LABOR - Unionized nurses flex their muscle - Caregivers direct their newfound clout at the political process as well as working conditions.

From intensive care wards to the halls of Congress, they're exerting growing influence over hospital practices and patient treatment. With the clout they've gained through unionization, they've raised their incomes and their profession's profile.

Now they're lobbying for a radical change to the country's healthcare system, starting in California.

On Monday, hundreds of members of the California Nurses Assn. marched on the Capitol in Sacramento and pledged to continue to campaign for universal healthcare coverage.

Gov. Arnold Schwarzenegger said he would call a special session of the Legislature to write a law to significantly expand coverage in the state -- though not by nearly enough to satisfy the nurses union.

For Rose Ann DeMoro, the union's executive director, the goal is to end what she called the "pay-or-die system" once and for all.

"We are a very, very strong and, some say, militant organization," said DeMoro, an AFL-CIO vice president. "And, honestly, in this environment it takes a militant organization. It's very hard for a registered nurse to go home at the end of a shift and feel good about the care she's able to give."

Emboldened by the nation's huge need for their skills, bulked up through unionization, and energized by their last dust-up with Schwarzenegger, organized nurses have become a bona fide political force.

"They have a very strong hand," said Darry Sragow, a Los Angeles lawyer and political strategist.

That's due in part to organized labor's big gains among nurses in recent years. In strongholds like California, Florence Nightingale is almost as likely to carry a union card, and a picket sign, as she is to wear clogs.

For Irene Gamboa, an operating-room nurse at USC/University Hospital in Los Angeles, the decision to join the California Nurses Assn. last year was about having a say in how the hospital operates.

Last month, the union won raises of about 25% over four years for Gamboa and 6,500 other nurses who worked for Tenet Healthcare hospitals. The new contract also sets minimum staffing levels and seeks to ensure that a nurse's judgment is not usurped by new medical technology.

"It's not only about the money," Gamboa said. "It's about quality patient care, which is very important to nurses."