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."...

[Woodenpug, BSN]

But the burden is on this thread. By the title. I also simply stated that if these articles exist, as you seem to report, I can find them, if they are peer reviewed.

The discussion is I think "do union organizations have improved staffing ratios and rn retention rates as compared to non-union organizations." My point is simpler, not enough evidence exists to support the conclusion that unions are good for nursing and good for patients.

[herring_RN, ASN, BSN]

History of the Ratio law by the California Healthcare association, an opponant of the ratios: http://www.calhealth.org/public/press/Article%5C113%5CImplementation%20of%20CA%20Nurse%20Ratio%20Law,%20History%20of%20the%20Law.pdf

The California Nurses Association Safe Staffing Ratio LAW didn't only improve staffing in union hospital.

This law is for ALL acute care hospitals.

http://www.calnurses.org/nursing-practice/ratios/ratios_index.html?print=t

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.prnewswire.com/cgi-bin/stories.pl?ACCT=ind_focus.story&STORY=/www/story/09-12-2008/0004884180&EDATE=FRI+Sep+12+2008,+04:32+PM

[Woodenpug, BSN]

Your point? All I'm asking for is some evidence. Title and author. I concede your point that improved staffing ratios equals improved patient outcomes. I also agree that magnet status and nurses as key decision makers improves patient outcomes. You seem to have the same difficulty as do I - the evidence to support unions as useful to improved patient outcomes as compared to no union is not available.

Once again, because my point seems to be ignored. Not enough evidence exists to support the conclusion that unions are good for nursing and good for patients. If it did , you would be able to list the title and author of the study. A descriptor of the author "he's a good guy from a great institution" is not enough for someone else to retrieve the original study.

BTW, I did offer a reasonable critique of the only sited study. I did not go far in depth, because so many problems existed with that study. The only credible part of that study was that it was apparently unbiased. Bias is not important to me. (Claiming bias is just another form of ad hominem rhetoric) What is important is whether or not the evidence is valid and reproducible; whether or not the evidence supports the conclusion of the authors. The sited study uses poor statistical methodology. The sited study presents a correlation using p values. (r coefficient is appropriate) The correlation is between patient outcomes years earlier than established union status. Some of the positive outcomes could have been from facilities which later became unionized. Some of the negative outcomes could have been from union hospitals which later lost their union status. But even if I accept the validity of the data and its analysis, and ignore the fact that it has no significant correlation, the study is old. Something better should be available. Not enough evidence has been presented to even do a pilot study. Obviously, no one was convinced by that data mining/retrospective study for anyone to fund more solid research.

My interest is that I would like to expand my job market. If I can believe that unions are at least not harmful to patient outcomes, I would be willing to work for a union hospital.

[RN Power Ohio]

Can anyone say Jackson Lewis??

[herring_RN, ASN, BSN]

this forum is for discussion. i think anyone interested enough will find the original study.

a 10 percent increase in adequate staffing and resources (as reported by nurses) was associated with

17 fewer deaths per 1,000 discharged patients. -- science daily, january 16, 2007

among critically ill patients on mechanical ventilation, the risk of pneumonia was lower when there

were higher levels of nurse staffing. -- critical care, july 19, 2007

cancer surgery patients are safer in hospitals with better rn-to-patient ratios. -- cancer journal of the

american cancer society, september 2005

poorer hospital nurse staffing is associated with higher rates of urinary tract infections, post-operative infections, pneumonia, pressure ulcers, and increased lengths of stay, while better nurse staffing is linked to improved patient outcomes. -- agency for healthcare research and quality-report 2004

low nurse staffing levels are a key cause of 98,000 preventable deaths each year. -- institute of medicine,

