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]

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.

I answered your questions. Were they rhetorical?

[woknblues]

I answered your questions. Were they rhetorical?

Yes they were. Let us revisit my two questions that I asked in my original post:

"Can anyone refute this?" when asked after a large unbroken paragraph of points is rhetoric.

"Why do nurses always have to advocate for someone else, even when it just comes down to decent working conditions for the nurse?" is obviously rhetorical, with or without any previous points.

Here is where you erred. You unfortunately, went on to dispute the rest of my statements, although you did not realize that my original statement had absolutely nothing to do with any of the back and forth you have been having with other members on this thread. You seemed to be so engrossed in your debate, that you failed to realize that this thread was a public one, so when you saw my post, you broke it out "line for line" and applied your argument to it, thinking that I had posted my statement to refute any of yours. This was not the case. You are simply arguing with someone who until recently, had no particular strong opinions regarding a link between patient outcome and unions.

The last word is all yours, I will be moving on.

[Woodenpug, BSN]

Yes they were. Let us revisit my two questions that I asked in my original post:

"Can anyone refute this?" when asked after a large unbroken paragraph of points is rhetoric.

"Why do nurses always have to advocate for someone else, even when it just comes down to decent working conditions for the nurse?" is obviously rhetorical, with or without any previous points.

Here is where you erred. You unfortunately, went on to dispute the rest of my statements, although you did not realize that my original statement had absolutely nothing to do with any of the back and forth you have been having with other members on this thread. You seemed to be so engrossed in your debate, that you failed to realize that this thread was a public one, so when you saw my post, you broke it out "line for line" and applied your argument to it, thinking that I had posted my statement to refute any of yours. This was not the case. You are simply arguing with someone who until recently, had no particular strong opinions regarding a link between patient outcome and unions.

The last word is all yours, I will be moving on.

My mistake, I was mislead by your quoting me at the start of your post. I did not know you wanted to make false statements without challenge.

[THAT Nurse., MSN, RN, APRN]

This thread got me to register.

As a nursing student who firmly believes nurses are underpaid and probably given the shaft routinely (and in my Research course preparing a proposal on whether nurse empowerment will improve patient outcomes...), I mulled over the idea of making it a long-term goal to organize a nurses union in Tennessee. I guess you could say this topic interests me a bit.

Is there a peer-reviewed research study done that supports the theory that unions are good for nursing and good for patients? I read the one by Ash and Seago, but it does not appear to a direct relationship between nurse unions and patient outcomes. Maybe I missed it in the thread, but I read every post. Are there any other studies?

[THAT Nurse., MSN, RN, APRN]

WP, appreciate the mail, for some reason I seem unable to reply. Suffice to say, I had a bad feeling that was true.

[RN4MERCY]

This thread got me to register.

As a nursing student who firmly believes nurses are underpaid and probably given the shaft routinely (and in my Research course preparing a proposal on whether nurse empowerment will improve patient outcomes...), I mulled over the idea of making it a long-term goal to organize a nurses union in Tennessee. I guess you could say this topic interests me a bit.

Is there a peer-reviewed research study done that supports the theory that unions are good for nursing and good for patients? I read the one by Ash and Seago, but it does not appear to a direct relationship between nurse unions and patient outcomes. Maybe I missed it in the thread, but I read every post. Are there any other studies?

As an RN with over 35 years of direct care experience, in both public and private "non-profit" hospitals, the studies worth paying attention are the IOM, and the Linda Aiken's study that showed the positive association of nurse to patient ratios and improved outcomes.

http://jama.ama-assn.org/cgi/content/abstract/288/16/1987?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=aiken&searchid=1065888732940_1831&stored_search=&FIRSTINDEX=30&journalcode=jama

http://www.iom.edu/Object.File/Master/4/117/0.pdf

Hospital-based errors leading to the deaths of up to 98,000 Americans every year have become a national scandal. Notably, the Institute of Medicine, which produced the findings, studied every conceivable variable except RN staffing ratios and deteriorating patient care conditions to explain the shocking numbers.

"All you have to do is talk to a direct care nurse to find out what the conditions are like," said Echo Heron, RN, and author of Tending Lives: Nurses on the Medical Front. "Forced overtime, working double shifts, having far too many patients to care for, then being asked to 'delegate' your work to a person with very little training, well, it all adds up. The hours. The strain. The stress on you, not to mention your family.

