Can (do) nurses unions help improve patient care

  1. I have heard claims from nurses' unions that they can and do help improve patient care by improving working conditions and reducing turnover, negotiating better nurse/staff ratios, eliminating mandatory overtime and floating, and giving nurses a greater voice in patient care through staffing and nurse practice committees. Is this true? If so, can anyone provide concrete examples. Thanks.
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  2. 21 Comments

  3. by   HM2VikingRN
    minimum laws in calif, MN has minimum required staffing negotiated in union contracts for Twin City hosp etc.
    Go Union!
  4. by   Simplepleasures
    Quote from HM2Viking
    minimum laws in calif, MN has minimum required staffing negotiated in union contracts for Twin City hosp etc.
    Go Union!
    :yeahthat:
  5. by   pickledpepperRN
    Registered Nurse Unions and Patient Outcomes.


    ...The significant finding in this study is that hospitals in California with RN unions have
    5.7% (.84-the RN union coefficient from Model 4/14.8-statewide risk-adjusted AMI mortality rate average) 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.
    Although we have not necessarily identified a causal relationship, the approach in this study demonstrates
    that there is a positive relationship between patient outcomes and RN unions. ...

    http://www.jonajournal.com/pt/re/jon...856145!8091!-1

    I bought this article but it is too big to attach.
  6. by   4nomark
    All of my posts are always Pro-Union because I look at the history of Big Business and Corporations in this country and the trend of low balling workers compensation packages is nothing new in these last couple of years. Many Nurses and others believe that a Degree and Professional accredidations mean that employers will only treat and consider them with the utmost respect when discussing or negotiating matters of compensation but nothing is farther from the truth. Something I would encourage everyone to read is the articles in this link. Not all the articles are union related but all the articles show the hidden costs when Unions aren't allowed fair and open access to all classes of worker.
    http://northbayclc.home.mindspring.c...tybennett.html
  7. by   whistle1429
    a sample of what i mean about the cna. this letter is from their representing attorney.... isn't it nice to know our rights? i think we all need to read the fine print, read between the lines, and remember that the union is only as powerful as it's members.
    another side note... the nlrb isn't real! there are no checks and balances between the union an nlrb, so if you think there is recourse against the union, it's not through the nlrb, but through state court!
    when i filed a complaint against my union/rep with the nlrb, the nlrb contacted me and stated, "im surprised you didn't file a complaint against the employer", i said, "i didn't know i could"... so i did. wasn't she so sly... after filing my complaint against my employer with the nlrb, i was contacted again, and informed, "although you do raise several issues that would probably warrant an investigation, it wouldn't look good on you, for you to go to arbitration with a complaint against the union who's representing you... so here's what i"m gonna do... i'm gonna drop the case against the union, and defer the one to arbitration against the employer.
    when i later contacted her, stating that i thought it was outrageous that she gave my charge against the employer over to the same union rep that i had filed a grievance against, she dismissed my concern, and stated, "well, the charge against the union is dropped, i'm not going back there." i informed her that i may file another complaint against the union, and she said that even if i did, she wouldn't take into account my past complaints, and i woudl have to come up with a whole new set of charges.
    i contacted the dol, attny general, ocr, and they all stated the same, as did nlrb... there is no entity that oversee's the nlrb. so... they "babysit" the union, but who babysits them???
    what a failure of the entire system... what in the world are we thinking we have protection if we have a union for when really... we're in the same boat as those who are nonunion members.. our only recourse is really suing them civally...
    read on... this came directly from cna's attorney.... become enlightened.....

    subject: re: friday meeting

    from: (attorney for c n a) @calnurses.org

    i cannot tell when the first e-mail to plwas sent and it may be that it preceded some of the other exchanges you included. therefore, some of the questions i am answering may have already been answered.
    with respect to your question about your attorney, you have already been informed, in writing, as shown in the e-mails from patty l. to you which you forwarded to me, that your attorney may not be present at the arbitration preparation meeting or at the arbitration.

    the reason is that the collective bargaining agreement (“cba”) is between slh and cna. as reflected in article 16 of the current cba, only the “parties” to the cba have rights under the grievance procedure. registered nurses represented by cna are third-party beneficiaries of the cba but have no direct rights as a party to the cba.

