzania because, in 1970, the President of Tanzania had a vision for the country of major reform away from the White colonial rule of the time. I connected with an American Nurse Midwife there who was a nun running a clinic in the Usambara Mountains. I spent six weeks with her. After this experience, I thought about doing international healthcare.
But, after returning for my senior year, I took community and psychosocial nursing courses. For my psychosocial rotation, I had a great clinical placement at McLean Hospital, a unique private hospital with often long hospital stays for patients. My instructor during this clinical placement was very influential on me, and I went on to choose psychosocial nursing as my specialty.
My first job out of college was at a state psychiatric teaching hospital for Harvard interns and residents. It was a lot like the depiction of The One Who Flew Over the Cuckoo’s Nest. At the time, I was reading several writers who were exploring the topic of the myth of mental illness, particularly as it related to women’s issues. They were asking questions about particular stereotypes and how they pigeonholed women with psychiatric or mental health issues. I felt these stereotypes held male and societal biases and there was more of an explanation that was not being discussed at the time. For example, the cause of women having depression. I studied this topic while in this job, and the learning environment was very rich. I loved it.
My next job was at a satellite clinic for another state-run hospital. In this job, I did a lot of family therapy beyond the individual and couple’s therapy. I was reading a lot about family dynamics and how intergenerational relationships can affect the psyche and behaviors. That was another area that expanded on what I was taught in school about mental health. So, I was always pushing boundaries, not content with the status quo. Back then, the psychiatric community was very traditional, and I was a disrupter.
I decided to get a master’s degree and visited the University of Washington in Seattle. It was a match made in heaven. I had an interview with the Director of the Psychosocial Nursing Department, Dr. Oliver Osborne. Dr. Osborne was an African American man in nursing and one in a leadership position in 1975. That was rare. I was inspired by him. So, I moved to Seattle to attend the program and worked per diem at Harborview while attending graduate school. One of my instructors there was Lois Price Spratlen. I felt the faculty came from many different perspectives. It was exactly what I was looking for.
My thesis was on androgyny, a type of gender identity that mixes masculinity and femininity. I hypothesized that people with androgyne identities were psychologically healthier than people who were stereotypically female or stereotypically male in their traits. Through my research, I was able to show that people who were not pigeonholed into exhibiting one trait or the other were in ways better adjusted.
Some of the other work I did as a psych nurse included consulting for a nursing home and setting up a psychosocial program at a time when many state-run psychiatric hospitals were deinstitutionalizing patients. These patients ended up in the community without any good programs or placement options. We still have this problem today. But back then a lot of patients ended up in long-term care facilities or nursing homes because they couldn’t care for themselves.
In 1991, I worked for Group Health as a therapist in their outpatient mental health department. During all this, I continued my political and social justice activism. Eventually, I saw an opportunity to work with a group of like-minded people in the community to think about starting one union for both nurses and healthcare workers. I decided then that was the next right step for me. My passion for collective voicing and decision-making took me in that direction. As an individual, you can be assertive and speak up, but you have more authority when you do it as a group. And that took me in the direction of building the union.
So, in 1983, working with coworkers at Group Health, we formed the first West Coast Local 1199NW. We weren’t SEIU back then. We were the National Union of Hospital and Healthcare Employees, part of a national healthcare union nurses and other healthcare workers assembled.
When we started, we had 1,200 nurse members at Group Health, and I became the first president. When I retired in 2022, we had over 33 thousand members. We also expanded from Washington State, adding a unit of nurses in Montana and Alaska because we represented nurses from Air Lift NW based out of the UW. In Washington, we represent the whole spectrum of the care delivery team, including doctors, nurses, physical therapists, pharmacists, technicians, and service and maintenance workers.
In the foundational bylaws of the union, our focus has always been on quality care and economic and racial justice. That is the north star. Part of delivering quality care is having your voice and observations considered to support effective problem-solving. All these people are at the bedside and with the patient. Everyone together impacts the patient experience.
WCN: What positions and experiences prepared you best for nursing leadership?
Sosne: It was a combination of things. It was getting comfortable in the role of challenging the status quo. It was having a variety of nursing experiences. My psych training also played an enormous role in thinking about individual and group dynamics. I also have to say that I had some amazing mentors, which is also why I am a strong advocate for mentorship. And finally, a belief in community, workplace empowerment, and the importance of racial equity for patients and staff.
WCN: How would you describe your leadership approach?
Sosne: It is a combination of things. It’s having the confidence to try things out and a belief that there is not one way to accomplish things. I am also someone who likes to be with people who have a variety of other experiences and skills. You can’t know it all. We all have blind spots. I also think of myself as a change agent and value working alongside others who want to make change. That approach has helped our organization achieve great things.
I am also willing to listen and learn from others. Every time I talk to nurses and other healthcare workers, whether informally, at the bargaining table, or lobbying, I learn something valuable. I combine my leadership approach with listening to people and then taking their experiences and stories and weaving them into a bigger narrative.
I also like teaching as a part of leading by helping people build skills so they can explain what’s going on. Part of it is helping people feel more confident and good about speaking out by reinforcing their strengths.
WCN: From your perspective, what attributes are important to be an effective nursing leader?
Sosne: To be an effective leader and an effective change agent, you must have integrity. You must be honest with people about what something means and what the pros and cons of taking action are. When you are working with employers, legislators, policymakers, and other advocates, you absolutely must have integrity. You must mean what you say and say what you mean. You can’t bluff it. At the end of the day, all you have is relationships, and you want these relationships to be genuine and respectful. That is important.
