RN Unions
Relationship Between Patient Outcomes and Hospitals with RN Unions
SUMMARY: Research in California shows you have a better chance of surviving a heart attack if you are fortunate enough to be treated in a hospital where the RNs are union members.
Rsearchers Jean Ann Seago and Michael Ash, using California data, found that hospitals with RN unions have 5.7% lower mortality rates for acute myocardial infarction that non-unionized hospitals.
Seago’s and Ash’s research follows the 1999 Institute of Medicine report on hospital errors. Drawing on data from 343 acute care hospitals in California, they sought to determine if there is a relationship between the presence or absence of a bargaining unit for registered nurses and acute myocardial infarction (AMI) mortality rate, adjusted for patient age, gender, type of AMI, and chronic illnesses. 35% of the hospitals in their survey 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.
It is difficult to separate the different effects unions may have on the quality of care. Unions might improve patient outcomes by negotiating increased staffing levels, better wage levels, reduced turnover, or by giving nurses a “voice at work” which allows them to change the way care is delivered. Seago and Ash attempted to distinguish these effects by controlling for wages and for RN hours, and found that the union has an effect on outcomes beyond simple increases in wages or bargaining unit hours.
Though their research demonstrates a positive relationship between patient outcomes and RN unions, Seago and Ash are unable to determine causation.
Seago, J.A. and Ash, M. Registered Nurse Unions and Patient Outcomes. Journal of Nursing Administration.1998; 32(3):143-151. For more information, contact jean.ann.seago@nursing.ucsf.edu.
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