Hospital Unions, Staffing, Wages, and Patient Safety

During the past two decades, there has been a resurgence in union activity in the health care industry in the United States, particularly in hospitals. As health care unions become more influential in hospital operations and in national policymaking, it is important we understand how they are likely to affect the landscape of health care.

This study has four specific objectives:

1. To measure the growth of hospital unions in the United States using numerical data at both the individual and hospital level, and to identify the factors that lead to unionization at a hospital.
2. To quantify the effects of hospital unions on wages in unionized and in non-unionized hospitals, and to assess the effect of union-driven wage growth on growth in overall hospital costs.
3. To examine the relationship between unions and hospital staff levels, and to determine whether unions increase nurse-to-patient and staff-to-patient ratios.
4. To evaluate whether hospital unions improve patient outcomes, both indirectly by improving working conditions and indirectly by improving process of care.

This study uses national and state data to address the objectives, with a focus from 1995 through 2006.