The U.S. Court of Appeals for the Fourth Circuit ruled in Palmetto v NLRB that registered nurses (RNs) and licensed practical nurses (LPNs) at a nursing home in South Carolina were not supervisors and could therefore lawfully unionize. The Fourth Circuit focused entirely on whether the nurses used independent judgment.

The NLRB found that “a judgment is not independent if it is dictated or controlled by detailed instructions, whether set forth in company policies or rules, the verbal instructions of a higher authority, or in the provisions of a collective bargaining agreement.” The Fourth Circuit held that the RNs and LPNs lacked such independent judgment. The court held that, at most, the evidence established that the nurses “exercise not independent, but heavily constrained, judgment.”

The RNs and LPNs assessed patients, administered medications, and performed general patient care duties. The CNAs assisted residents with activities of daily living, such as helping them bathe, repositioning them in bed, and aiding them in using the restroom. The nursing home’s handbook described the nurses as the CNAs’ “first line of authority,” and placed the RNs and LPNs above the CNAs on its organizational chart.

The court ultimately concluded, “In every case, the nurses’ responsibility seems to amount to the same thing: making sure the CNAs follow the written instructions. This suggests that the Nurses serve merely as conduits for these instructions.”


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