Do Nurses Strikes Kill? (‘fraid so – as you’d expect)

From the NBER digest.

U.S. hospitals were excluded from collective bargaining laws for three decades longer than other sectors because of fears that strikes by nurses might imperil patients’ health. Today, while unionization has been declining in general, it is growing rapidly in hospitals, with the number of unionized workers rising from 679,000 in 1990 to nearly one million in 2008. In Do Strikes Kill? Evidence from New York State (NBER Working Paper No. 15855), co-authors Jonathan Gruber and Samuel Kleiner carefully examine the effects of nursing strikes on patient care and outcomes.

The researchers match data on nurses’ strikes in New York State from 1984 to 2004 to data on hospital discharges, including information on treatment intensity, patient mortality, and hospital readmission. They conclude that nurses’ strikes were costly to hospital patients: in-hospital mortality increased by 19.4 percent and hospital readmissions increased by 6.5 percent for patients admitted during a strike. Among their sample of 38,228 such patients, an estimated 138 more individuals died than would have without a strike, and 344 more patients were readmitted to the hospital than if there had been no strike. “Hospitals functioning during nurses’ strikes do so at a lower quality of patient care,” they write.

Still, at hospitals experiencing strikes, the measures of treatment intensity — that is, the length of hospital stay and the number of procedures performed during the patient’s stay — show no significant differences between striking and non-striking periods. Patients appear to receive the same intensity of care during union work stoppages as during normal hospital operations. Thus, the poor outcomes associated with strikes suggest that they might reduce hospital productivity.

These poor health outcomes increased for both emergency and non-emergency hospital patients, even as admissions of both groups decreased by about 28 percent at hospitals with strikes. The poor health outcomes were not apparent either before or after the strike in the striking hospitals, suggesting that they are attributable to the strike itself. And, the poor health outcomes do not appear to do be due to different types of patients being admitted during strike periods, because patients admitted during a strike are very similar to those admitted during other periods.

Hiring replacement workers apparently does not help: hospitals that hired replacement workers performed no better during strikes than those that did not hire substitute employees. In each case, patients with conditions that required intensive nursing were more likely to fare worse in the presence of nurses’ strikes.
“From Evidence on the Effects of Nurses’ Strikes” By Jonathan Gruber and Samuel A. Kleiner

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11 years ago

Well, obviously they kill.

Does this mean nurses — who provide life-saving services — should be slaves and forced to work against their will, because they chose to do something particularly and visibly crucial in their careers?

I am no fan of unions. At all.

Nor am I a fan of nurses’ unions in particular.

But they’re not soldiers (where truly subjecting their individual will and interests to the majority is part of the social contract they agree when they “sign up”). They’re civilians, free people, and should have the right to negotiate and strike… be criticized for striking… and work out whatever deal they can.

But then, nurses shouldn’t be forced to join a union either. And if a particular nurse, for either economic or moral reasons, chooses to work … they should be permitted to. Any attempt (other than social and economic pressure, for example, by denying the benefit of any collective agreement) by the unions to interfere with this nurse’s willingness to work (and save lives) should not be tolerated.


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Edward Mariyani-Squire
Edward Mariyani-Squire
11 years ago

Interestingly, or strangely, or disturbingly, nurses strikes might fall within the perview of Australia’s anti-terrorism legislation. Here’s what Michael Head, in his co-authored book, Law in Perspective (pp.426-427) has to say:

Thus, terrorism extends to acts or threats that advance ‘a political, religious or ideological cause’ for the purpose of ‘coercing or influencing by intimidation’ any government or section of the public. ‘Advocacy, protest, dissent or industrial action’ is exempted but not if it involves harm to a person, ‘serious damage’ to property, ‘serious risk’ to public health or safety, or ‘serious interference’ with an information, telecommunications, financial, essential services or transport system.
This definition could cover any demonstration or strike action in which a person was injured or felt endangered. The ‘coercion or intimidation’ clause is practically meaningless, given that the purpose
of many protests and strikes is to apply pressure to a government, employer or other authority. Nurses taking strike action that shuts down hospital wards in support of a political demand for greater health spending, for example, could be accused of endangering public health and thus the nurses could be charged as terrorists.

Tom N.
Tom N.
11 years ago


Well, according to this, anyway. Go figure…