Why unions are good for nursing and good for patients

[advocateforsafety]

The article below is long but a good reference to support why unions are best practice.

Nursing Journal Study Shows Nurses Unions Improve Patient Outcomes in Hospitals.

Patients Treated for Heart Attacks Have Lower Mortality Rate at RN-Unionized Hospitals

Patients with heart trouble would be wise to seek care at a hospital with a nurses union according to a recent study of the impact of nurses unions and the mortality rate for patients with acute myocardial infarction (AMI, the medical terminology for heart attack). The study, which was published in the March issue of JONA (Journal of Nursing Administration), studied hospitals in California and found that hospitals with a nurse’s union had a "significantly predicted lower risk-adjusted AMI mortality."

The study’s authors, Jean Ann Seago, PhD, RN and Michael Ash, PhD, concluded that "this study demonstrates that there is a positive relationship between patient outcomes and RN unions." Editor’s Note: for a fax copy of the study, contact the MNA at 781.249.0430

"Thirty-five percent of hospitals in California have RN unions. The significant finding in this study is that hospitals in California with RN unions have 5.7% lower mortality rates for AMI after accounting for patient age, gender, type of MI, chronic diseases and several organizational characteristics. This result includes controls for number of beds, AMI-related discharges, cardiac services, staff hours and wages.

In discussing how unions impact the quality of patient care, the authors stated, "unions may impact the quality of care by negotiating increased staffing levels…that improve patient outcomes. Alternatively, unions may affect the organization nursing staff or the way nursing care is delivered in a fashion that facilitates RN-MD communication. This is the ‘voice’ function of unions…Yet another possible mechanism by which unions can improve care is by raising wages, thereby decreasing turnover, which may improve patient care."

The authors conclude, "perhaps having an RN union promotes stability in staff, autonomy, collaboration with MDs and practice decisions that have been described as having a positive influence on the work environment and on the patient outcomes."

"We at the MNA couldn’t have said it better ourselves,’ said Karen Higgins, RN, MNA President. "In fact, we have been saying this for years - a patient’s greatest advocate is a unionized nurse, because a unionized nurse has the protected right and the power to stand up for their practice and their profession. The fact that this same message is being delivered through a research study published in a journal for nursing administrators is even more telling. These are the folks who often fight tooth and nail to prevent nurses from forming a union. Perhaps now they will see the value of having a union at their facility. We know the staff nurses here in Massachusetts have seen the value."...

[advocateforsafety]

Well if you want Weingarten rights, you have to belong to a union. Personally I find those rights to be silly in nature.

As For the study by Dr. Seago and Dr. Ash. Any study results are preordained by the way you set up your study criteria. You can take the same data and by how you choose to evaluate it. You change to outcome to be what you want it to be. So if this study is set up by prounionists, then they evaluate it the way the want to.

As far as rights , you have the right to live and the right to die, nothing else. Anything else is just a benefit you work out for yourself. So enjoy your benefits.

My personal experiences with Union shop hospitals. Is they promote an environment of mass mediocrity. And inhibit personal initiative.

What country are you living? I know that we have lost many of our individual rights under this administration but it is not the Russia that you describe. Our country is based upon the idea that decent is good for freedom and without the right to decent, freedom will not grow and will fail at the hands of those in power.

How many "union shop hospitals" have you worked? Also hospitals are seldom places that foster personal initiative. They are more often places that have mock commitees that get nothing done because they give no real authority to the staff level nurses and almost always fail to put any changes they do allow in to writing. They are hollow promises, only through contract can we be somewhat gauranteed that they will abide by their agreements. Those contract can only be had through unionization.

The article that started this stream was posted in a nurse managers journal. Nurse managers have hardly been a union advocate. There are many studies out their that have examined unions and their effect on outcomes and yes they are sponsered by unions but that is called a hypothesis when you set out to prove any concept. Scientific methodology directs the studies so that they can be accepted by the scientific community as having merit and like I said in prior post this study went through that same examination or it would not have been published, especially in a managerial magazine.

