DAILY MEMO: HEALTH CARE:

If a hospital is unionized, might care be better?

One study says yes, and suggests higher wages and pushes for nurse-to-patient ratios are key reasons

Fri, Oct 10, 2008 (2 a.m.)

When labor contract negotiations with hospitals progress slowly — much like the current stalemate at St. Rose Dominican Hospitals — nurses and their unions often launch public relations campaigns.

This classic union tactic is designed to try to tip the balance of power at the bargaining table. But union ploys aside (last month there was a candlelight vigil), the public might have a reason to pay attention to organized workforces in health care. New studies show that unions in hospitals make a difference in the quality of care.

One recent study found that hospitals with unionized registered nurses have 5.5 percent fewer deaths from heart attacks than nonunion hospitals. That mortality rate is a key statistic used to evaluate a hospital’s performance.

The study, conducted independently and without union funding, was by an economics and public policy professor at the University of Massachusetts, Amherst, and a community health professor at the University of California, San Francisco. Published in Cornell University’s “Industrial and Labor Relations Review,” the study looked at many variables that could affect quality, including how better wages might increase productivity. It concluded that the presence of unionized workers meant higher quality of care.

Health care is one of the few sectors showing signs of growth in union membership, but only about 12 percent of the industry is unionized, according to Ariel Avgar, an associate professor at the University of Illinois who studies labor issues in the health care industry.

Hospitals argue they don’t need union workforces because they have a built-in motivation for taking good care of patients: In this fiercely competitive industry, a hospital that does a poor job will lose customers to better hospitals. (In fast-growing Southern Nevada, a shortage of available beds weakens that argument.)

The reasons unions improve patient care are difficult to pinpoint, but the study found they involve more than wages. Altruistic or not, unions also are leading advocates in some areas of patient care, forcing debates that hospitals sometimes don’t want to enter.

The most prominent of those is nurse staffing levels. Nursing professional standards call for specific nurse-to-patient ratios, but health care experts say nurses are often overworked and assigned to too many patients.

As a result, care can suffer.

Unions have made the issue slightly more complicated in Nevada. Two unions are locked in a local turf war over nurses. Whether the Service Employees International Union or the California Nursing Association ends up the dominant union could influence whether state government decides to regulate staffing levels, as has been the national trend. The CNA is pushing for such legislation. The SEIU emphasizes high-level partnerships as opposed to regulation.

It is easy to be skeptical about a union’s motivation. For example, during previous major contract negotiations with Valley Health Systems hospitals, the SEIU marched under the banner of patient care and then settled for large raises but few gains for patients.

Still, with or without a union, nurses are front-line staff and in a good position to advocate for patients.

Many Las Vegas-area nurses have said they are burdened with work that isn’t traditionally their responsibility, such as changing linens, and that these tasks are eroding their ability to perform their nursing duties well. Addressing these kinds of working conditions is not only a union’s bailiwick but also promotes better quality of care for patients, Avgar said.

That’s not to say that unions are necessarily the right or only path. Nonunion hospitals could adopt the practices of union hospitals that improve patient care.

But for health care consumers, unions might be more relevant to patient care than they thought.

Discussion: 7 comments so far…

By vandermeyj

10/10/08 at 6:50 a.m.

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Can you point to any companies, that weren't unionized that became unionized and service improved?
By neiman1

10/10/08 at 9:07 a.m.

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The CNA nurses in Northern California struck 11 Hospitals at once. This wasn't a disagreement over wages, this was an attack on the lives of the people of California. When you destroy care at 11 hospitals at one time you need your professional license revoked and never be allowed around patients again. This was by workers who averaged over $47 dollars an hour.
By service

10/10/08 at 8:51 p.m.

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Of course the care is better in a hospital which has a union that keeps nurses and patients needs at the forefront. Advocating for patients is part of the nurse practice act in every state I have worked, but without a union it is difficult to be heard. Lets look at nurse to patient ratio would you rather have your nurse taking care of 10 or 6 patients. 10 or more was common in the Vegas Valley 4 years ago. I stressed a union that has nurses/patients first. A union that is 100% nurses is not only able to fight for the nurse, but nationally for any person that needs healthcare. CNA/NNOC not only sets the standards nationally on nurse to pt ratios but stands behind their RN's when due to "unexpected events" nurses are told they will need to take more patients, which not only places the individual patient but nurse in jeopardy. CNA/NNOC also is currently lobbying for HR 676, single payer healthcare, which would provide healthcare to every person in the US. You say you have healthcare- do you know how quickly you will meet you max or how easy it is for insurance companies to deny care that is experimental or not the "norm" for your diagnosis.
By NurseAdvocate1

10/12/08 at 10:48 a.m.

