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The Relationship Between Nursing Unions, Job Satisfaction and Quality Patient Care

By Bisk
The Relationship Between Nursing Unions, Job Satisfaction and Quality Patient Care

There are 3.1 million registered nurses nationwide, which makes nursing the nation’s largest healthcare profession. Out of all licensed registered nurses, 85% of them are currently employed and working in the field of nursing.

A large number of healthcare services require some form of care to be provided by a nurse. In hospitals nurses make up the largest component of the staff and are the primary providers of patient care. In the U.S. there are four times the amount of nurses than there are physicians, which means nurses are required to provide a large variety of healthcare services in a large number of areas.

In almost all cases, nurses are caring for multiple patients during their 12-hour long shifts. These long shifts and high pressure working environments are what lead to a high amount of fatigue and job dissatisfaction among nurses, which can lead to burnout. Low wages and poor benefits also play a big role.

These frustrations and pressures are not unique to the nursing sector, and are familiar to other workers in other sectors as well. However, there are few jobs that are as highly in demand as nurses. Nurses know they are not so easily replaced and because of that they refuse to tolerate a dysfunctional working environment along with low wages and poor benefits. In cases where these are obstacles, unionization can prove to be useful.

The largest union and professional association of registered nurses in the U.S., National Nurses United (NNU), has about 185,000 members, according to CNN. The NNU is evidence of the popularity and success of unions when it comes to the field of nursing.       

How Job Dissatisfaction Affects the Quality of Patient Care

Many nurses join unions because they feel their voice is not currently being heard at their job when it comes to making decisions that affect them and how they do their job. The goal of many nurses is to provide quality care to each one of their patients, but without any say in the policies that shape their working environment nurses feel less empowered to provide their patients with high quality care.

“Control over practice means nurses have ‘a voice in decisions that affect the patient care environment and their ability to deliver quality care,’” according to

This kind of control requires an organizational structure that gives nurses the freedom to shape policies pertaining to patient care as well as access to the organizational resources that are required in order to provide that care.

When resources are threatened or unavailable, nurses start to feel a loss of control over something they value and strive for everyday, which is to provide the highest quality care possible. This is when feelings of frustration start to rush in causing job dissatisfaction along with a decline in the quality care of patients. Nurses left without control over their practice will either leave the hospital setting altogether or seek out other means of empowerment by joining a nursing union. Unions use a method known as collective bargaining to offer nurses the possibility of control over their practice. 

Through collective bargaining, a collective voice is formed among nurses so they can effect change and do what they can to improve the present patient care environment.

The Relationship Between Unions and Retention Rates

Similar to other professions, job satisfaction is an important predictor when it comes to retention among nurses. Studies have shown that turnover-rates are highest for newly licensed hospital-based nurses. Within 3 years of employment, 43% of these nurses leave their job, according to 

Some healthcare facilities have implemented nursing residency programs to help reduce turnover. These programs are meant to assist new graduates while transitioning into their first nursing position. A systematic review performed by Nurse Education Today in 2014 showed that residency programs do indeed reduce turnover and are actually more cost effective when compared to traditional orientation of new graduates.

Job dissatisfaction among nurses not only leads to high turnover rates, but it also increases the number of unionized nurses, which may not be such a negative thing it turns out. In fact, a study published by the Journal of Nursing Administration showed that retention rates are higher among nurses that belong to unions. The same study also showed that unionized nurses had a higher average income than non-unionized nurses.

So while job dissatisfaction does usually lead to unionization, it also seems to improve retention rates of nurses by giving them a way to voice their concerns and then hopefully have them resolved. Some common grievances causing job dissatisfaction among nurses include: lack of autonomy, job-related stress, lack of opportunities for self-growth and promotion, negative interactions with physicians and not being involved in decision-making processes. Any one of these issues could be addressed in an attempt to improve retention rates among nurses.

Category: Nursing