[Woodenpug, BSN]

It took me a little while to find the original article. I think there were sufficient "red flags" to consider this further investigation into the article a waste of time. Still, to keep myself honest, I went beyond the obvious problems.

The most glaring problem is that MNA uses as its sole reference an article which had been published 6 years prior to the MNA article. Reading the abstract shows that the article was not based upon research but instead on data mining.

The methodology of a study and not the title of the Journal determines bias. The Journal of Nursing Administration (JONA) is a peer reviewed journal. However, the article uses data from 1993 and 1994 and correlates it to union status in 1998 and 1999. The authors admit that "We also could not determine how long an organization had been unionized."(p148) Thus whether or not the hospitals were unionized at the time the data was collected is in question. Any correlation is therefor questionable.

The authors did not describe the models used sufficiently for another researcher to duplicate or validate their study. The authors did not describe how the regression and data analysis was preformed. Usually, I would expect to know who/what provided the statistical expertise, since neither author has credentials in that area. How do we know that a p value of <.01 is statistically significant with the data used>

Back to the more obvious problems, why was it not possible for the authors to compare mortality rates at union hospitals as compared to the general population of all AMI admitting hospitals in California? The mortality statistics were based on AMI mortality rates. Not on overall survivability to discharge for patients admitted with a diagnosis of AMI.

Some respondents to this thread state that many studies have been done. Please list those studies. My casual search has shown very little research into whether or not RN unions improve patient outcomes. I feel I've spent too much time following this red herring already. I would like to see some convincing evidence which correlates RN unions to positive patient outcomes.

[Iam46yearsold]

What country are you living? I know that we have lost many of our individual rights under this administration but it is not the Russia that you describe. Our country is based upon the idea that decent is good for freedom and without the right to decent, freedom will not grow and will fail at the hands of those in power.

How many "union shop hospitals" have you worked? Also hospitals are seldom places that foster personal initiative. They are more often places that have mock commitees that get nothing done because they give no real authority to the staff level nurses and almost always fail to put any changes they do allow in to writing. They are hollow promises, only through contract can we be somewhat gauranteed that they will abide by their agreements. Those contract can only be had through unionization.

The article that started this stream was posted in a nurse managers journal. Nurse managers have hardly been a union advocate. There are many studies out their that have examined unions and their effect on outcomes and yes they are sponsered by unions but that is called a hypothesis when you set out to prove any concept. Scientific methodology directs the studies so that they can be accepted by the scientific community as having merit and like I said in prior post this study went through that same examination or it would not have been published, especially in a managerial magazine.

As far as what country I live in, I live in Texas.

Being published in any magazine, is more a matter of money as opposed to anything else.

Scientific methodology is only as accurate as the criteria thus selected. And the criteria can be manipulated to achieve the desired result. So if unions want a specific result in their study, then the criteria are altered to justify the result. I only needed to take stats once to learn that.

[herring_RN, ASN, BSN]

From the article attached in post #12

..."Financial support was provided by a 1998 American Nurses Foundation grant, UCSF The Center for the Health Professions (Drs.Edward O'Neil and Jonathan Showstack, Directors), UCSF Center for California Health Workforce Studies (Dr. Kevin Grumbach, Director). Data was provided by Dr. Hal Luft and Dr. Patrick Romano from the California Hospital Outcomes

Project (CHOP), sponsored by the California Office of Statewide Health Planning and Development (OSHPD)."...

Not union funded.

[Woodenpug, BSN]

O.K. so little evidence exist to support the positions, that data mining from almost a decade ago, published six years ago is considered good evidence. I guess because it is not union funded?