"keeping patients safe: transforming the work environment of nurses," november 2003

chances of a hospital patient surviving cardiac arrest are lower during the night shift because staffing

is usually lower at night. -- annual meeting, american heart association, november 2003

inadequate staffing precipitated one-fourth of all sentinel events. -- the joint commission on the

accreditation of healthcare organizations, august 7, 2002 (this 25% continues to be consistant through 2008 so far)

improved rn-to-patient ratios reduced rates of pneumonia, urinary infections, shock, cardiac arrest,

gastrointestinal bleeding, and other adverse outcomes. -- new england journal of medicine, may 30, 2002

improving nurse working conditions can improve patient safety. - medical care * volume 45, number 6, june 2007

if all hospitals increased rn staffing to match the top 25% best staffed hospitals, more than 6,700 in-hospital patient deaths could be avoided.-health affairs, january/february 2006

a primary mechanism by which quality would be affected is nurse staffing levels.-health services research, june, 2006

cutting rn-to-patient ratios to 1:4 nationally could save as many as 72,000 lives annually-medical care, journal of the american public health association, august 2005

the institutes of medicine of the national academy of sciences reports that "nurse staffing levels affect patient outcomes and safety."-iom, november 4, 2003 up to 20,000 preventable patient deaths each year can be linked to low rn staffing.

for each additional patient assigned to an rn the likelihood of death within 30 days increased by seven percent. four additional patients increased the risk of death by 31%-journal of the american medical association (jama), october 22, 2002, aiken, linda. h., clarke, s. p., sloane, d. m., sochalski, j., & silber, j. h.(attached)

improved rn-to-patient ratios reduced rates of pneumonia, urinary infections, shock, cardiac arrest, gastrointestinal bleeding, and other adverse outcomes-new england journal of medicine, may 30, 2002

chances of a hospital patient surviving cardiac arrest are lower during the night shift because staffing is usually lower at night.-annual meeting, american heart association, november 2003

low levels of rn staffing put patients at risk for life-threatening infections, shock and bleeding. - harvard school of public health, may 29, 2002

nurses intercept 86% of all medication errors made by physicians, pharmacists, and others prior to the provision of those medications to patients-jama, 1995

* improved staffing ratios equals improves patient outcomes

* the safe staffing law sponsored by a registered nurse union in california did improve staffing

* therefore a union improved staffing.

[Woodenpug, BSN]

That's it? No supporting ideas? Well, thank you. Even strong union supporters are unable to present any evidence in favor of unions. One more reason to not waste my time with any "literature" supporting unions. Get back to me when you can cite some evidence. Oh, I prefer the work of Robert Lynd.

[Woodenpug, BSN]

To be clear, I support the idea that good staffing improves patient outcomes. You still need to show that Unions improve patient outcomes. That would be in comparison to non-unions.

You have convinced me that no such evidence exists. You should have found something. An I believe that were I to make the effort, I could find more recent evidence to support good staffing ratios.

I am equally sure I could find evidence supporting Magnet status as improving patient outcomes. But......

The thread title is "Why unions are good for nurses and patients." So far it seems the answer is "No evidence exists to support that statement, We just wanted to see if you would look." O.k. I fell for it and you "made me look."

Improved staffing ratios equals improves patient outcomes

* The Safe Staffing law sponsored by a registered nurse union in California did improve staffing

* Therefore a (law not the union) improved staffing.

another thread supports the idea of safe staffing and links to a site, sponsored by the ANA, which advocates for safe staffing ratios. Please see http://www.safestaffingsaveslives.org. You can advocate for this and if you belong to a union you can advocate for your unions support.

[woknblues]

I am in way over my head on this topic as a current SN, but I am by no means unfamiliar with unions from my past job experiences.

I really think that the concept of improving patient outcomes is noble, but not really the point. The point to me is that nurses should be able to work an honest day for a commensurate salary befitting their education, responsibility and output. Without unions or the threat of unions (in general and what I have seen) nurses are generally abused, overworked and under compensated. Can anyone refute this?

The care for a better patient outcome is noble, but not related at least in my mind to the issue here. Why do nurses always have to advocate for someone else, even when it just comes down to decent working conditions for the nurse?

[Woodenpug, BSN]

I am in way over my head on this topic as a current SN, but I am by no means unfamiliar with unions from my past job experiences.

No, at least I do not support the idea that an SN is not capable of supporting a conclusion with facts.

I really think that the concept of improving patient outcomes is noble, but not really the point. The point to me is that nurses should be able to work an honest day for a commensurate salary befitting their education, responsibility and output. Without unions or the threat of unions (in general and what I have seen) nurses are generally abused, overworked and under compensated. Can anyone refute this?

Yes, I can refute the above. Without unions or the threat of unions (in general an what I have seen) nurses are generally not abused (Abuse must be reported and violates several laws).

