27-02-2013, 04:53 PM
THE EFFECT OF REGISTERED NURSES UNIONS ON HEART-ATTACK MORTALITY
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Work Organization and Productivity
Many studies show that organizational
characteristics of hospitals influence patient
outcomes. Showstack and others
(Flood, Scott, and Ewy 1984b, 1984a;
Mitchell and Shortell 1997; Showstack,
Kenneth, and Garnick 1987) have found
that higher patient volumes in hospitals are
associated with reduced patient mortality
in both medical and surgical patients. These
studies conclude that patient volume is a
proxy for experience or expertise of the
hospital staff and care providers. In a quasiexperimental
setting that controlled for
hospital-patient-procedure selection,
McClellan, McNeil, and Newhouse (1994)
and McClellan, Henson, and Schmele
(1994) found that cardiac technology was
of limited value in reducing heart-attack
mortality, but that the quality of care in the
first 24 hours following the attack had important
effects on the likelihood of death.
Aiken, Smith, and Lake (1994), Aiken and
Fagin (1997), and Aiken, Slaone, Lake,
Sochalski, and Weber (1999) found that
the organizational characteristics of “magnet
hospitals,” distinguished by good human-
resource practice for R.N.’s, are related
to decreased 30-day mortality rates
and improved patient satisfaction.
Wage Effects and Seniority
Research indicates that R.N. unions are
associated with slightly higher R.N. wages
(Hirsch and Schumacher 1995; Wilson,
Hamilton, and Murphy 1990), although
Hirsch and Schumacher (1998) found
smaller union wage premiums among
healthcare workers than among similar
workers in other industries and smaller
union premiums among R.N.’s than among
less-skilled health workers.
A higher wage may shock management
into improving H.R. practice and other
aspects of work organization (Booth 1995).
For example, a higher wage might improve
the quality of the nursing staff by changing
hospital hiring practices. Facing the higher
wage, employers may become more selective
in hiring and limit hires of nurses with
the associate’s degree in nursing in favor of
nurses with bachelor’s degrees or graduate
education.
Staffing Levels
The work burden is one of the mandated
topics of collective bargaining, and staffing
levels have been a particular focus of activism
by R.N. unions in California. Unions
may improve the quality of care by negotiating
increased staffing levels, which improve
patient outcomes (Kovner and
Gergen 1998; Needleman, Buerhaus,
Mattke, Stewart, and Zelevinsky 2002). On
the other hand, unions may raise wages to
such an extent that the employer slows
hiring or stops hiring nurses, adversely affecting
staffing.