Objective: Test the hypothesis that unionized RNs bargain as professionals (i.e. bargaining on two levels, for both traditional economic goals (level I goals) and for goals designed to uphold professional standards (level II goals) and are willing to trade off some level I goals in favor of level II goals).
Data/Methods: A model of RN union bargaining is developed and the wages of hospital registered nurses and the patient care environment are examined. Adapted from the traditional efficient-contracts model of union-employer bargaining, the model uses wages to represent the level I goals and patient care to represent level II goals. A wage equation is derived. I test the model in two steps. I first examine the likelihood that unionized hospitals will have characteristics associated with better a patient care environment, and then estimate the size of the union wage premium. Data from the 1992 American Hospital Association’s Annual Survey of Hospitals and Nursing Personnel Survey are examined to test the model empirically. While more recent data would be desirable, the AHA discontinued the Nursing Personnel Survey in 1992.
Results: Results indicate that unionized hospitals are more likely to have characteristics associated with a higher quality patient care environment and that nurses have a lower wage premium than that usually observed for all wage and salary workers. In particular I find that unionized hospitals are more likely to temporarily close beds, limit inpatient admissions, and delay scheduling of elective procedures when faced with a nursing shortage. Unionized hospitals are also more likely to require cross-training for RNs who regularly float between units and to pay a wage premium for a bachelor’s degree and special certifications. I estimate a union wage premium for med/surg RNs of 5.5 percent, which is considerably lower than those achieved by traditional unions. This suggests that the hypothesis that nurses bargain as professionals holds.