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It is apparently clear to America that our healthcare system is "broken." Who is going to lead this change? It will be the bedside nurses. We are the ones that witness the catastrophes that happen as a result of this mess. It makes since that a "unionized hospital" should be able to provide better, guality patient care. The union empowers the nurses to stand against the "administration" who's only concern is the bottom line, not quality patient care.
The nurses in Nevada have been represented by SEIU for quite sometime now. How has this enabled us to increase quality patient care? We have inferior contracts and patient ratios verbaige that requires management's approval. How often do you think that happens? There had not been a grievance filed at CHW in Las Vegas until the CNA/NNOC threatened SEIU's representation of the nurses. When did it become acceptable in these "unionized hospitals" to have patients in the hallways and conference rooms? These patients have no bathrooms, call lights or privacy. There are many nurses that are given 3 patients in ICU on a daily basis. There are makeshift ICU units without adequate staffing or equipment. SEIU's focus in on organizing new nurses without representing the nurses that they already have. SEIU has left the nurses and patients behind.
The charges that have been filed against the DON's of these facilities are a ploy tactic for the upcoming negotiations at UHS. These violations have been occurring for quite sometime. SEIU wants the nurses to believe that they are "really" doing something for them. How many nurses and patients have suffered since the last contract was ratified. TOO MANY.
This is why we have invited the CNA/NNOC to Las Vegas. It is time for a change. It is time to stand up and say that patients dying and suffering is unacceptable. It is time to say that hostile working environments for the nurses have to stop.
By ERRN

10/12/08 at 12:35 p.m.

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This article cites a well conducted study on unionized hospitals vs nonunionized hospitals. It's imperative that the people of every community understand the importance of Nurse to Patient ratios. Without these ratios the care that needs to be given will be suboptimal, not only for the patients but for the healthcare professional that has dedicated their lives to delivering. There currently is no law on a National level regulating nurse to patient ratios. California is fortunate to have had a law passed and implemented to secure the safety for all patients and their nurses delivering their care. One of the many agendas of CNA/NNOC is to educate the public and the legislatures of the importance of having this become a Federal Law. This is an example of how a union has taken the high road and not the easy road to support the very nurses that they represent. SEIU has been in the Las Vegas Valley representing nurses and bargaining contracts and have yet to secure the very much needed staffing ratios we all so deserve. The ratios that SEIU bargained for and put in our contracts did not secure accountability for our employers to follow. CNA/NNOC not only secured this for the California nurses but pushed for legislation and won. They have a proven track record of success and I know this Valley is in dire need of a radical change for our nurses and our community. Most people either don't understand or don't care to understand until it becomes personal. Ask yourself if your loved one has to be in the hospital do you want the nurse taking care of them spread so thin that they get suboptimal care or would you rather have their nurse readily available to deliver the very care that we took the oath to do ?
By rtrn

10/13/08 at 1:17 p.m.

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Nursing professional standards are consistently compromised in SEIU contracted hospitals due to the "high level partnerships" with management refered to in the above article. Nurses are regularly given over ratio assignments that are unsafe and inconsistent with quality patient care with no corrective action ever taken by SEIU. As a former steward, I personally forwarded numerous Occurence Report Forms to SEIU officials and NOT ONCE did I see action, let alone some sort of response from SEIU saying that it was being addressed. These reports are intended to initiate appropriate corrective action to ensure this situation does not happen again. CNA contracts factually contain ratio language giving the RN true leverage when dealing with assignments that are historically known to put our patients at higher risk for substandard care. This is not about money for nurses, it is about providing quality care for our friends and neighbors in one of the fastest growing communities in the country. The first time I was ever approached by an SEIU official was only after CNA was invited to local CHW hospitals. This invite occurred because other caring RNs sick of SEIU's lack of commitment to patient issues, invited CNA to inform CHW RNs about it's achievments elsewhere. SEIU then sent local and national reps to CHW in herds, pronto. It was a real wake up call for most RNs to see SEIU's true focus, retaining membership. CNA has a proven track record in getting real results for patients locally and nationally and resently demonstrated their effectiveness and patient advocacy in the contract completed in a Reno hospital also run by CHW. Ratios are part of the contract. "High level partnerships" need not apply. CHW is striving to be the first magnet status hospital in Nevada so it would only make sense for them to welcome a union voted by over 50% of their nursing employees to represent them. CNA represents well over 10,000 nurses employed by CHW in California and Nevada. Numbers like this help the effort in bringing patient/nurse ratios to the Nevada legislature as CNA advocates.