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High Road Versus Low Road: Hospitals Can Afford to Do the Right Thing

Beyond the quality of working life for nurses and quality of care for patients, high-road practices may ultimately save hospitals money. The landmark Harvard study concluded that higher nurse staffing ratios result in shorter lengths of stay and thus reduce both direct hospital costs of treatment and indirect costs associated with a hospital's liability and loss of reputation.28

Similarly, Johns Hopkins researchers report that patients with fewer RNs in the ICU at night incurred 14 percent higher hospital costs.29 Finally, the evidence suggests that hospitals that have adopted the high road remain at least as profitable as their counterparts. The University of Oregon's Labor Education and Research Center's survey of "magnet hospitals" shows an average profit rate of 5.2 percent, substantially above the national median of 3.2 percent. Costs associated with recruiting and training new nurses are reduced.

The Impact of Collective Bargaining: Unions Prevent Heart Attacks

Unions clearly have a significant impact on wages, benefits and staffing levels — the most important determinants of recruitment and retention. In addition, unions also play a critical role in providing nurses a meaningful voice on the job. Numerous studies point to the importance of employee involvement in hospital decision-making processes and of having a voice at work as one of the conditions that impact nurse retention.

One recent study compared union and non-union hospitals in California. Even after accounting for unions' potential impact on pay and staffing ratios, researchers found that unionized hospitals had 5.7 percent lower mortality rates for patients suffering acute myocardial infarction.30

The study's authors conclude that RN unions may promote "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" — exactly those attributes identified as constituting the heart of magnet hospital practices.31

This finding suggests that not only nurses themselves, but the country as a whole, may have an interest in seeing increasing numbers of nurses win the right to represent themselves through collective bargaining.

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