"And too many RNs feel that they aren't safe and their patients aren't safe," Heron said. "When nurses are overworked and exhausted, run ragged by too many patients, mistakes happen."

Nurses have been blamed and held accountable for errors; they are "disciplined" and are being fired by a greedy industry that deliberately short-staffs and short changes patients in order to increase their profit margin. The research shows that these are preventable errors and patients are suffering from preventable complications and have an increased mortality rate because of a faulty system, an environment of care that serves the industry, but not patients or nurses.

Quite frankly, belonging to a strong all RN nurses union is the only way to protect your voice as an advocate for patients. Union members are entitled by law, to fairness in the grievance procedure, "just cause" disciple vs. "at will" employment; Weingarten Rights, and the opportunity to address and correct working conditions that have caused the so-called nursing shortage and have endangered patients without fear of retaliation.

I've said it before and I'll say it again. Without those protections, your voice is marginalized and silenced. Nurses have been given subjectively bad evaluations, fired and blackballed for not being silent accomplices in hospital/insurance industry schemes designed to limit and control patient's access to nursing/medical care that they need in order to maximize their profits. Our silence protects no one.

A single-payer, universal health care system in this country, like that proposed in HR 676 will insure that people receive the care they need, that hospitals, doctors, and nurse practitioners are reimbursed for the medically necessary care they provide, and that treatment decisions are left in the hands of providers and patients. It's a publicly accountable, transparent, and equitable system of health care delivery.

So, it is America's RN unions, like CNA/NNOC, that are leading the fight for healthcare justice by supporting HR 676, a national health insurance program. They deserve your support. Advocacy power is the kind of power that stands alongside and enables patients to progress toward their optimum level of wellness. Patients and their families count on us to "run interference" for them; it's our duty to remove barriers to their ability to receive safe, therapeutic, and effective care. Hospital policies that promote the interests of a greedy industry at the expense of our patients are wrong.

Patients are safer when their nurses are protected, and feel free to advocate in their exclusive interests, even when those interests are in conflict with the financial goals of the employer. Those protections are only possible when bedside nurses stick together and belong to an all RN union. Check it out! :typing:redbeathe

http://www.calnurses.org/nnoc/

[THAT Nurse., MSN, RN, APRN]

RN4,

Some of my classroom instructors have actually shown those to us. While I enjoyed politics and have been active (it is Nov 4th, and I voted two weeks ago) they did a very good job of relating the political world to nursing practice, and the studies on staffing and ratios have been rather prominent in my BSN program. They are quite good at pointing out nurses lack of political activism vs the Medical or Hospitals. Our weakness politically is causing quite a few problems in practice.

Here in Tennessee, we are in kind of a bad spot. Our "professional" organization, the Tennessee Nurses Association is, in my opinion, hurting nursing and not helping the problem.

We were required at my school to attend their legislative summit, held in April. At the summit, I went from ready to join, to hoping the TNA is abolished. Why?

Anti-male attitude. Here is a verbatim joke told by one of the women running the TNA: "Why aren't there more men in nursing? Because nursing is hard work, and men don't like hard work." It is worth noting that her joke only received a few laughs, but sure did drop a lot of jaws.

Admitting to not being independent/un-biased. It is really bad form to admit you generally side with the Democratic party because you like their values better. The TNA should not care about specific parties, nor should it possess a pre-existing bias in favor of one. It is unprofessional, and at a time when the GOP is taking a stronger position in TN detrimental to political activism.

Outright lies. I still kick myself for not taking the microphone and drilling whoever the woman was who stated that no woman has ever been elected to either statewide or federal office without the supporter of Emily's list. (This was during her speech extolling the virtues of a pro-abortion, liberal feminist democrat organization. To a group of young Tennesseans, the majority of whom I think were pro-life. And yes, I asked more than a few what their personal views were. And a majority is pro-life.) To tell such a lie, in such a way as to alienate future members, is just silly.

It was so bad, our instructor who pushes us to join and be involved in professional organizations even had bad thoughts. I think she said she was shocked and dismayed it was so unprofessional (from her, that was pretty harsh, and coupled with the fact multiple students told her she was leaving, and she responded "I don't blame you", says a lot. I know she did not hold it against us, because I told her I was going to meet one more Rep, then going home and skipping the rest. She nodded understanding.) It really did not matter if you were a GOP, Dem, or an Ind like me, it was utterly shameful.

