The California Nurses Association (CNA) is quarterbacking the drive for single-payer, government-monopoly health care. Such a system, experience shows, creates problems for nurses and patients alike.
The CNA is so powerful that a recent Wall Street Journal article described it as “co-equal” with management in governing operations at many facilities of Kaiser Permanente. The CNA also plays a key role in the National Nurses Organizing Committee (NNOC), dedicated to militant unionization of the entire U.S. nursing workforce. The CNA/NNOC recently announced that the Massachusetts Nurses Association has voted to join it in the emerging National Nurses Union, which will be affiliated with the AFL/CIO. The Service Employees International Union (SEIU), which split from the AFL/CIO in 2005, is also competing vigorously to organize nurses.
Any movement needs some crowd-pleasing ideas to win support, and the CNA has long held one that seems reasonable: minimum nurse-patient ratios in hospitals. They got what they wanted in 2004 with AB 394, which required California hospitals gradually to comply with government-dictated – actually union-dictated – nurse-patient staffing ratios, with a four-year roll-out.
The ratios range from 1:2 for intensive/critical care to 1:5 for medical/surgical care. U.S. Senator Barbara Boxer has sponsored similar federal legislation. These folks hope that a government-run health care system will give them complete power over nurses’ working conditions.
California’s hospitals, and Governor Schwarzenegger, credibly allege that the staffing ratios have contributed to unsustainably high costs and reduced hospitals’ capacity. Research sponsored by the American Nurses Association and the Association of California Nurse Leaders – which are professional societies rather than unions – concluded that California’s mandated staffing ratios did not improve relevant outcomes, such as improved safety from falls or less likelihood of hospital-acquired pressure ulcers.
In 2008, Debra Delaney, RN, of Blue Jay Consulting, LLC, completed a thorough review of primary and secondary literature on nurse-patient ratios and health outcomes. Delaney concluded that while a higher number of nurses is associated with better health outcomes for hospitalized patients, this does not imply that mandatory nurse-patient ratios has the same effect. While legislated nurse-patient staffing ratios might appear to serve the narrow interests of the nursing profession, it’s pretty clear that access to medical services via a single-payer system does not lead to an adequate number of nurses.
In Canada, 61 percent of the health workforce is unionized, versus only 11 percent in the United States. During the last year, the Canadian province of Ontario has cut about 1,150 full-time nursing positions from the government-monopoly health system that controls health care for its 13 million residents. One-quarter of surviving nurses in the province is at least 55 years old.
According to a 2008 report by the Canadian Federation of Nurses Unions, “The nursing labor market, once characterized by cyclical periods of shortage and surplus, has progressed to a stage where there now exists a pervasive shortage of nursing human resources.” The report emphasizes that the profession has been discussing the nursing shortage for 10 years. As far back as 2002, the Canadian Nurses Association forecast a shortage of 78,000 RNs by 2011.
Similarly, the British media and professional journals have warned about nursing shortages in its National Health Service. As in Canada, the problems are retention of trained nurses and a shortage of students entering nursing schools. Conventional wisdom blames lack of adequate government funding for the failure. The true culprit is a system of government monopoly characterized by rule-bound, militantly unionized workplaces.
Given the harm that government-monopoly health care inflicts on nurses, why does the CNA advocate for it? At a conference I attended some years ago a Canadian nursing union leader spoke passionately in favor of continuing Canada’s prohibition of private facilities. Her only ground for the ban was that private facilities would offer nurses better pay and benefits than they received in the government-run hospitals, which would not be able to compete in hiring nurses.
Contrary to appearances, that is not a strange position for someone who is supposed to advocate in favor of her profession. The quest for a government-monopoly system is not about advancing the interests of nurses or patients. It’s about unlimited union power.