Navigating the Nursing Landscape: Labor, Wages, and Patient Outcomes

Abstract

The strained relationship between the US healthcare system and its nursing workforce affects patients’ access to high-quality care and health outcomes. Fifty-six percent of nurses report burnout and one in five plan to leave the bedside within the next 6 months—largely a consequence of inadequate compensation, insufficient staffing, and challenges to delivering high-quality, safe patient care. Despite the potential for collective action through unions, unionization in nursing remains limited; this prompts questions about nurses’ ability to exert their labor power and drive meaningful change within the systems they operate. Considering the historical oppression of women and the persistent gender pay gap, concerns arise about the nursing workforce’s vulnerability to labor exploitation. Nurses who have effectively leveraged collective action have not remained silent; recently, we have seen a drastic increase in nursing strikes. While motivated by improvements in employment conditions (e.g., staffing, safety, compensation, etc.) and patient outcomes, evidence suggests that nursing strikes may also present an immediate temporary challenge to the provision of high-quality patient care. To deepen our understanding of the relationship between the nursing workforce and the US healthcare system, as well as its impact on patient outcomes, the aims of this three-paper dissertation were: 1) to conceptualize labor exploitation and apply the conceptual framework in examining the modern employment relationship between hospitals and nurses (paper 1), 2) to describe the average wage growth and wage gap between RNs and other professional and support healthcare occupations between 2012 and 2023 (paper 2), and 3) to measure and describe the effect of a nurse strike action on organizational behavior and patient outcomes (paper 3). Upon the completion of these aims, we identified two key attributes of labor exploitation: the presence of a power imbalance in the workplace and less than value-based compensation for workers. Our results also revealed that over the past decade, RNs experienced slower annual wage growth (0.51%) compared to other healthcare occupations (0.61%-1.48%), causing the widening of the wage gap between RNs and professional occupations (NPs, PAs and surgeons) and narrowing the gap between RNs and support occupations (LPNs and NAs). Finally, we found changes in organizational behavior over the course of a nurse strike action, such as adjusting the number of scheduled visits and inpatient admissions to accommodate potential nursing shortages; we also found changes in patient outcomes, such as longer lengths of stay and increased 30-day readmissions. These findings can further the research aimed at establishing a healthier relationship between the nursing workforce and the US healthcare system. Prioritizing nurses’ well-being can contribute to a sustainable nursing workforce, enhancing the overall functioning the US healthcare system and ultimately leading to improved patient health outcomes.