(a) This portion of the rule shall be applicable to acute care hospitals, as defined in paragraph (f) of this section: Except in extraordinary circumstances and in circumstances in which there are existing non-conforming units, the following shall be appropriate units, and the only appropriate units, for petitions filed pursuant to section 9(c)(1)(A)(i) or 9(c)(1)(B) of the National Labor Relations Act, as amended, except that, if sought by labor organizations, various combinations of units may also be appropriate:
(1) All registered nurses.
(2) All physicians.
(3) All professionals except for registered nurses and physicians.
(4) All technical employees.
(5) All skilled maintenance employees.
(6) All business office clerical employees.
(7) All guards.
(8) All nonprofessional employees except for technical employees, skilled maintenance employees, business office clerical employees, and guards.
Provided That a unit of five or fewer employees shall constitute an extraordinary circumstance.
(b) Where extraordinary circumstances exist, the Board shall determine appropriate units by adjudication.
(c) Where there are existing non-conforming units in acute care hospitals, and a petition for additional units is filed pursuant to sec. 9(c)(1)(A)(i) or 9(c)(1)(B), the Board shall find appropriate only units which comport, insofar as practicable, with the appropriate unit set forth in paragraph (a) of this section.
(d) The Board will approve consent agreements providing for elections in accordance with paragraph (a) of this section, but nothing shall preclude regional directors from approving stipulations not in accordance with paragraph (a), as long as the stipulations are otherwise acceptable.
(e) This rule will apply to all cases decided on or after May 22, 1989.
(f) For purposes of this rule, the term:
(1) Hospital is defined in the same manner as defined in the Medicare Act, which definition is incorporated herein (currently set forth in 42 U.S.C. 1395x(e), as revised 1988);
(2) Acute care hospital is defined as: either a short term care hospital in which the average length of patient stay is less than thirty days, or a short term care hospital in which over 50% of all patients are admitted to units where the average length of patient stay is less than thirty days. Average length of stay shall be determined by reference to the most recent twelve month period preceding receipt of a representation petition for which data is readily available. The term “acute care hospital” shall include those hospitals operating as acute care facilities even if those hospitals provide such services as, for example, long term care, outpatient care, psychiatric care, or rehabilitative care, but shall exclude facilities that are primarily nursing homes, primarily psychiatric hospitals, or primarily rehabilitation hospitals. Where, after issuance of a subpoena, an employer does not produce records sufficient for the Board to determine the facts, the Board may presume the employer is an acute care hospital.
(3) Psychiatric hospital is defined in the same manner as defined in the Medicare Act, which definition is incorporated herein (currently set forth in 42 U.S.C. 1395x(f)).
(4) The term rehabilitation hospital includes and is limited to all hospitals accredited as such by either Joint Committee on Accreditation of Healthcare Organizations or by Commission for Accreditation of Rehabilitation Facilities.
(5) A non-conforming unit is defined as a unit other than those described in paragraphs (a) (1) through (8) of this section or a combination among those eight units.
(g) Appropriate units in all other health care facilities: The Board will determine appropriate units in other health care facilities, as defined in section 2(14) of the National Labor Relations Act, as amended, by adjudication.
[54 FR 16347, Apr. 21, 1989]
Notes of Decisions
Am. Hosp. Ass'n v. Nat'l Labor Relations Bd., 499 U.S. 606 (1991).
· cites it 3× “See 29 CFR § 103.30 (1990). Petitioner, American Hospital Association, brought this action challenging the facial validity of the rule on three grounds: First, petitioner argues that § 9(b) of the National Labor Relations Act (NLRA or Act) requires the Board to make a separate…”
Nat'l Labor Relations Bd. v. The Long Island Coll. Hosp., 20 F.3d 76 (2d Cir. 1994).
· cites it 3× “However, rather than decide the Hospital’s ease under the 'disparity of interests test as the NLRB announced it would do with all pending cases, the NLRB continued to withhold decision.”