More recent example of the TNA's bias and shame. Here in Tennessee, one of our 33 state Senators was a nurse. She won her party primary for re-election again, and was a shoe in. (This nurse defeated an incumbant to win her seat. Though I disagree with her politics largely, Rosalind Kurita deserved her seat.) However, the TN Dem party did not like one of her votes as a Senator, so they vacated her election. Not a word from the TNA. That in and of itself is damning that they would allow a nurse, who won her election fair and square, who even held the line on many TNA issues, to be abused shows their bias in favor of a party, and not values.

Back to the topic at hand, unions. Like I said before, I want there to be something for nurses. I will admit, I question whether outright unions are the answer. Maybe it is just my area, but unions not only are not popular (even with rank and file), but generally not trusted. It sure does not help their reputation that multiple large unionized businesses collapsed during the boom of the 90's. Still, we need a real professional organization I think more than anything else. If that was done I think most of TNs problems could be fixed minus the unpleasant union effects.

Also, I do not know if socialized medicine would be a panacea to our problems. I will gladly go more into depth, but I have to get ready for work.

[Woodenpug, BSN]

I'm sure we can all agree that staffing ratios are important to patient safety. What we seem to disagree on is whether or not unions are beneficial. Both sides, I'm sure have experiences to validate their opinions. Still, either position is only opinion, no evidence seems to be available to demonstrate that unions are good for nurses and good for patients. Good ratios can be achieved without unions and without the threat of unions.

[herring_RN, ASN, BSN]

I'm sure we can all agree that staffing ratios are important to patient safety. What we seem to disagree on is whether or not unions are beneficial. Both sides, I'm sure have experiences to validate their opinions. Still, either position is only opinion, no evidence seems to be available to demonstrate that unions are good for nurses and good for patients. Good ratios can be achieved without unions and without the threat of unions.

Do you have peer reviewed published studies to support this?

[RN4MERCY]

Good ratios can be achieved without unions and without the threat of unions.

WP, I'm just curious about your use of the word "threat" in relation to the concept of union. For me, I would choose to use a positive analogy, like, the "threat" of a rainbow after a refreshing rain. An all RN union is not something to be feared, but something to look forward to; it's a thing of beauty for patients and nurses. It's more than a promise of protection amidst the tragedy of illness or injury that befalls a patient. An RN can legally and safely advocate for patients to receive the care they deserve, based on medical need.

You will not be able to name a state where legally enforceable minimum, safe nurse to patient ratios-- that includes mandated staffing up based on individual patient acuity, based on the independent professional, clinical judgement of the direct care nurse accountable for the patient's care exists-- without the collective effort of unionized nurses.

California's ratio law is the first in the nation. It was and is vehemently opposed by the hospital industry and the so-called nurse executives and their "leadership" union/associations. Their paychecks and bonuses are tied to their complicity with profit margins and unrealistic budget constraints, that benefits their boss at the expense of patients.

Industry wants supreme flexibility when it comes to staffing, without accountability for poor patient outcomes. Industry wants supreme profit and control because the paternalistic, top down system works for them. Based on a lot of personal experience organizing with CNA/NNOC, nurses welcome and recognize the benefits of collective advocacy for protecting their patients and their professional practice domain. Nurses understand their duty to protect their patients' health from being sacrificed on an accountant's spreadsheet.

[Woodenpug, BSN]

Just a brief answer RN4. I used the term threat because that was used in an earlier post. I think your logic does not work.

Let's us attempt to make a review of literature which we all agree will demonstrated whether or not unions make a difference to patient outcomes.

I follow this with a complete open mind. I think it is possible. We simply need to agree on a measurable outcome. Then do the research.

Using the blanket terms union, outcomes, ect. in several combinations, has not returned any evidence in reviewed literature. Still measurable outcomes are reported. I think we can work something out.

My proposed null hypothesis is:

Unions do not measurably effect patient outcomes.

[Woodenpug, BSN]

Do you have peer reviewed published studies to support this?

That improved staffing ratios are beneficial? Or that anyone has an opinion? The point is I did not attempt to show that I had any evidence. I made a clear statement that Im offering an opinion here. The op presented his opinion as if it were evidence. That study is clearly of little scientific value. I offer various ways where something similar to proof could be offered. The responses are simply more rhetoric and "cutesy" phrases. I do think some evidence exists or can be found one way or another. That, of course, until some such proof is found, is opinion.