Do nurses strikes harm patients? It's a definite maybe

Nurses strike outside of United Hospital.
Nurses march outside United Hospital on Monday.
Evan Frost | MPR News

Brier Grote, an intensive care nurse at Abbott Northwestern, said she had four weeks of orientation training when she was hired.

While she and about 4,800 other nurses are on strike this week, they're being replaced with nurses who had just a few days of training before they began work. That's worrisome for the nurses union.

However, it's unclear to what extent nurses strikes have an impact on patient safety. At this point, the issue of safety at Allina hospitals is little more than a war of words between the union and management.

Striking nurses will often argue patients' safety is at risk when they strike. Grote says a longer training period — one replacement nurses don't have — is necessary to get familiarized with a hospital and its various protocols, procedures and equipment.

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"To think they're just going to allow people who have never even set foot into that hospital before to take care of patients that, especially in an ICU area, it's a scary thought," Grote said.

There's a lot of potential for problems with replacement nurses, said Jon Christianson, a professor at the University of Minnesota's School of Public Health. Still, he said it's a tricky argument to make.

"If you're in favor of management's approach, you're response would be, 'Well the nurses union put their patients in that situation by going on strike,'" Christianson said. "If you're in favor of the union approach, then you'll say, 'Well, we gave management ample warning about what was going to happen and they weren't prepared and they should have been prepared.'"

One-off patient injuries or deaths during a hospital strike can attract a lot of media attention. But beyond anecdotal incidents, there's just one comprehensive study looking at whether nursing strikes can be fatal for patients.

The 2012 review analyzed 50 nursing strikes in New York state over the 20 years ending in 2004. Some of the hospitals used replacement workers, and most did not.

But the overall effect of the New York strikes was essentially the same — more patients died because of strikes than would have if there were no strikes.

The findings were dramatic, complex and raised more questions. The hospital death rate during a strike rose three-tenths of a percentage point to just 2.2 percent. That fractional increase was statistically significant and compared to non-strikes, it amounts to an 18 percent greater risk of death.

The risk of being re-admitted for a complication also rose, the study found.

But the strikes and location were quite different from the one-week walkout in Minnesota. The average strike in the study was longer than a month.

Cornell University assistant professor Samuel Kleiner, who co-authored the study, stopped well short of saying the findings are applicable to Allina's strike.

Still, strikes are disruptive, said economist Joanne Spetz, a professor in the School of Nursing at the University of California, San Francisco. It's hard for replacement nurses to provide optimal care when they're new to a hospital's protocols and layout.

She said the difference in risk between strike and non-strike times isn't going to be huge, but it is notable.

"You know, if you had a choice of having your knee replacement now or waiting until the strike is over, you may as well wait," she said. "But obviously if you have an emergency come up, you just need to go."

Minnesota health regulators increased inspections at the five striking hospitals and Allina says the agency has found "no issues of concern." The Health Department is only saying that if it did substantiate reports of significant concern, it would act immediately to protect patients' safety and health.