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."

Higgins points to a number of examples in recent years of where the strength of nurses unions, and the ability of nurses to stand up to health care administrators over patient care issues have had direct impact on the quality of care patients receive.

She points to specific provisions nurses have negotiated into MNA union contracts. These include:

• Limits on the Use of Unlicensed Personnel - Throughout the early 1990’s hospitals across the country and throughout Massachusetts attempted to cut costs by implementing care delivery models that involved replacing registered nurses with lesser qualified, unlicensed personnel. In 1996, nurses at Brigham & Women’s Hospital drew national attention when they took a vote to go out on strike to prevent implementation of such a plan at their facility. The nurses won language in their contract to prevent this practice and since then, a number of other MNA hospitals secured similar language, which protects patients from receiving care from someone unprepared to meet their needs.

• Limits on Mandatory Overtime - Again, as hospitals cut costs by laying off nurses and operating with a skeleton nursing staff, the practice of using forced overtime to compensate for lack of staff proliferated through Massachusetts hospitals. Patients throughout the state began receiving care from exhausted and overworked nurses, who were more prone to make errors. In 1997, nurses at Boston Medical Center voted to go out on strike over the issue. In 2000 and 2001, nurses at St. Vincent Hospital/Worcester Medical Center and Brockton Hospital did go out on strike over this issue. The result of these actions was the negotiation of landmark language in contracts to require appropriate staffing, limit mandatory overtime and to allow nurses the right to refuse overtime should they feel too tired to provide safe care.

• Improvements in Staffing - The most important factor contributing to a nurse’s ability to provide safe, quality patient care is the number of patients he or she is assigned. Because of health care cost cutting measures, most nurses in Massachusetts are being asked to care for too many patients. Here again, MNA local bargaining units have been able to negotiate a number of provisions to help improve nurses staffing ratios. At Boston Medical Center, the nurses’ union and management work together to determine appropriate staffing levels, at St. Vincent Hospital/Worcester Medical Center actual staffing guidelines have been established. Unionized nurses are also leading the effort to pass legislation that will mandate safe nurse-to-patient ratios in all health care facilities, union or non union, to ensure that all nurses can practice safely, and that all patients have access to quality patient care.

• Inappropriate Floating of Nurses - As hospitals have cut back on nurses, they have attempted to compensate for short staffing by forcing nurses to move from one area of the hospital to another to cover for vacancies on a given shift. Very often they move nurses from unit to unit without any effort to ensure the nurse being floated is prepared to practice in the new area. For example, a medical surgical nurse is moved from her floor to cover in the emergency room, even though she has no training or experience in emergency nursing. A number of MNA bargaining units have used the collective bargaining process to negotiate limits on this activity and/or to force the hospital to provide appropriate orientation to a nurse before he or she is floated to an unfamiliar unit.

According to Higgins, the biggest and most obvious advantage unionized nurses have is the ability to say "no." "If you work in a non-unionized hospital and management decides it wants to impose mandatory overtime, replace your colleague with an unlicensed person, or ask you to care for 12 patients when you should be caring for five, there is really nothing you can do to stop them. In fact, many nurses in non-unionized facilities have found themselves without a job when they speak up about such conditions. When that happens, the patients being cared for in that environment are the ones who suffer. Their health and safety depends on the conditions the nurse is asked to practice in. If nurses lack a protected voice and cannot truly advocate to make those conditions safe, then the patient will not be safe."