Improving Patient Safety Through Nurse Collective Bargaining

Abstract

Nursing workload and time worked are two key working conditions tied to the risk of adverse events and medical error. In Canada at the provincial level, these issues, which I call “patient safety issues”, are raised, negotiated and ultimately resolved within collective bargaining structures that are based on traditional “Wagnerist” labour law theory. I reviewed the results of decisions on patient safety issues within fifteen years of nurse collective bargaining in six of the thirteen provinces/territories. My findings are that patient safety issues of workload are inadequately addressed in nurse collective agreements, but at the same time these agreements contained strong patient safety-driven protections relating to time-worked issues of scheduling, hours of work and overtime. I further conclude that these limitations can be attributed to a series of trends in the process of nurse collective bargaining that tended to limit the ability of nurses’ unions to push for patient safety protections and more generally to marginalize patient safety issues in the bargaining process in favour of more traditional economic issues. To overcome these problems, I propose that patient safety issues in nursing be decided instead in locally-based “patient safety committees” instead of in the current traditional labour law model.