In spite of overall union membership decreasing in the U.S. over the past 30 years, the field of healthcare has seen a steady increase in representation. Organized labor has targeted the field of healthcare to increase membership dues even in right-to-work states. As registered nurses are an important cornerstone of the healthcare industry and provide the preponderance of direct patient care, one must ask the question if unions, or collective bargaining units, are benefiting or harming healthcare?

While many industries are leaving their union roots in the past as globalization and technological advances outpace the represented worker, nursing union membership is steadily rising. According to the Bureau of Labor Statistics, 20.4% of nurses belonged to a collective bargaining unit, which is significantly higher than the national average of 13.1% across the U.S. Nurses and healthcare workers were granted the right to unionize by the National Labor Relations Act nearly 40 years ago, a controversial move considering the "essential" public nature of nurses to provide care in various settings. Since that time, numerous labor unions have targeted nurses to unionize under the guise of improving patient outcomes.

RELATED: What Are Some Ways Nurses Can Influence Healthcare Organization Costs?

There is no single labor union that represents nurses across the nation. Unions such as Service Employees International Union represent nurses as well as many employee groups such as janitors and airport workers. Unions such as National Nurses United and state organizations like the California Nurses Association encourage nurses to join as they claim to be nurse-focused. However, most of these unions are neither organized nor led by nurses. Many union business representatives are labor lawyers who are unfamiliar with nursing practice or healthcare. This reflection of the leadership can cause the assumption that so-called nursing unions, or those representing nurses, are more interested in the power of membership dues. Nurses in a collective bargaining unit pay as much as $90 per month for union representation. Given the number of nurses working in represented organizations, unions are a lucrative business.

The power of having a union negotiate for the nurses can be appealing to many nurses, considering that nurses in union roles are paid 20% higher than nurses in non-union facilities. However, when a union decides to go on strike, many nurses are faced with losing significant wages during the strike as well as their own personal ethical dilemma of leaving their patients to replacement nurses who are unfamiliar with their patient population. Patient outcomes decline significantly during a nursing strike and the cost to the organization can be detrimental. Organizations have reported losses of over $46 million to train and replace the nurses for large strikes. These costs, even the deaths reported during strikes, are worn like a badge of honor for some nursing unions who boast of these outcomes to their constituents. Some smaller community hospitals have had to close their doors to serving their communities, never recovering from the cost of the nursing strike.

RELATED: What Does It Mean for a Nurse to Work in a Union Environment?

Research studies, such as Nurse Unions and Patient Outcomes, show that hospitals with successful unionization have slightly improved patient outcomes in the areas of hospital-acquired infections and readmission rates. Although this study concluded a casual effect of the union for the improvements, one can argue that patients fare better when admitted to a facility where nurses are represented. There are also studies showing that patients are less likely to die of a heart attack in unionized hospitals. Nurses working in unionized facilities also report a better job satisfaction rate than their non-union colleagues.

For states that do not have nurse-to-patient ratios, or that require their nurses to work overtime to the point of potential patient harm, a collective bargaining agreement can address these safety concerns. Nurses can see the value of contractual language that requires shared governance and quality committees. Consistent pay raises and healthcare coverage benefits are also written into nursing contracts. Conversely, union seniority will overrule skill and knowledge for most unionized roles as well as a lack of performance-based pay increases.

There is much research yet little definitive proof for either argument on the harm or benefit of unionizing nurses. The unstainable wage increases and golden ticket benefit packages with some institutions are creating sinkholes of cost versus a reasonable at-market wage that allows organizations to invest more into patient care programs. One fact remains true: unions in healthcare is big business for union leaders. Under the guise of improving nurses' working conditions and patient outcomes, unions continue to advocate for their own survival first and foremost.