The Impact of Collective Bargaining
Although they are not much discussed in the nursing literature, hospital unions have a critical role to play in solving the nursing shortage. In most of the industry, unions provide the best — or only — avenue for improving the pay and staffing levels of staff nurses in the face of management teams that have been overwhelmingly driven by cost-cutting strategies. Given that pay and staffing are the two most commonly cited factors affecting recruitment and retention, unions stand at the heart of the nation's efforts to solve the nursing shortage.
Beyond their impact on wages and staffing, however, 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. Both scholars and administrators stress that to truly improve the working conditions of RNs and facilitate an effective recruitment and retention strategy, employees must have a meaningful say over the policies that shape their work lives. Token input on committees where the final say is dictated by management will do little to alleviate the cynicism, stress and burnout nurses report experiencing on the job. In this sense, unions may be ideally suited to help hospitals achieve this dimension of best practices for recruitment and retention. While it is possible for hospital administrators to share real decision-making authority with staff nurses even without a union, it is exceedingly rare. It is much more realistic to find this type of partnership constructed through a collective bargaining relationship.
One recent study compared union and non-union hospitals in California, controlling for both staffing levels and wages among other factors. 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.325
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 that Aiken and others identify as lying at the heart of magnet hospital practices.326 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.