The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #60008

Joanne E. Spetz, PhD¹, Jean Ann Seago, PhD, RN¹, and Michael A.O. Ash, PhD². (1) Department of Community Health Systems, University of California, San Francisco, 3333 California Street, Suite 410, San Francisco, CA 94118, 415-502-4443, jojo@alum.mit.edu, (2) Department of Economics, University of Massachusetts - Amherst, Thompson Hall, Amherst, MA 01003

In the past decade, there has been resurgence in union activity in the hospital industry. Unions that represent health professions have initiated elections for representation in an increasing number of hospitals and have engaged in work stoppages and strikes against hospitals. In the 1970s and 1980s, a number of studies found that hospital unions increased the wages and fringe benefits of workers represented by the unions. Recent hospital union activity has focused on workplace conditions. Unions emphasize their interest in increasing nurse-to-patient staffing ratios, “mandatory” overtime, and other non-wage issues. Some skeptics believe that these issues are a public relations ploy and that unions remain fundamentally interested in increasing the wages of the workers they represent. However, economic theory and empirical research suggests that job protection and improved workplace conditions are legitimate goals of unions. This study examines the causes of recent union activity in the hospital industry, and the effects of this activity on wages, staffing, and benefits. We are interested in three questions: (1) Do workers unionize because of low wages, poor working conditions, both, or neither? (2) How does unionization affect wages paid to workers, and has the wage effect changed over time? (3) How does unionization affect staffing ratios at hospitals, and has this effect changed over time? Using a unique dataset from California, we first estimate the factors that lead to unionization at a hospital, such as prior changes in staffing, wage declines, hospital characteristics, and market characteristics. We then estimate the effect of unionization on hourly wages and benefit expenditures per employee. Finally, we determine whether hospitals increase their staffing ratios after unionization has occurred. We pay special attention to differences between nonprofit and forprofit hospitals, between differently competitive markets, and in regions where hospitals are experiencing more financial pressure (such as from managed care). We also address the likely endogeneity of union existence with wages and staffing.

Learning Objectives:

• The audience will understand the effects of nursing unions on hospital staffing and wages.

Keywords: Workforce, Hospitals

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.