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Evidence for Nursing Staff Unions

Several studies have examined the effects of RN unions on patient outcomes and RN job satisfaction. A 2002 study of hospitals in California found that those with a RN union had 5.7% lower mortality rates from acute myocardial infarction after accounting for demographics and risk [1]. Another study in California found that hospitals with a RN union outperform non-union hospitals in 12 of 13 nurse sensitive outcome measures including depression and metabolic derangement [2]. Nurse unionization efforts in California contributed to legislative victories such as mandatory patient-to-nurse ratios, which have consistently led to better staffing and retention and higher job satisfaction among nurses [3].


The AFSCME International union represents one of the largest nurse unions in California and brings support from a large organization to help us negotiate for similar benefits in the interest of optimal patient outcomes. Some older studies have shown a negative correlation between nurse unions and workplace satisfaction, but this correlation was highest in the first years after unionization and likely a result of factors which led to unionization in the first place [4]. This may also reflect increased levels of self-efficacy and willingness to speak felt by unionized nurses. Overall, evidence suggests that nurse unions lead to better patient outcomes and better working conditions for nurses, and positive changes in healthcare delivery systems.


We are organizing to collectively bargain for better conditions for all nursing staff at McLean. We are doing so not because we want a simple wage adjustment, a billboard declaring us heroes, or a luau in our honor. We only want to continue to provide the highest quality care possible for our patients. Better compensation and working conditions are the clear solution to the staffing shortage which is burning us out and taking a toll on patient care. We hope that all RN and MHS/CRC staff join us in this effort to bring democracy to the workplace and allow McLean to continue to serve as the nation’s foremost bastion of psychiatric and behavioral healthcare.


1. Seago, J. A., & Ash, M. (2002). Registered nurse unions and patient outcomes. JONA: The Journal of Nursing Administration, 32(3), 143-151.

2. Dube A, Kaplan E, Thompson O. Nurse Unions and Patient Outcomes. ILR Review. 2016;69(4):803-833. 

3. Koen Van den Heede, Justien Cornelis, Nicolas Bouckaert, Luk Bruyneel, Carine Van de Voorde, Walter Sermeus, Safe nurse staffing policies for hospitals in England, Ireland, California, Victoria and Queensland: A discussion paper, Health Policy, Volume 124, Issue 10, 2020, Pages 1064-1073.

4. Freeman R, Medoff J. Are They Satisfied? What Do Unions Do? New York: BasicBooks; 1984:136-149

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