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Study tallies costs of nursing strikes

Findings show increases in mortality, readmissions as a result of walkouts

Topics: Workforce, Nursing, Mortality, Quality, Performance Improvement, Readmissions

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February 03, 2012

Nursing strikes in hospitals are associated with a 19.4% increase in patient mortality, according to an analysis of New York state data conducted by National Bureau of Economic Research (NBER) economists. 

There have been a slew of nursing strikes in recent months, as unions continue to focus on organizing health care staffers to compensate for declining membership in other sectors. Nearly one million health care workers in 2008 were union members, up from 679,000 in 1990. Overall, more than 15% of hospital workers are unionized, accounting for 6% of all U.S. union members.

Using data reported to the Federal Mediation and Conciliation Service, NBER's Jonathan Gruber and Samuel Kleiner reviewed 50 nursing strikes that occurred at 43 New York hospitals between 1983 and 2004. They also evaluated hospital discharge data reported to the New York State Department of Health before, during, and after a strike.

Related: The tangible—and intangible—costs of nursing strikes

For each strike, the researchers compared in-hospital mortality rates occurring within 10 days of admission and 30-day readmission rates at the hospitals experiencing nursing strikes with rates at control hospitals in their area. They accounted for patient characteristics and found no meaningful change in patient populations during strikes that would account for rate variations.

According to the analysis, inpatient mortality rose by 0.36% from a baseline mortality rate of 1.86% during strikes, representing an increase of 19.4%. Moreover, readmission rates rose by 0.9% from a baseline of 13.8%, representing a 6.5% increase in readmissions.

The researchers note that increased mortality and readmission rates were especially pronounced among patients who diagnoses required more intensive nursing care. In addition, they found that hiring replacement workers to fill in for striking nurses had little impact on mortality or readmissions. However, hospitals that hired replacement RNs experienced no notable decrease in hospital admissions, while admissions at hospitals that did not hire replacements dropped by over 55%.  

Overall, 38,228 patients were admitted to New York hospitals during nursing strikes from 1983 to 2004. Based on their findings, the researchers estimate that, because of the strikes, an additional 138 patients died and an additional 344 patients were readmitted.

However, the researchers warn that the findings only "reveal a short-run adverse consequence of hospital strikes." They note that strikes may "contribute to long-run improvements in hospital productivity and quality driven by union-related workplace improvement initiatives" (Gruber/Kleiner, NBER paper, February 2012).

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