    as reflected in article 16.b, at step two of the grievance procedure, even for grievances between the rn and the employer, such as yours, a representative of cna meets with a representative of the employer to attempt to resolve the grievance. only a party to the cba and not an individual employee can refer a grievance to an impartial arbitrator for determination.
    cna functions in an arbitration to advance the cause of the individual grievant while considering the impact of the case on the bargaining unit as a whole.

    there’s no issue of your “waiving” your right to have an attorney at the arbitration because you do not have any such right to start with.
    cna will continue to represent you with the same care and dedication with which we represent all the rns at s.l. and hundreds of other hospitals in california and in other states.

    cna does not use attorneys for all the arbitrations; we do always use representatives who are skilled and proficient in conducting arbitrations
    the types of settlement offers that cna might accept over your objection, there is no way to create a list of hypothetical offers. the critical fact is whether the settlement is “reasonable” in cna’s view.

    binding arbitration means that there is no right to appeal the arbitrator’s decision to court. under certain very limited and narrow circumstances, a union or an employer may move to vacate an arbitration decision but disagreeing with it or having lost certainly is not a basis for petitioning to vacate. sometimes an employer will indicate that it does not intend to comply with a decision, despite the fact that there is no legal basis to do so) and in that case the union probably would file a court action to confirm the award.

    basically the arbitrator orders a make whole remedy so that your compensation and benefits would be the same as if you had not been terminated. typically a grievant does not get compensated for time spent in grievance meetings or preparing for the arbitration or for costs expended in connection with the case.
    m. j
    legal counsel
    california nurses association
    Last edit by whistle1429 on Jan 31, '07
  8. by   music
    Quote from spacenurse
    Registered Nurse Unions and Patient Outcomes.


    ...The significant finding in this study is that hospitals in California with RN unions have
    5.7% (.84-the RN union coefficient from Model 4/14.8-statewide risk-adjusted AMI mortality rate average) 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.
    Although we have not necessarily identified a causal relationship, the approach in this study demonstrates
    that there is a positive relationship between patient outcomes and RN unions. ...

    http://www.jonajournal.com/pt/re/jon...856145!8091!-1

    I bought this article but it is too big to attach.

    Well, sorry but that is just totally not in the least bit believable. If that study is true, then why is King Drew Medical Center in Los Angeles closing most of the hospital, losing funding due to poor patient outcomes and being taken to task for inadequate care and poor patient outcomes. If the study was true, then the nursing staff would not have been written up negatively in the LA TIMES so frequently over the past year or more. If the above article is true, then do we blame the union for the hospital's failure? I guess we should. After all, according to the study mentioned, the hospital should be terriffic due to having a union...........and so I think maybe there is a flaw in this study! Yes indeed. Actually, I know that there must be many nurses there who are quite good and the failure of the hospital is due to many things, not just the union.......but King-Drew Medical Center has a nurses union. I rest my case.


    Baloney! Whoever wrote that study needs to go back to the drawing board. There are many non-union hospitals across the country that have excellent nurses and patient outcomes.

    The fact is, there are both union and non-union hospitals that have excellent care. This is just another example of pro-union advocates manipulating the facts to make it appear that their way is the only way.

    Not true............Just not true.
  9. by   pickledpepperRN
    King Drew did not have an all RN union.

    I doubt The Journal of Nursing Administration has many pro union advocates. Read the entire study. It is quite inexpensiveto purchase . Their facts are from public sources.

    I know personally that King Drew had terrible understaffing and bad management.
    My opinion is that the blame is shared by the County Board of Supervisors, county health department, hospital management, staff, and a union that is NOT an all RN union.
    I think nursing staff either quit, were disciplined for trying to improve conditions, or lowered their standards. I also suspect criminal curruption. I think probably someone was stealing money and got away with it because of incompetent management. I know for certain that in this century consultants were pain millions and did not do what they were paid to do.

    Registered Nurse Unions and Patient Outcomes.

    Articles
    Journal of Nursing Administration. 32(3):143-151, March 2002.
    Seago, Jean Ann PhD, RN; Ash, Michael PhD
    http://www.jonajournal.com/pt/re/jon...856145!8091!-1
  10. by   music
    Quote from spacenurse
    King Drew did not have an all RN union.

