Study: Nursing Strikes Erode Patient Care


SAUSALITO, CA (ASRN.ORG) -- Do Strikes Kill?  That is the provocative title of a study released last month that examined the quality of care in New York hospitals during 50 nursing strikes over two decades.

The answer appeared to be yes.

The authors, an MIT professor working with a Carnegie Mellon University student found that in-hospital deaths rose by 19.4 percent and readmissions by 6.5 percent for patients treated during strikes.

"This study provides some of the first analytical evidence on the effects of health-care strikes on patients, and suggests that hospitals functioning during nurses' strikes are doing so at a lower quality of patient care," the authors wrote in a working paper published by the National Bureau of Economic Research.

Temple University Hospital is now in the second week of a strike by 1,500 nurses and allied health professionals. The hospital has hired 850 replacement workers.

As she has many times before, Sandy Gomberg, a nurse who is interim chief executive officer of the hospital, said Friday that Temple has a plan that ensures "uninterrupted quality care." In a written statement, she said, "All of the activities in the hospital are closely monitored and have given rise to no concerns."

Striking nurses, though, say quality is surely suffering. Patricia Eakin, a Temple nurse who is president of the Pennsylvania Association of Staff Nurses and Allied Professionals, the striking union, said nurses transferring from one department in the hospital to another might need months of orientation. There have to be problems with starting so many brand-new employees at once. "How could it possibly be seamless?" she asked. 

Jonathan Gruber, the MIT economist who led the study, said those are typical comments during a strike. As someone with a long-standing interest in how resources matter in health care and "shocks" to the environment, he wanted to see some numbers. To his knowledge, his is the first study to look at the broad impact of nursing strikes on quality. One other found an increase in cesarean sections and problems with newborns during a strike in Ontario. 

Gruber said he was not surprised by his results. "I've seen how vital nurses are to hospital production," he said.

Until 1974, Congress prohibited hospital workers from striking, fearing it would disrupt patient care. Fifteen percent of hospital workers now belong to unions, the study said.

The researchers thought that strikes might have little impact because studies have shown that many hospitals provide too much care.

The study, though, found that strikes increased mortality and readmissions. The authors estimate that, out of 38,228 patients admitted during the New York strikes, 138 patients died because of the strikes and 344 more had to return to the hospital after release.

The increases occurred whether or not replacement workers were hired. Gruber said he does not know why, but that the change was greatest in "nursing intensive services." The study did not list those, but intensive-care units, for example, require more nurses per patient than typical medical-surgical floors.

"It clearly is about the nurses not being there or about the same quality of nurses not being there," Gruber said.

He said he couldn't say how to make patient treatment safer during a strike, but added that the study is "a cautionary tale that this strike has costs for patient treatment and moving a strike to resolution is an important goal for making sure hospital quality is maintained."

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    Stan Kenyon
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