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."...

[lpnflorida]

That is an interesting article. My next question would be is the MNA also associated as being the representatives ( union) of the Mass. RN"s. Without that piece of info. it would be hard to say if the article were not biased .

[RN Power Ohio]

That was the position statement of the Massachusetts nurses not a research study.

MNA like most state nurses associations represents nurses in collective bargaining agreements.

[RN4MERCY]

That is an interesting article. My next question would be is the MNA also associated as being the representatives ( union) of the Mass. RN"s. Without that piece of info. it would be hard to say if the article were not biased .

Biased? I say, follow the money. Consider this: the Magnet Recognition Program, is run by the American Nurses Credentialing Center (ANCC), a for-profit subsidiary of the American Nurses Association. It's a business! The ANCC executive consultants market and sell their Magnet Program to hospital administrators who purchase it with the purpose of acquiring a proprietary award. It's an award, a badge, for executive nurse administrators, NOT for direct care nurses. Do the administrators at Magnet Hospitals really "share" governance and power? Or do they just pay lipservice to the concept, and divert patient care dollars to pay the consultants for the "privilege" of using the trademark or "brand name" magnet label. The consultants market themselves and their program to hospitals, but they have no direct accountability for patients.

Now, put on your critical thinking cap. Does magnet do what it says it does? MNA is both a labor and a professional nursing organization that represents the interests of nurses who provide direct patient care. Collectively their members work at both Magnet and non-Magnet designated hospitals. Collectively, they have the resources to study the issues and do a comparative analysis of their members' experiences. Collectively, they have the protection to stand up and say, "the emperor has no clothes" so-to-speak. Union or not, the MNA doesn't "profit" from the Magnet marketing and recognition program.

I think the article calls the question. Beyond the thousands of dollars diverted from real patient care needs, the program diverts nurses away from direct patient care time. Nurses are "invited in" to participate in management controlled "multidisciplinary" partnership or governance councils that have no real decision making power. The bedside nurse who finds him or herself with a legitimate patient care or nursing practice issue stands at the bottom point of an upside down triangle. At least that's been my experience. The MNA article is a direct and articulate validation of the collective staff nurses perceptions and experience with "magnets."

In a non-union hospital, staff members may have real fears about being targeted and retaliated against for not "buying in" to the manager's/administrator's directives regarding their facility's embarkation on a "mission" or "journey" to achieve magnet status. There are facilities where some union members initially bought in to the concept and participated in grooming their facility for "recognition." University of California at Davis Hospital is one example. When RN staff members realized that there was no real change in the "culture" of the administration, they collectively stood up, told it like it was, and the "magnet" was repelled! Ultimately, there was no longer any money in the budget to invest in keeping up the facade from administration's standpoint.

Don't get me wrong. I'm not against a collegial relationship with management, but "partnerships" don't work. Power is not "shared." It must be taken, boldly, in the exclusive interests of protecting patients and nursing's right to control it's practice in the environment of care. I'm for fairness and equality in the process to insure that the ultimate right and duty of the direct care RN to advocate in the exclusive interest of the patient is protected. I'm for good stewardship of precious health care dollars and for insuring that the money directly benefits patients who need nursing care.

For my money, and in my experience, those ends can only be achieved collectively by pursuing a national political and social advocacy agenda. RNs need to be represented by an all RN, member led union. Patients are safest when their nurses have real whistleblower protections and do not have to fear retaliation when they exercise their duty as patient advocates. An all RN union is a great equalizer and insures that members will have due process in grievance proceedings, and fairness in bargaining for their wages, hours, and working conditions, that attracts and retains nurses at the bedside.

In California, the CNA/NNOC union fought for and achieved the first in the nation RN to patient safe staffing ratios; staffing up from the minimum must be done according to the patient's acuity! Remember, Magnet programs are voluntary and proprietary; guidelines are subject to discretionary and whimsical change. The Ratio Law can only be changed through the legislative process, and interpreted by the judicial system. The Ratio Law includes real, enforceable saftey standards and all hospitals in California must comply. Following California's lead, several other states are in the process of introducing ratio legislation.

To insure good stewardship and equitable distribution of health care resources, we need a publicly accountable single-payer national health plan in this country. HR 676 is national legislation that will extend MediCare to all. It will reduce and control administrative costs. Hospitals will compete based on true quality indicators, not based on "market share" and "magnet" schemes, paid for with money and profits derived from deliberate short staffing and care rationing. Healthcare should not be a privilege only for the wealthy.

[Woodenpug, BSN]

In other words, no evidence exists to support the concept that unions are a benefit to nurses or patients. This thread is a waste of time. No one wants to present credible evidence, just practice rhetoric. Fine, I agree...you can present anything anyway you want. It is possible to use credible sources, with reproducible evidence. That is, of course, if you have a true and valid point.

It is perfectly possible that unions benefit nursing and patients, but I have seen no credible evidence. I subscribed to this thread in the belief that such evidence does exist. So far, I am, if it is possible, even more anti-union.

[Iam46yearsold]

Im neither prounion or antiunion. I just fail to see why so many feel that there is a superiority in the union environment, morally, ethically, effectively, categorically, whatever. I cant see where as prounionists claim that unions are solely responsible for all nursing improvements. I just cant see it. Except when so announced by only prounionists, tooting their own horns.

[RN Power Ohio]

Without the union (CNA) there would be no nurse to patient ratio law in California. There are more than 60 studies from a variety of researchers - including AHQR, IOM that better staffing = better outcomes.