    I doubt The Journal of Nursing Administration has many pro union advocates. Read the entire study. It is quite inexpensiveto purchase . Their facts are from public sources.

    I know personally that King Drew had terrible understaffing and bad management.
    My opinion is that the blame is shared by the County Board of Supervisors, county health department, hospital management, staff, and a union that is NOT an all RN union.
    I think nursing staff either quit, were disciplined for trying to improve conditions, or lowered their standards. I also suspect criminal curruption. I think probably someone was stealing money and got away with it because of incompetent management. I know for certain that in this century consultants were pain millions and did not do what they were paid to do.
    Space Nurse, I agree that the blame is shared by many. However, the nurses at King Drew were in a union as far as I know and NOT ONE TIME did I ever see them defended in the press by their union. So, not only did the consultants not do a very good job, the union didn't do a very good speaking up for the nurses if they had such bad management,working conditions, etc. I felt sorry for those nurses as I'm sure they weren't all wrong..........So much for being in a union.

    I also agree that there was obviously incompetent management and WAY TOO MUCH money was wasted on consultants. Consultants leave after getting paid. Unions take your money and sometimes, as in this case, do nothing else. Both consultants and unions have their pros and cons.

    However, the point I was making is that the article is wrong, wrong, wrong in stating that care is better in union hospitals. Simply not true. I work in one of the best hospitals in the country and we are not unionized. We give excellent care because of excellent nurses and a union has nothing to do with it.

    I think that most nurses really try to give good care and to speak up for their patients whether they are in a union or not. Good things have come to some nurses from joining unions and speaking out and a lot of good things come from nurses speaking out against giving their voice to unions. I think trying to draw a line and say on this side the nurses are in a union and their care is better and on the other side, the nurses who are not in a union give less care............is irresponsible and causes nothing but divisions.

    Some "studies" are so high up in the lofty tower of "NOT in touch with the real world of nursing" that their presentations are not always realistic. This one sure isn't very realistic to me for sure.

    I do respect your viewpoint and the time you take to share news of interest on this board. You post many articles that are informative and cover many areas. I just had to comment on this study as it struck a nerve and I think it doesn't serve a good purpose in the long run as there are many nurses all over this country who work long and hard hours doing the best they can. They all should be saluted for staying in the profession and for their willingness to share their viewpoints on this site.

    With respect................
  11. by   pickledpepperRN
    The point is that the study was retrospective. Patients with acute myocardial infarction had a statistically better survival rate in hospitals with RN UNIONS.
    The union at King Drew was NOT an RN UNION.
    I know patients are better cared for because of the unity of our nurses and the improvements in staffings, policies, and having adequate working supplies and equipment made by our Professional Practice Committee.
    It is the value of a single human life!
    ...The significant finding in this study is that hospitals in California with RN unions have 5.7% (.84-the RN union coefficient from Model 4/14.8-statewide risk-adjusted AMI mortality rate average) 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.
    Although we have not necessarily identified a causal relationship, the approach in this study demonstrates
    that there is a positive relationship between patient outcomes and RN unions. ...

    http://www.jonajournal.com/pt/re/jon...856145!8091!-1
    Only an RN UNION would have these provisions with education for registered nurse so WE can enforce our contract:

    CNA contracts have created new standards for RNs
    and patient protection
    .
    A crucial part of quality
    patient care is reversing the trend of inadequate
    hospital staffing that is putting patients at risk and driving
    nurses out of the profession. CNA representation provides
    nurses with a voice in patient care decisions, which we can
    use to create safer healthcare facilities to protect our
    patients, our licenses, and ourselves.

    Professional Practice Committees
    CNA contracts negotiate staff RN-controlled committees with
    the authority to document unsafe practices and the power to
    make real changes. The Professional Practice Committee
    (PPC) is an elected, staff RN committee with representatives
    from every major nursing unit. The PPC meets in the hospital
    on paid time and tracks unsafe conditions through
    an independent documentation system called the
    Assignment Despite Objection (ADO).

    Staffing Ratio Protections
    ■ Ratios in contract to protect against future attacks:
    Enforced through the RN's legal contract guarantees,
    with disputes settled by a neutral third party arbitrator.