Resiliency is also important. Look at COVID. Nurses and healthcare workers were taking care of patients who were so sick, and for a while, there was no vaccine. There was a lot of risk in that. So, I think there is risk-taking involved. But you want to be strategic about it. You want your data and your analysis on the various paths to take.
My approach throughout my nursing career has also been to think organizationally. As individuals, you can achieve a certain number of things, and we have examples of nurses doing that for centuries. But the power of being organized and having people of all racial and economic groups working together to amplify their voices is important. Just because something has always been done a certain way doesn’t mean that’s the right way to continue to do it. I like to think of nursing as continuing to make major contributions to improving our healthcare system and the quality of patient care. Nurses should run for office and become policymakers. I have a saying… nothing is impossible. Nurses are in such close contact with patients and their communities and are in an excellent position to look at how we can improve access to healthcare.
WCN: What do you enjoy most about the profession of nursing?
Sosne: There are so many areas of nursing to pursue that it’s a lifetime of potential jobs and opportunities. You don’t have to be a med-surg nurse, you can work in any setting, inpatient, outpatient, or home care. You can use your knowledge base to go into data collection and analysis. You can be an elected official. Our original union treasurer was Eileen Cody, who was a staff nurse at Group Health at the time. There was an opening for a state legislator in West Seattle where Eileen lived, and through our work together, we encouraged her to run for that seat. She did, and she won! She ended up serving for 30 years and becoming the most powerful legislator on healthcare issues and healthcare policy in the state by becoming the head of the House Healthcare Committee, where she had great accomplishments.
There are an infinite number of things you can do as a nurse in the field. But continuing to work on policy and how to fix our broken healthcare system is critical. When we started the union, I believed, and still believe, that healthcare is a human right. It is not a commodity. People with money should not have access to better healthcare than people who don’t have money. People of color need equal access and care. Nurses have a holistic view. That view is what is needed as we look at improving healthcare systems and eliminating racism in these very systems whether you are a caregiver or a patient.
WCN: America’s healthcare systems are marred by structural racism and bureaucracies that contribute to health inequities. How do you see nursing contributing to action-based solutions to improve access to quality healthcare for everyone?
Sosne: We have been doing an inward look at our profession over the last several years. We have been looking at how we function in the healthcare delivery system, including how patients are treated who don’t look like us. And this includes a look at who is admitted into the profession of nursing. We know that over the past century and beyond, nurses of color did not have the same opportunities or access to educational programs or positions as their white counterparts. We have done studies on nursing curriculums and how they reinforce biases and institutional racism. And I am encouraged to see changes we so desperately need start to happen. Nursing needs to be the North Star in eliminating racism and bias institutionally in our practice, in our educational system, and in our governing. And we have seen changes. The Department of Health now requires, and it is the law now, that before license renewal, nurses must take a class on health equity and health disparities every four years.
As part of my work in the union, we started a labor-management training fund. We just celebrated 15 years. One of the things that has been so successful about this training fund is its management support. We bargained for contributions with employers and have millions of dollars of annual contributions. We also get legislative dollars, foundation money, grants, and Federal Department of Labor money to help people move up the career ladder. And for a high percentage of our members, let’s say in the service sector, the majority of whom are people of color, having an established labor management-governed organization that can address the needs of patients through the opportunity to move healthcare workers into positions of decision-making, like becoming a nurse, is phenomenal. That has been one of my biggest accomplishments that I’m proud of, outside of establishing the union. It will help change how healthcare is delivered because it will empower the people with the experiences and wisdom to create the new, more equitable systems we need. When you are a patient in the hospital, and you are sick or chronically ill, you are very vulnerable. I believe having people who understand you, look like you, and can talk to you in your language is part of the healing process.
I also want to say that the opportunity to serve as a board member of the Washington Center for Nursing was a real privilege. I was there from the beginning. The strength of the WCN is in its governance structure. It is outlined in the bylaws that the WCN board of directors (BOD) has nurses from different aspects of the profession represented. It is a place for these representatives to get together and advocate from different positions. But there is also a team dynamic that is healthy and helpful. The BOD can take problems as a diverse group and look for common solutions. And again, like the union, we can have a larger impact than any individual or organization can have on its own.
I’m proud of how, after the death of George Floyd, we as a center came together, like many organizations at that time, to say we wanted to be an anti-racist organization. I’m proud of the statement we came up with as an organization and the committees that have been working to operationalize this value in all the work WCN does.
Recently, I attended the celebration of the Manning Price Spratlen Center for Anti-racism & Equity in Nursing at the University of Washington. There were students and nursing leaders there. The families of Frankie Manning and Lois Price Spratlen were also there. So almost fifty years after meeting Lois Price Spratlen in 1975, I met her children and told them that I knew their mother back when. At the event, they reported that there is now a permanent structure at the UW for the Center. The Center is an excellent place to look at these issues of racism in healthcare and the broader educational system. There is this continuity, this networking, this bond, that we have in our profession that is very special.
WCN: What advice do you have for future nursing leaders?
Sosne: Be curious. Don’t go with the status quo just because it is the status quo. Take risks. Try new things. Have a sound educational and experiential background. Use data to substantiate problem-solving approaches. Work in multiracial groups to enhance your impact. And listen to a lot of voices.
