New Nurse Union Will Press for More Nurses

As the result of the merger of three large nurse unions, hospitals may find themselves under more financial pressure from labor. But whether this will help patients or ameliorate the nursing shortage is unknown.

The three unions that merged are the United American Nurses, the California Nurses Association, and the Massachusetts Nurses Association. The new organization, an AFL-CI0 affiliate known as the United American Nurses-National Nurses Organizing Committee, claims to represent about 150,000 nurses. Its two biggest priorities are organizing more nurses and getting more states to require the kind of minimum nurse-to-patient ratio that’s required in California.

The California law, which went into effect in January 2004, initially mandated that medical-surgical units in all acute-care hospitals maintain a ratio of at least one nurse for every six patients.  A year later, that ratio was amended to one nurse per five patients.

If the new nurse union has its way, every state would adopt similar legislation to improve patient safety and the quality of care. But a recent study by the California Healthcare Foundation found that the quality of care has not improved in the state’s hospitals since the nursing ratio law became effective. For example, the average length of stay has remained the same since the ratio was imposed. “Other nursing-sensitive measures such decubitis (pressure) ulcers, failure to rescue after a postsurgical complication, deep vein thrombosis/pulmonary embolism (DVT), pneumonia mortality, and postoperative sepsis show similar results,” according to the report.

Of course, the nursing shortage is real and growing worse across the country. A 2003 study calculated that inflation-adjusted wages of nurses would have to grow about 3.5 percent a year for 14 years to end the shortage. Another study in Health Affairs found that from 2000 to 2006, California nurses experienced real wage growth that was 12 percent higher than that of nurses in other states. If that’s true, California hospitals have not only had to hire more nurses but have also had to pay them more to fill the number of positions required by law.

To the extent that the more powerful combined union can persuade state legislatures to mandate that hospitals hire more nurses, hospitals will feel intense pressure to raise nurse salaries to find enough job candidates. It’s not clear that even that will work, given the lack of sufficient output from nursing schools. But it’s certainly a prospect that hospitals should consider in their future business planning.