    ■ Binding arbitration for safe staffing: Disputes between
    management and PPC may be submitted to a neutral
    arbitrator for a binding decision.

    ■ All-RN staffing: A commitment to only hire RNs into all
    open non-relief licensed positions in designated units.

    Safe Lift Policies
    Contract language to assure safer lift policies, including
    "appropriately trained and designated staff" to assist with
    patient handling available 24 hours a day.
    Precedent-setting language that prevents new technology
    from displacing RNs or RN professional judgment.

    Binding Arbitration for Safe Staffing
    Disputes between management and the RN-elected staffing
    committee may be submitted to a neutral arbitrator for
    a binding decision.

    Floating Policy Improvements
    Floating not required outside the RN's clinical area.
    No floating allowed unless RN clinically competent.

    Ban on Mandatory Overtime
    Prevents nurses working when they are exhausted,
    endangering patients.

    Quality LiaisonsStaff RNs selected by CNA who work as independent
    patient care monitors on staffing problems and structural
    concerns regarding quality of care improvements and
    nursing practice.

    Charge RNNot counted in the staffing matrix. Has the authority
    to increase staffing as needed.

    Paid Education LeaveUp to 12 days per year.

    Resource RNs
    RNs who are not given a patient care assignment or
    counted in the patient acuity mix available to assist RNs
    as needed on their units.

    http://www.calnurse.org/assets/pdf/cna101.pdf
  12. by   music
    Space Nurse,

    Like I said: I think that most nurses really try to give good care and to speak up for their patients whether they are in a union or not. ............................I think trying to draw a line and say on this side the nurses are in a union and their care is better and on the other side, the nurses who are not in a union give less care............is irresponsible and causes nothing but divisions.

    I think it's obvious you are happy with your union and that's good for you.
    I am supportive of ALL nurses whether union or non-union. I think it's important for us all to be able to talk with one another and share our viewpoint.

    When you say the King-Drew nurses where not in an all RN union, do you mean the SEIU is not a nurses union? I thought they worked hard for nurses too. I thought they worked just as hard to get the nurse/patient ratios passed. Aren't we all trying to do the same things? Speak up for our patients.
    Just wondering.

    The main point I was making about the union at King-Drew is this. No matter which one it was, it did not speak out publicly in support of the nurses when the stuff hit the fan.............I found that disappointing and felt sorry for the nurses that were so maligned in the paper and no one spoke out in support of them, the challenges they faced and the lack of support they received in effecting change as you alluded to. .......so much for unions.
  13. by   pickledpepperRN
    A union lead by registered nurses who the needs of patients are paramount provides education and contract provisions to assist RNs in improve their work environment to improve patient care.

    Unfortunately a partnership with management does not.

    This thread gives an example:
    http://allnurses.com/forums/f195/sei...-194374-2.html

    http://www.lmpartnership.org/news/lo...423/index.html

    Of course I am aware that not all unions improve patient care when they represent RNs.

    No union improves care in every hospital on every uniy.
    It is up to the nurses who are the union.

    A union that represents many categories of worker including non healthcare workers cannot concentrate on improving healthcare.

    There are hospitals where the nurses are not represented by a union where the care is excellent.
    I worked at one. Too bad it was bought by a for profit chain.
    Last edit by pickledpepperRN on Feb 6, '07 : Reason: Add a thought
  14. by   music
    YOU SAID: "No union improves care in every hospital on every uniy.
    It is up to the nurses who are the union."

    And I say: It is also up to the nurses who are not in a union to participate in improving care on their individual units.......and many of us do just that every day without paying dues.

    So there you have it. It's up to ALL of us, working together to make a difference whether you're in a union or not.

    Thank you for sharing your views and for your passionate support of nurses. I can clearly see that you feel very strongly that your union is making a difference.

    I just hope you will keep in mind that those of us who do not want to join a union have the same passion for our profession and we have much to say also.

    Through this site, you and I have found a way to share our views in a calm and professional manner. We should all be able to do that, without interference from non-nurse organizers who twist and manipulate the truth, causing friction and mistrust among nurses. When unions rise above those tactics, we will all make progress.
    Best wishes for continued success in your profession.

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