Essays On The Relationship Between Labor Protections and Turnover Among Hospital-Based Registered Nurses
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This three-essay dissertation examines the relationship between labor protections, namely mandated nurse-patient ratios and union membership, on turnover among hospital-based registered nurses. The first paper employed a difference-in-differences design to determine if California’s 2004 implementation of mandated nurse-patient ratios decreased turnover. It found the policy did not decrease turnover overall but may have modestly decreased the rate at which new nurses left the field. The second paper sought to determine what hospital characteristics were associated with unionization between 2015 and 2022. It found a hospital being in a right-to-work state has a significant negative association with both union presence and formation. Hospitals that were government-owned or nonprofit were also less likely to have unions. Notably, indicators of a hospital’s financial health did not have a robust significant relationship with unionization, nor did affiliation with a hospital system. It also found no relationship between union presence and staff vacancies. The third paper compared the rates at which union and non-union nurses turned over and the reasons therefor in 2018 and 2022, capturing the effects of the COVID-19 pandemic. It found the groups equally likely to turn over, but union members were more likely to cite burnout and inadequate staffing, among other reasons, for their departure. This may be attributable to the union raising nurses’ awareness of where their working conditions fall short. These studies, while they found few affirmative results, generated numerous testable hypotheses for further research surrounding the relationship between labor protections and nurse turnover.
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