That’s a big yes, according to a new research paper from the National Bureau of Economic Research (NBER).
The study shows that nurse strikes increase in-hospital mortality by 19.4 percent and 30-day readmission by 6.5 percent, numbers based on strikes in heavily organized New York State from 1984 through 2004. Patients who require extra attention are particularly affected and the study also shows that outcomes are just as negative for those patients admitted to hospitals that employ replacement or “scab” labor.
(For perspective: more than 15 percent of hospital employees are unionized; that’s six percent of American organized labor. And while unionization rates in most American labor markets have been in freefall for decades, union membership in hospitals is actually increasing, from 679,000 in 1990 to around 1 million in 2008. Outside of retail, construction, and manufacturing, healthcare workers go on strike more frequently than any other group of workers.)
The NBER paper’s findings are deeply troubling, if not particularly surprising. Nurses are an essential part of medical services. They are the people regularly closest to the patients, functioning as the eyes and ears of the a medical operation. A hospital without nurses simply won’t be able to comprehensively cover its patients and, given the nature of the work, it’s easy to see how a strike could be deadly. (Of the 38,228 patients admitted during strikes in the sample studied, 138 patients died who might have lived under normal conditions.)
If this study creates enough of a stir, we could see some states try to take steps to mitigate the dangerous consequences of a nursing strike. But should the labor rights of hospital staff be curtailed due to the nature of their work? If so, how should policy makers react? Three thoughts on this below the jump.
1. I could easily see some states simply outlawing strikes among hospital workers. There is plenty of precedent for such an action. In many states unionized police officers and firefighters are legally unable to go on strike because their duties are too important to risk prolonged absences.
2. Health care union laws could be reformed, although I’m not sure what fix could address the essential problem. Current law requires health care unions to provide a written notification to management and the Federal Mediation and Conciliation Service, pinpointing the exact date and time of striking or picketing, 10 days prior to the action. This provision gives hospitals time to prepare and find replacement workers. But the study shows that these temporary employees don’t have much affect on the in-hospital mortality or re-admission rates. I imagine that’s because the scabs simply don’t have the experience or the workplace relationships to work the job well. Extending the notification period wouldn’t change that.
3. Before significant reforms take place, there is another issue to consider. Labor lawyer/blogger Jeff Hirsch writes: “I also wonder what data is out there on patient care in unionized hospitals versus nonunionized ones. That’s a slightly different topic, but has some relation to the policy questions involved.” True, and while a comprehensive study hasn’t been conducted, to my knowledge, the NBER study’s authors note that unrelated researchers have found higher output rates and lower heart-attack mortality rates at unionized hospitals. I’m not surprised. Having a job with benefits, consistently decent pay, and worker representation usually results in less turnover, higher levels of productivity, improved workplace communication, and a better trained workforce. Policy makers should keep these benefits in mind. As the NBER study’s authors write, “Our results reveal a short-run adverse consequence of hospital strikes. These strikes may, however, contribute to long-run improvements in hospital productivity and quality…”
“But should the labor rights of hospital staff be curtailed due to the nature of their work?”
How about firemen, police, or paramedics?
Where’s the Waste Management coverage, dude?
Perhaps what this study is really telling us is that nursing care is vital to the health and well-being of patients, and that management’s conscious decision to place profits over patient care is as much a factor here as anything.
It would be very interesting if a similar study could be made on the effects of, say, hospital administrators walking off the job on patient mortality and re-admission rates. I realize it’s not likely there would be enough examples of such on a large scale to correlate, but my guess is still that, if one COULD see such numbers, they’d show little-to-no negative impact at all.
I wonder also how this compares to the quality of care and mortality impacts of administrative practices which have resulted in worsening working conditions for nurses at some clinics and hospitals? For example, my mom works at a private clinic in Vancouver WA which recently moved almost all of its pediatric RN staff off-site, replacing them with LPNs. The nurses at this clinic aren’t organized, so RNs like my mom have no way to fight back against management policies which they believe will negatively impact quality of care in their departments…
Maybe if the hospitals (and doctors also) stopped treating nurses like shit, they wouldn’t need to worry about them unionizing, eh? Or is that too easy?
@5 Too easy and spot on. Nurse unions ensure that nurses don’t have to work extreme hours in shortage situations. It means nurses get to do a good job, save lives, and not burn out. If they strike, it’s because hospitals are fucking them over. Fix that and people won’t die.
@6: Do they, or do most labor contracts just assure that nurses get compensated decently when they work insane hours? My understanding is that mandatory overtime is pretty commonplace for nurses.
Nurses need labor contracts, and their patients need them even more. I work with a shit-ton of nurses, and I can’t believe the amount of work and responsibility that gets piled on. You couldn’t get me to do that job if you held a gun to my head.
I second #2. I am having trouble making any sense of the stories in mainstream press. If the P-I is to be believed, then the union flatly turned down a contract that would have paid garbage truck drivers in excess of $100k/year, including benefits. (By way of comparison, last I checked, the median income for Seattle was under $70k/yr.) This seems so wholly absurd that it cannot possibly represent the whole story.
@8:
It doesn’t.
http://www.teamsters117.org/index.cfm?zo…
Do remember to check the source and take it with a bit of a grain of salt. NBER, Inc. is not a non-partisan governmental office, regardless of how it sounds. Check the following:
http://www.sourcewatch.org/index.php?tit…
I find it unsurprising that an organization headed by a strongly “free market” economist would find that labor organization is terrible. They are largely funded by the Smith Richardson Foundation, which is largely headed by very conservative folks (e.g. a lot of overlap with the American Enterprise Institute).
http://old.mediatransparency.org/funderp…
Seriously. Shouldn’t the headline here be, “Does paying nurses shit to do an incredibly difficult job and forcing them to beg for COLA and benefits have killer consequences?”
@2 Good question. Things have been a bit hectic of late with my other jobs, and I’ve had to scale back my Slog posting. I’ll be back with a Seattle-centric post later this afternoon or tomorrow, perhaps a catch-up on the Waste Management labor troubles.
nursing unions in Washington State work together to protect and improve the working conditions for nurses and other healthcare workers we passed a law in 2001 for no mandatory overtime. We are working on staffing committees in all of our hospitals, Safety for nurses is safety for patients. we continue to get pushback from the Hospital Association on issues we raise, it is not all about the money, but proper staffing, skill mix, rest time to provide quality, safe patient care.
First get the facts straight. The ten day notice to the employer is NOT to allow for the hiring of scabs but instead to give the facility time to stop voluntary non emergent admissions, and time to transfer more acutely ill patients to other facilities. The intent should be to lower the census. Instead most employers hope to make it look like nurses are inconsequential in the day to day operations and so they needlessly put patients at risk. When nurses strike it is not for the same reasons that other disciplines strike. It is usually the means of sharing with the community the serious concerns about the environment that patients are in. Staffing shortages, mandatory overtime, limited supplies, overwhelming regulatory obligations and management who seem to forget that there are human beings lying in those beds, not blocks of wood. There is nothing more egregious to a nurse then to leave a patients bedside knowing that the care that patient needed was not given. But after pursuing every other avenue sometimes you have to cross the line in the sand to make people understand that if the necessities to improve the level of care are not provided more patients will suffer in the long run.