Jessica Hill/AP Photo
Long-term care members of the New England Health Care Employees Union, SEIU 1199, rally at the State Capitol, July 23, 2020, in Hartford, Connecticut.
Why are jobs so dangerous in America? The rates of fatal work injuries in the United Kingdom and several European countries are one-third that of the United States, where a worker is killed on the job every 99 minutes. One leading cause of this heightened mortality rate is the proliferation of violations of employment and labor law that result in workers’ exposure to hazardous conditions on the job. We studied one such law, the legal requirement that certain businesses report summary workplace injury and illness data to the Occupational Safety and Health Administration (OSHA). This law is routinely violated without consequence, but our research identifies an important mechanism to boost compliance: labor unions.
In 2016, as OSHA’s administrator during the Obama presidency, David Michaels, one of our co-authors, implemented a regulation that requires companies in certain industries to report injury and illness data to OSHA, which it loads onto a public-facing website. The idea is to provide OSHA with more accurate information about high-hazard workplaces in order to target enforcement and compliance assistance resources, while also encouraging employers to prevent work injuries by publicly disclosing data about the safety profile of their establishments.
Disclosure is a powerful tool. Businesses that become known as enterprises where workers are at greater injury risk will likely be seen as poorly managed, since the safety of workers is a sign of operational excellence. These firms may also have more difficulty recruiting staff. In health care, patient safety and worker safety are closely linked; would you want to place an aging parent in a nursing home where the workers are at increased risk of injury?
Collective-bargaining agreements often require employers to provide safety and health precautions far stronger than OSHA’s standards.
Experts know that injury tracking is a vital part of safety management; injury prevention programs need to be based on reliable, complete data. But today, seven years after OSHA first began requiring businesses to submit injury and illness data, only half actually do. Given OSHA’s limited resources and small fines, it is difficult for the agency to boost compliance with this important rule.
Unions have long played an important role in improving the health and well-being of workers, and unionized construction sites and coal mines have been found to be safer than ones where there is no union. Collective-bargaining agreements often require employers to provide safety and health precautions far stronger than OSHA’s standards. In addition to negotiating higher wages and retirement benefits, many union members have more access than their non-union peers to better health insurance plans, allowing them to access preventative care earlier and more cheaply. In many cases, unions are often the first and only place that workers learn about their health and safety rights, and they train workers to identify and report hazards, and alert OSHA where necessary.
Our research, just published in the journal Health Affairs, focuses on compliance with OSHA reporting requirements in long-term care facilities. Although all nursing homes are required to report summary data to OSHA, only 40 percent actually do. Perhaps such low compliance shouldn’t be surprising in nursing homes, which have long been among the most hazardous places to work in the country. Even before the pandemic, being a nursing assistant was a particularly dangerous occupation—with one of the highest injury rates—in the United States.
Our examination of nursing home compliance with OSHA’s reporting rule shows that two years after caregivers establish a union at their facility, it was over 30 percentage points more likely than its non-union counterparts to report illness and injury data to OSHA. That is a 78 percent increase in employer compliance compared to the industry’s average compliance rate from 2016 through 2021. Extrapolating out, this suggests industrywide unionization would increase compliance among an additional 2,361 nursing homes.
How exactly do unions make employers follow the law?
“Most of our union agreements explicitly indicate that the employer has to follow federal health and safety laws,” explained Jessie Martin, executive vice president of New England Health Care Employees Union, District 1199NE, a union that represents nursing home workers. “This reporting law is one of them … Non-union workers simply don’t have the same opportunity.”
In other words, some employers follow the law only when they have to—and they have to when unions are watching. “There’s a fear that if the companies aren’t doing something they’re supposed to do that the union could make it public,” Martin said. “And we do. They’re right to be afraid of that … The result is that they tend to follow the law.”
Part of the reason why unions have this impact is related to OSHA’s limited ability to enforce its own policy on data tracking. OSHA simply doesn’t have the resources to reach into every workplace. At its current strength, with its current resources, it would take the agency 190 years to inspect every U.S. workplace just once.
Offsetting OSHA’s limitations, however, union members can act as whistleblowers and safety inspectors, often with the assurance that speaking up won’t trigger retaliation. Unfortunately, unions represent workers in only about 16 percent of nursing homes. Given that the vast majority aren’t unionized, policymakers will continue to miss vital injury and illness data from many of the most dangerous workplaces in the country, and those workplaces will be able to avoid abating hazards and preventing work injuries by remaining off the radar screen.
But change—at least, some change—is coming. In the near future, we can expect to see far more data about injuries in nursing homes and other high-hazard workplaces made public. OSHA just finalized a rule requiring establishments with 100 or more workers in certain high-hazard industries to report not just summary data but also granular data on each serious work injury or illness. Hopefully, this will further encourage employers to abate hazards before workers are hurt or killed on the job.
This reform won’t diminish unions’ vital role in ensuring these data are reported and publicly posted, with the goal of making workplaces safer. Add to this the fact that unions in nursing homes also significantly reduced the transmission of COVID-19 at the height of the pandemic, mitigating deaths and infections among staff and residents, and a picture emerges: Where and when it matters most, unions make a life-and-death difference.
Our research shows that unions in health care act as a much-needed counterweight to poor management that allows workplace hazards to exist unabated. They are critical to building safer and more accountable workplaces.
