Nursing unions: A scoping review of outcomes for employees, patients, and administrators

Abstract

Background

Nursing labor organization is consequential to many stakeholders, but collective evidence for outcomes associated with nurse unionization is lacking.

Purpose

To synthesize evidence of associations between nursing unions and nurse, patient, and system outcomes.

Methods

A scoping review.

Findings

Twenty-four articles spanning nearly 50 years were abstracted. Most studies (n = 16; 67%) included nurse outcomes, usually remuneration (n = 10; 42%). Patient and system outcomes were less common (for each: n = 7; 29%). Union wage premiums were modest. Evidence for other nurse outcomes (e.g., job satisfaction, retention) was limited and mixed. Unionization was associated with improvements in many but not all patient outcomes studied, and with operational differences, including decreased staffing and labor substitution.

Discussion

Collective bargaining outcomes may help administrators understand nurses’ needs and concerns and thereby improve nurse recruitment and retention. For example, modest wage effects may signal nonwage priorities among nurses, which are understudied and worthy subjects of future research.