The care for a better patient outcome is noble, but not related at least in my mind to the issue here. Why do nurses always have to advocate for someone else, even when it just comes down to decent working conditions for the nurse?

It is related to this thread. Again the title is "Why unions are good for nursing and good for patients."

Nurses are bound to a code of ethical principles. One of them is patient advocacy. That is why nurses always have to advocate for someone else. Nurses can and do advocate for decent (if you mean better) working conditions. One way to do that is by going to http://www.safestaffingsaveslives.org and participating. You don't have to be a union member and you don't have to feel threatened by unions. Just load the link in your browser.

[Mindful, RN]

It is related to this thread. Again the title is "Why unions are good for nursing and good for patients."

Nurses are bound to a code of ethical principles. One of them is patient advocacy. That is why nurses always have to advocate for someone else. Nurses can and do advocate for decent (if you mean better) working conditions. One way to do that is by going to http://www.safestaffingsaveslives.org and participating. You don't have to be a union member and you don't have to feel threatened by unions. Just load the link in your browser.

My Friend, please get a handle on your corporate beliefs............

[herring_RN, ASN, BSN]

Sorry but tens of thousands of nurses worked with their UNION for a decade to get a law passed

Gathered signatures, attended rallys, wrote letters, met with elected officials and their staff, made phone calls, worked with patient support groups and consumer agencies, authored "letters to the editor" and educated our fellow nurses.

Classes were held in more than 20 towns and cities teaching about the ratio law and the how to ensure our hospitals obey.

WE did this for all hospitals not just union hospitals. IT WAS THE UNION NURSES WHO DID IT!

THIS is part of how it is done:

AND HOW NURSES OUTSIDE CALIFORNIA ARE IN THE

PROCESS OF ACHIEVING SAFE STAFFING LAWS WITH A UNION

AND PROFESSIONAL ASSOCIATION:

California's Nurse-Patient Ratio Law Saving Lives, Reducing the Nursing Shortage

...The ratio law, AB 394, was authored by current California State Sen. Sheila Kuehl, the same legislator now fighting so valiantly for a guaranteed healthcare system for all. It was signed in 1999 by then Gov. Gray Davis.

CNA/NNOC sponsored the law, and we have had to fight long and hard against concerted efforts by the state's wealthy hospital industry to kill it....

http://www.californiaprogressreport.com/2008/01/californias_nur.html

[woknblues]

It is related to this thread. Again the title is "Why unions are good for nursing and good for patients."

Nurses are bound to a code of ethical principles. One of them is patient advocacy. That is why nurses always have to advocate for someone else. Nurses can and do advocate for decent (if you mean better) working conditions. One way to do that is by going to http://www.safestaffingsaveslives.org and participating. You don't have to be a union member and you don't have to feel threatened by unions. Just load the link in your browser.

First off, I am not an RN, so my opinion on the matter is not addressed on the link given. (I have looked into it before, and found the petition to be rightfully excluded to "RN" nurses)

Second, yes, abuse "must be reported" But people like to keep their jobs to pay bills for their families. Standing in front of their HR department who has management and corporate behind them to register that complaint rarely results in a net win for the soon to be ex employee. Very soon, a case will be built against them. Paperwork issues, SOP violations, uncorroborated verbal abuse claims, and leveraging other scared workers against them. Pretty soon it is either the employee does what is best, and quits, or is escorted out the door by security. If they want to risk it all, they can hire a lawyer during this process. Out of pocket until they "win", if they do.

Next, you have not refuted in the slightest the notion that management would not take advantage of nurses without threat of, or under the protection of union, other than to simply state that no

"proof" has been given on the side of unions and safe staffing. If unions demand and litigate for safe staffing (or adequate staffing) under the unfortunate threat of strike, and management bows to that pressure, are you blind to the relationship between unions and staffing issues? In case you missed my point in my original statement, I was actually trying to distance the patient outcome angle from the cause for unionized nursing, since I feel it should be a right to have a reasonable workplace environment as an employee. If the patient benefits from this fact (and how could they not?), then all the better.

Last, I am well aware of the title of the thread, and since I prefaced my comments, I reserve the right in taking any direction in the conversation I wish to, as long as it pertains to the topic, namely, in support of unionized nursing, and will do so without your permission. Good day.