[herring_RN, ASN, BSN]

study suggests unions increase quality of care in hospitals

a new study, published in cornell university's "industrial and labor relations review" found that compared to nonunion hospitals, hospitals with unionized nurses have 5.5% fewer deaths from heart attacks.

the study was conducted by a university of massachusetts economics and public policy professor in conjunction with a university of california community health professor, and examined many variables potentially affecting quality of care, such as wages.

other factors included union advocacy for patient care, union efforts to increase staffing levels, and union concerns over excess work outside the scope of job responsibilities taking time away from nursing tasks.

see "if a hospital is unionized, might care be better?," by megan mccloskey, las vegas sun, oct 10 2008 (kbt)

http://www.ilr.cornell.edu/library/research/worldofworknews/wit/

[lpnflorida]

I worked 20 years in a union Mn hospital from 1978-1999. While my union was the MLPNA , and the RN"s were MNA. With that said, our union made it possible to preserve the ability of the LPN's numbers/fte's to remain within a certain percentage to RN"s Our Hospital also could not change our duties without first getting permission from our union. Trying to fire a poor or unsafe nurse took an act of God. Not funny in the least. Senority ruled.

Fast forward to I now have worked in Florida 10 years no union. I see both hospitals as having given excellent care to their patients .

As to nurses satisfaction. Yes I suppose some nurses felt more comfortable with a union. I did at the time.

Truth be known though while in a union my wages were restricted by union who bargained and all LPN's.. all RN;s received the same identical raises based on years of service and terms of sign contract.No matter if you excelled at your job and just barely got by.

I no longer have a union, instead I have received merit raises based upon my own performance and the units ability to maintain budget, oh don't forget those lovely Press Gainey Scores. I have received larger raises under the merit system than I did in a union hospital.

Facts and figures can be skewed to any outcome the orginal writer intends. We all understand this.

Patient outcomes are based on best nursing practice and the ability of the staff who care for them to perform/ to analzyse to carry out what is best to garner best outcomes.Not unlike the acuity systems we once had in hospitals, personally I love it. It matched the nurses skills to the needs of the patient. That is not necessarily happening today. Acuity went out the window as someone came up with, but the numbers entered into it could be skewed to raise the numbers of nurses needed on a unit. Ask who I think that benefitted, the patient, the nurse, or administration.

[Woodenpug, BSN]

I would like to see the original study/s. Would anyone assist me by giving the title and author? I've chased too many red herrings. Thank you in advance.

[lpnflorida]

http://www.medscape.com/viewarticle/490769_print,

I found this article intersesting to read.

I am wondering. Perhaps we should be comparing Magnet status Hospitals without unions. to Non Magnet Hospitals with unions . While the article did not address the contrast of the two I would be interested.

link about why Magnet Status of Hospitals are good for nurses and patients

http://www.arna.org/snas/ar/edu/CE[1].pdf

[Woodenpug, BSN]

A well written case study. And I agree, Magnet status does improve patient outcomes. Could a non-union hospital attain magnet status?

[lpnflorida]

Woodenpug,

yes, of course My hospital is currently working towards Magnet Status, have been for a couple of years and we do not have unions.

[RN Power Ohio]

November, 2004

Position Statement On the "Magnet Recognition Program for Nursing Services in Hospitals" and Other Consultant-Driven Quality Improvement Projects that Claim to Improve Care

MNA opposes the latest industry strategy to avoid safe RN-to-patient ratios

In the wake of an onslaught of studies and reports detailing deplorable nursing care in hospitals and a massive exodus of nurses who are refusing to work under such conditions, and in the face of a growing movement by nurses, the public and legislators for the imposition of mandated RN-to-patient ratios to correct these deficiencies, the hospital industry has increasingly turned to a voluntary process of accreditation and validation of its nursing programs (similar to that provided for hospitals by the Joint Commission on the Accreditation of Health Care Organizations). This designation, known as "Magnet Recognition" has been around for years, but more recently has been embraced by hospital and nursing administrators as a means of boosting public confidence in their nursing care, improving retention of its nursing staff and, perhaps more importantly, increasing its reimbursement for services by the federal government and private insurers.

http://www.massnurses.org/pubs/positions/magnet.htm