The Effect of Registered Nurses' Unions on Heart-Attack Mortality

Abstract

Although hospital work organization affects patient outcomes and in some states registered nurses (R.N.'s) are increasingly forming unions, the relationship between R.N. unions and patient outcomes has received little attention. This study examines the relationship between R.N. unionization and the mortality rate for acute myocardial infarction (AMI), or heart attack, in acute-care hospitals in California. After controlling for patient and hospital characteristics, the authors find that hospitals with unionized R.N.'s have 5.5% lower heartattack mortality than do non-union hospitals. This result remains substantively unchanged when the analysis accounts for possible selection bias-specifically, the possibility that unionized hospitals have certain important but unobservable characteristics, independent of unionization, that affect patient care. During a lengthy and acrimonious dispute with the KaiserPermanente healthcare corporation, the California Nurses Association (CNA), a labor union for registered nurses (R.N.'s), mounted a public relations campaign with the mes-sage that changes in the work of R.N.'s and other healthcare workers jeopardize patient safety and negatively influence patient outcomes (Sherer 1994). Kaiser Permanente, of course, denied the charges.

A Balancing Act: Work-Life Balance and Multiple Stakeholder Outcomes in Hospitals

“…2001). Decreasing turnover intentions, associated with the use of WLB practices, will therefore increase the ability to deliver high‐quality care (for additional support, also see Ash and Seago 2004; Avgar et al . 2011; Plomondon et al .…”

Do Strikes Kill? Evidence from New York State

“…These strikes may, however, contribute to long-run improvements in hospital productivity and quality driven by union-related workplace improvement initiatives. Such improvements have been implied by both Register (1988) and Ash and Seago (2004) who respectively document both a hospital union output effect and lower 1983-19861987-19901991-19941995-1998 All regressions are weighted by the number of daily admissions at each hospital. and control for day, week, year, region, region×year and hospital fixed effects.…”

Mortality Rates From COVID-19 Are Lower In Unionized Nursing Homes

“…Unions generally demand high staff-to-patient ratios, paid sick leave, and higher wage and benefit levels that reduce staff turnover. [12][13][14] They educate workers about their health and safety rights, work to en-sure that such rights are enforced, demand that employers mitigate known hazards, and give workers a collective voice that can improve communication with employers. [14][15][16][17] In the specific context of the COVID-19 pandemic in New York, labor unions advocated for access to PPE and new infection control policies.…”

“…[12][13][14] They educate workers about their health and safety rights, work to en-sure that such rights are enforced, demand that employers mitigate known hazards, and give workers a collective voice that can improve communication with employers. [14][15][16][17] In the specific context of the COVID-19 pandemic in New York, labor unions advocated for access to PPE and new infection control policies. 18 Health care worker unions have been shown to improve the occupational safety of health care workers and, in some cases, overall patient outcomes.…”