[RN Power Ohio]

Here is a suggestion: try to get your boss to implement Ca minimum staffing ratio's in non-union environment. Also, see if you can get a 13% pay raise and a pension.

If you succeed- then union vs. non-union is equal. If your boss laughs at you let's revisit.

Saint Mary’s Reno RNs Win Landmark Nevada Pact

Huge Breakthroughs in Patient Safety with RN Staffing Ratios 29.5% Pay Hikes, Pension, Retiree Health Will Aid RN Retention

Registered nurses at Saint Mary’s Regional Medical Center in Reno won a groundbreaking tentative agreement with hospital officials early this morning on their first-ever collective bargaining pact that sets a new Nevada standard for patient safety protections and enhanced conditions for RNs.

Establishment of hospital-wide minimum, specific RN-to-patient staffing ratios is a centerpiece of the proposed pact, the California Nurses Association/ National Nurses Organizing Committee (CNA/NNOC), which represents 500 RNs at Saint Mary's, said this morning. Saint Mary's RNs voted to join CNA/NNOC last December.

http://www.calnurses.org/media-center/press-releases/2008/september/saint-mary-s-reno-rns-win-landmark-nevada-pact.html

[herring_RN, ASN, BSN]

In other words, no evidence exists to support the concept that unions are a benefit to nurses or patients. This thread is a waste of time. No one wants to present credible evidence, just practice rhetoric. Fine, I agree...you can present anything anyway you want. It is possible to use credible sources, with reproducible evidence. That is, of course, if you have a true and valid point.

It is perfectly possible that unions benefit nursing and patients, but I have seen no credible evidence. I subscribed to this thread in the belief that such evidence does exist. So far, I am, if it is possible, even more anti-union.

Of course I want to present credible evidence. I am sorry the studies don't meet your standards.

I'm just a bedside nurse. Somehow I thought that a "Scholar; Department of Community Health Systems; Center for the Health Professions;

University of California, San Francisco (Dr Seago)" and "Department of

Economics; Center for Public Policy and Administration; University

of Massachusetts--Amherst (Dr Ash)" would be credible.

The attachment from post #12 is reattached here.

Got lucky in finding the Cornell publication.I apologise for my error in not knowing they are both the same study!

Are you interested in doing such a study?

I don't think a union would do it because then it would be viewed as suspect.

Retrospective studies are done all the time. I wouldn't want to participate in a study using human beings where the control group were cared for with fewer RN and other nursing staff members.

Please don't think I'm asking but it would help me if someone wanted to critique why the study is not credible. "Data mining" doesn't seem an accurate term to me.

Only IF someone wants to.

[Woodenpug, BSN]

Without the union (CNA) there would be no nurse to patient ratio law in California. There are more than 60 studies from a variety of researchers - including AHQR, IOM that better staffing = better outcomes.

Two ideas. One - list the studies, by title and author. Two, show that union health care organizations have improved staffing as compared to non-union health care organizations. I completely agree, improved staffing does, in fact equal better patient out-comes. Not that my opinion counts, just that I have reviewed satisfactory evidence (from my point of view.) Thank you for your time and effort in fulfilling my two requests.

[RN Power Ohio]

Woodenpeg,

I am not going to do your research. One union has unarguably improved staffing- CNA- as evidenced by the law that exists in the state of California.

Let's try a little logic:

P1 Safe staffing = better outcomes

P2 unions are effective at improving staffing conditions

C Unions improve patient outcomes

If you pull the latest nursing research that correlates staffing to a specific outcome you will see virtually ever other relevant research article in the references. Look all those up and read them- then look up all the citations in those articles.

Or you can do a Cochrane database search.

Or you can read the IOM report

Or the CDC report

Or the WHO report

Or the AHQR report

Or read them all. Now that you have a basic understanding of how a meta- analyis is done you can read all the studies for yourself and even design your own inclusion criteria.

[Woodenpug, BSN]

Following logic. Better staffing is a necessary condition for better conditions but not sufficient. You also have to define "better." But more to the point - Those reports may exist, but I have wasted too much time researching bogus reports. Simply give the title and author. If it is peer reviewed, I can find it. Also, pasting the link seems not to work. The report is blanked out.

Thank you in advance for your efforts.

I have done much research, your statements are not supported. but I accept that I may be overlooking something because of my bias.

lease don't think I'm asking but it would help me if someone wanted to critique why the study is not credible. "Data mining" doesn't seem an accurate term to me.

I gave an earlier critique. I have many more issues with the study than just the fact that the research was based on data mining. As evidence, data mining is less than adequate. You decide on a fact than see if you can find evidence to support that fact. It is a start and a credible one. I simply would not stake my life or another's on the evidence. Btw, data mining can be done in a better way. Cochran libraries has many examples. In those studies they state; what evidence they seek, the specific key words and databases searched, the criteria for inclusion and dis-inclusion, how many results, and why any particular study was included or dis-included. Stating that, for now, this is the best evidence available, works for less than 2 years and has most certainly expired in four years.

Lack of evidence to support data mining conclusions in that period of time, is equal to the data mining evidence itself. In other words, it's a wash. Time for a new study and if supported, a valid experiment.

FYI, for lengthy reasons I will not explain: The principles set out in the Belmont report must be followed for an experiment to be valid.

The posts have not supported the thread tile.

[RN Power Ohio]

The burden is not on me. Why don't you find me research that proves that unions do not improve staffing, outcomes or RN retention.

Please list author last name, year of publication and name of peer reviewed journal.

I only accept studies that include more than three medium to large sized hospitals in their study group.