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Unions are groups of workers who band together to engage in collective bargaining with their employer over working conditions, working hours, and compensation and benefits (Massachusetts Nurses Association, 2019). For instance, nurses unions have been known to advocate for improved safety protocol, higher nurse-to-patient ratios, and against forced overtime (, 2017). These are all potential positive results of unionization in healthcare aimed at not only improving job satisfaction but consequently improving patient care.

The California Nurses Association (2019) published pleasing results from their collective bargaining process. Their new contracts included:

  • safer staffing levels
  • more clearly worded meal and rest breaks
  • an expansion of workplace violence definitions
  • substantial pay increases with step increases and shift differentials

The article noted a positive response by one RN in regard to the safer staffing levels aimed at improving patient care (California Nurses Association, 2019). (2017) indicated that though various studies have attempted to identify correlations between nurse union membership and improved patient outcomes, the results have been inconclusive.

Perhaps contributing to this phenomenon is the fact that a union member can be tough to fire even for poor performance and bad behavior, therefore retention of problematic employees may be higher among unionized groups (, 2017). Likewise, mandated union mediation can make it difficult for a union member and their supervisor to resolve issues between the two of them.

It seems that while unions have greater power to negotiate desirable outcomes for staff and consequently patients, their presence can also lead to undesirable outcomes. The retention of problematic employees and the delay of conflict resolution are just two of the cons related to union presence in healthcare.


California Nurses Association. (2019). Wrap-up report. National Nurse,

Massachusetts Nurses Association. (2019). Why unions matter for young nurses.… (2017). Should I join a nurses union? Pros and cons.

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