In SuperFreakonomics, we wrote about the very mixed evidence concerning health outcomes when doctors go on strike or leave town for conventions. Surprisingly, when doctors disappear for awhile, patients don’t seem to suffer, and maybe the opposite in the short run.
But what about nurses?
A recent study by my friend Jonathan Gruber, an economist at MIT, and co-author Samuel Kleiner, finds that things go haywire when nurses go on strike. From the abstract of their recent NBER working paper:
We utilize a unique data set collected on nurses’ strikes over the 1984 to 2004 period in New York State, and match these strikes to a restricted-use hospital discharge database which provides information on treatment intensity, patient mortality and hospital readmission. Controlling for hospital-specific heterogeneity, patient demographics and disease severity, the results show that nurses’ strikes increase in-hospital mortality by 19.4% and 30-day readmission by 6.5% for patients admitted during a strike, with little change in patient demographics, disease severity or treatment intensity. This study provides some of the first analytical evidence on the effects of health care strikes on patients, and suggests that hospitals functioning during nurses’ strikes are doing so at a lower quality of patient care.
So when nurses strike, the patients who show up at the hospital are more likely to die there and also are more likely to be readmitted to the hospital within 30 days. The obvious concern with this analysis is that the nursing strike might affect the kinds of patients that show up to be treated. If only the sickest patients brave the hospital when nurses strike, their outcomes will be worse whether or not the nurses are there. In other words, the link between nurse strikes and bad outcomes could be spurious.
What I like best about this paper is how Gruber and Kleiner deal with that potential criticism. First, they show that on a range of observable characteristics (types of illness, patient age, percent uninsured, etc.), the patients who come to the hospital during the strikes look a lot like the typical patients. Second, if the relatively healthy patients waited to go to the hospital until after the strike, or went to hospitals in other areas during the strike, there should be evidence in the data, but they don’t find anything.
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So you will likely have a better outcome if you go to a hospital with nurses? Noted.
Most doctors and nurses wouldn’t rate their effectiveness on “mortality”. I sure know my dentist wouldn’t. The business of nurses is not primarily to keep people from dying.
Many issues work to complicate medical statistics. Much surgery is elective, and when people are unemployed, they have the time to get the elective surgery– Often before their medical benefits run out. But this doesn’t mean unemployment makes them wind up in surgery. Likewise, extremely good doctors often get the worst cases. This really screws up the statistics.
Nurse. I am done with my Bedpan.
Nurse! Its very full. Its hard to keep it upright.
NURSE!
When the people who do 80% work leave , conditions deteriorate ? Who would have thought
BTW who won that contest?
Did the study account for the fact that nursing strikes can be date range targeted to periods of time when patients are more ill?
Regionally, hospitals experience higher and lower rates of complications, mortality, extended length of stays and readmissions with seasonal changes. Nursing strikes sometimes hit during these periods to maximize impact if it is a more combative contract dispute.
This may be a regional phenomenon though since I only have experience with the West Coast states of WA, OR, CA, AZ and NV.
Those who criticized this study only did it because never needed a long-term hospitalization. So if you had never been with a nurse, you can not understand his role.
We do have a medicalized health perspective (even worse when your vision is dependent on such crap TV series as “Greys’ Anatomy,” emergency department “), so it’s hard to believe that we need to care primarily, instead of drugs.
Regards from Portugal
When doctors go on strike, mortality goes down. This is interesting because it shows the opposite for nurses.
So patients have worse outcomes when there are no nurses? You needed a study to tell you that?