San Miguel Hosp. Corp. v. Nat'l Labor Relations Bd., 697 F.3d 1181 (D.C. Cir. 2012).
· cites it 2× “29 C.F.R. § 103.30 (a). Petitioner also claimed that the Board violated the Rule itself by combining professionals and non-professionals together in the absence of a showing of “extraordinary circumstances.”
Temple Univ. Hosp. v. NLRB, 39 F.4th 743 (D.C. Cir. 2022).
· cites it 4× “The Board has provided specific instruction concerning the appropriate composition of bargaining units in the health care setting since 1989, when it promulgated what has become known as the Health Care Rule.”
Salem Hosp. Corp. v. Nat'l Labor Relations Bd., 808 F.3d 59 (D.C. Cir. 2015).
“Under recent Board precedent, Salem also challenges the validity of the regulation — 29 C.F.R. § 103.30 (a) — pursuant to which the Union was certified.”
Presbyterian Univ. Hosp. v. Nat'l Labor Relations Bd., 88 F.3d 1300 (3rd Cir. 1996).
· cites it 12× “Following two notice and comment periods, the Board ultimately promulgated the Final Rule, 29 C.F.R. 103.30, defining eight appropriate bargaining units for acute care hospitals, see Majority Opinion, typescript at 7-8, and declaring that "[e]xcept in extraordinary circumstances…”
Airlines for Amer v. Dept of Trans, 127 F.4th 563 (5th Cir. 2025).
“29 C.F.R. § 103.30 (a). The NLRB promulgated the rule pursuant to § 6 of the National Labor Relations Act (“NLRA”), which allows the NLRB to make, pursuant to the APA, “rules and regulations as may be necessary to carry out the provisions” of the NLRA.”
Nat'l Recycling Coalition, Inc. v. Reilly, 884 F.2d 1431 (D.C. Cir. 1989).
“16336 (1989) (to be codified at 29 C.F.R. § 103.30 ) (subsequently adopted rule allowing up to eight bargaining units in acute care hospitals).”
St. Margaret Mem'l Hosp. v. Nat'l Labor Relations Bd., 991 F.2d 1146 (3rd Cir. 1993).
· cites it 3× “Margaret’s eighteen skilled maintenance employees, a unit the Board found appropriate under its Final Rule on Collective Bargaining Units in the Health Care Industry (“Rule”), 29 C.F.R. § 103.30 (1992). In deciding the un *1148 fair labor practice charges against St.”
— 29 C.F.R. § 103.30(a) — 1 case
Presbyterian Univ. Hosp. v. Nat'l Labor Relations Bd., 88 F.3d 1300 (3rd Cir. 1996).
“Following two notice and comment periods, the Board ultimately promulgated the Final Rule, 29 C.F.R. 103.30, defining eight appropriate bargaining units for acute care hospitals, see Majority Opinion, typescript at 7-8, and declaring that "[e]xcept in extraordinary circumstances…”
— 29 C.F.R. § 103.30(a)(1) — 1 case
— 29 C.F.R. § 103.30(a)(5) — 1 case
Presbyterian Univ. Hosp. v. Nat'l Labor Relations Bd., 88 F.3d 1300 (3rd Cir. 1996).
“Following two notice and comment periods, the Board ultimately promulgated the Final Rule, 29 C.F.R. 103.30, defining eight appropriate bargaining units for acute care hospitals, see Majority Opinion, typescript at 7-8, and declaring that "[e]xcept in extraordinary circumstances…”
— 29 C.F.R. § 103.30(f)(5) — 1 case
Presbyterian Univ. Hosp. v. Nat'l Labor Relations Bd., 88 F.3d 1300 (3rd Cir. 1996).
“Following two notice and comment periods, the Board ultimately promulgated the Final Rule, 29 C.F.R. 103.30, defining eight appropriate bargaining units for acute care hospitals, see Majority Opinion, typescript at 7-8, and declaring that "[e]xcept in extraordinary circumstances…”
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