The Massachusetts Nurses Association, United American Nurses and California Nurses Association/National Nurses Organizing Committee announced yesterday their merger, creating a 150,000-member-strong force to be reckoned with.  While improved terms of employment for nurses should be welcome, it will be important to balance a variety of other factors.  One thing that leaps to mind upon reading this news is the California experience with mandated nurse-to-patient ratios, circa 2004.  The mandate was supported by the California union, among other constituencies.  The improved staffing ratios, intended to benefit patient care, instead resulted in some unit closures, whole hospital closures, and ambulance diversions, when there were insufficient numbers of nurses available to fill the mandated positions.  Recent coverage of the union merger notes that research has shown that mandated nurse staffing ratios do not improve key quality indicators or outcomes Here's hoping that the merged union does not push for mandated staffing ratios, since (a) the nurses needed to meet those ratios just aren't available (in fact, there's already a shortage), and (b) the mandates apparently do not improve patient care.  There are other avenues open to facilities and their staff to improving patient care.

Update 2/20/09:  Health Affairs just published a study documenting California's higher-than-average rate of nurse salary increases since the implementation of the staffing ratio law.  The usual caveats are provided, but … coincidence? I think not.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting