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Nurse Unions and Patient Outcomes

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  • Arindrajit Dube
  • Ethan Kaplan
  • Owen Thompson

Abstract

The authors estimate the impact of nurse unions on health care quality using patient-discharge data and the universe of hospital unionization in California between 1996 and 2005. They find that hospitals with a successful union election outperform hospitals with a failed election in 12 of 13 potentially nurse-sensitive patient outcomes. Hospitals were more likely to have a unionization attempt if they were of declining quality, as measured by patient outcomes. When such differential trends are accounted for, unionized hospitals also outperform hospitals without any union election in the same 12 of 13 outcome measures. Consistent with a causal impact, the largest changes occur precisely in the year of unionization. The biggest improvements are found in the incidence of metabolic derangement, pulmonary failure, and central nervous system disorders such as depression and delusion, in which the estimated changes are between 15% and 60% of the mean incidence for those measures.

Suggested Citation

  • Arindrajit Dube & Ethan Kaplan & Owen Thompson, 2016. "Nurse Unions and Patient Outcomes," ILR Review, Cornell University, ILR School, vol. 69(4), pages 803-833, August.
  • Handle: RePEc:sae:ilrrev:v:69:y:2016:i:4:p:803-833
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    References listed on IDEAS

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    1. Carol Propper & John Van Reenen, 2010. "Can Pay Regulation Kill? Panel Data Evidence on the Effect of Labor Markets on Hospital Performance," Journal of Political Economy, University of Chicago Press, vol. 118(2), pages 222-273, April.
    2. Aaron J. Sojourner & Brigham R. Frandsen & Robert J. Town & David C. Grabowski & Min M. Chen, 2015. "Impacts of Unionization on Quality and Productivity," ILR Review, Cornell University, ILR School, vol. 68(4), pages 771-806, August.
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    4. Cook, Andrew & Gaynor, Martin & Stephens Jr, Melvin & Taylor, Lowell, 2012. "The effect of a hospital nurse staffing mandate on patient health outcomes: Evidence from California's minimum staffing regulation," Journal of Health Economics, Elsevier, vol. 31(2), pages 340-348.
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    6. Lee, Lung-Fei, 1978. "Unionism and Wage Rates: A Simultaneous Equations Model with Qualitative and Limited Dependent Variables," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 19(2), pages 415-433, June.
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    Cited by:

    1. Emin Dinlersoz & Jeremy Greenwood & Henry Hyatt, 2014. "Who do Unions Target? Unionization over the Life-Cycle of U.S. Businesses," NBER Working Papers 20151, National Bureau of Economic Research, Inc.

    More about this item

    Keywords

    unions; health care quality; nursing; productivity;

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • J51 - Labor and Demographic Economics - - Labor-Management Relations, Trade Unions, and Collective Bargaining - - - Trade Unions: Objectives, Structure, and Effects

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