Although unionization can be linked to better job safety and other improved occupational outcomes for frontline skilled nursing workers, there’s not enough evidence to show that it improves resident care.
That’s the finding of a first-of-its-kind scientific review directly examining how labor representation may improve conditions for direct care workers, including nurse aides in long-term care settings and home health aides.
“Past research on the influence of unionization among providers in the healthcare sector has found that unions are often associated with higher wages, better benefits and enhanced outcomes for both employees and patients,” a team from Cornell University and Weill Cornell Medicine reported in JAMDA last week.
“These reviews, however, have not focused on DCWs, a growing sector of the healthcare workforce poised to care for millions of older adults in the coming years,” they added. “Our study fills this gap and advances our understanding of unionizations’ impact on DCWs. Specially, unionization was associated with higher wages, better benefits and improved retention and job satisfaction.”
But the study found wide variation by setting in terms of results for workers and their patients.
The review of 19 previous studies showed unionization improved take-home pay for skilled, including licensed nurses, and unskilled frontline workers, such as CNAs in nursing homes. But job quality and staff turnover outcomes only improved for unskilled positions when workers unionized.
The study also found that while unionization sometimes lowered risk of injury and infection on the job, it did not do so consistently. Most studies related to patient quality measures were of poor design, the researchers added.
While unionization was tied to reduced turnover, and reduced turnover and consistent staff have been previously linked to better care for residents, the researchers in this review did not make the jump from unionization to quality care.
“I think it was a bit beyond the scope of our paper,” co-author Daniel Spertus of Weill Cornell told McKnight’s Long-Term Care News in an email. “While I believe the link between reduced turnover and care quality is logical, I also believe that it could be influenced by various other factors, like organizational practices, specific work environments.”An abstract of the study is available here.
