The Hospital Workers Study

This research is the flagship initiative of the Pittsburgh Wage Study. This research is supported by the Heinz Endowments and the Social Science Research Initiative at the University of Pittsburgh. The main goal of this study is to document the effects of incremental wage increases negotiated through a service union at a local hospital on the lives of hospital workers. We accomplish this with a longitudinal, mixed methods study including annual surveys and in-depth interviews. Explore below to learn more about this study and hospital workers’ experiences.

Research Objectives

What hardships do workers experience under the current wage structure, as well as under the improved wage structure? How does a wage increase address some of these hardships?

How do wage increases affect the following domains:

  • participation in public benefits and community nonprofits;
  • participation in employer benefits;
  • workers’ mental and physical health;
  • workers’ ability to save;
  • participation in family and community life;
  • workers’ feelings about and commitment to their work

Sample

Clerical, technical, and service workers in a service union at a local hospital are included in this study. This union covers a wide range of workers. Examples include: unit secretaries; nursing and medical assistants; sterilization, pathology; and cardiac monitor technicians; patient transporters; hospital operators; and physical therapy assistants. This population includes about 1,000 workers. In wave one, 51 workers were interviewed and 165* workers completed surveys. In wave two, 44 workers were interviewed and 257* workers completed surveys. Data collection for wave three is underway.

*These numbers reflect surveys with complete data for analytical purposes. Larger numbers of surveys were actually completed.

Research Method

This research uses a longitudinal, convergent, mixed methods design. The quantitative arm of the study includes an annual survey inviting the whole population to participate. The qualitative arm uses in-depth, semi-structured interviews of a subset of the population. The two methods inform each other, confirming or deepening understanding of the other. The first wave of data collection occurred 2016-2017 and analyzed the effect of the first wage two wage increases. The second wave occurred in 2017-2019 and analyzed the third wage increase. The third wave is active now, beginning in fall of 2019 and continuing through the spring of 2020.

Funders

  • University of Pittsburgh, Office of the Provost, Social Science Research Initiative
  • Heinz Endowments

Products from This Research

Research Briefs

 

Putting our Lives on the Line- Early Pandemic Experiences from Essential Hospital Workers

  • Doctors and nurses have been lauded as essential workers during the COVID-19 pandemic but service, clerical, and technical hospital workers have not been as well recognized and supported for their important contributions.
  • Service, clerical, and technical hospital workers, who are paid by the hour, have had to simultaneously navigate making ends meet amid workplace fluctuations and keeping safe from the heightened COVID-19 threat posed by hospital work. 
  • Unions have facilitated service, clerical, and technical hospital workers’ voice and power to address COVID-19 risks and provided social support throughout the pandemic.

    Moving Beyond $15- Comparing Hardships among Healthcare Workers Earning Below and Above $20 Per Hour

    • Compared with those above $20/hour, workers earning below $20/hour are more likely to be Black, tend to be younger, and are less likely to have a college degree.
    • Workers below $20/hour experience more hardships than those above $20/hour.
    • Food insecurity among workers below $20/hour is almost 3 times that of workers above $20/hour.
    • Almost 90% of workers earning below $20/hour are financially insecure.

     


    One-Year into the COVID-19 Pandemic: Mental Health of Healthcare Workers

    • Nurses and healthcare service workers report similarly high levels of anxiety, depression, PTSD, and suicidal ideation.
    • Nurses report significantly more vicarious trauma and work-related burnout than do healthcare service workers, though both groups experience these at high levels.
    • Both nurses and healthcare service workers report high levels of personal burnout.

     

     


    Pathways from Hardship to Health Among Low-Wage Workers :: December 2020

    Screenshot of Research Brief entitled Pathways from Hardships to Health Among Low-Wage Workers from December 2020

    • Hospital workers who make well above the minimum wage still experience substantial financial, medical, and food hardships.
    • Medical hardships are directly associated with physical health. 
    • Financial hardship and food insecurity are related to higher levels of stress. 
    • Higher levels of stress are related to worse mental and physical health. 

     

     


    Raising Wages of Low-Wage Workers: Does it Help?:: April 2020 Raising Wages of Low-Wage Workers: Does it Help?

    • Hospital workers experienced enormous hardships in multiple domains of their lives.
    • Hospital workers utilized a variety of strategies to make ends meet, such as using public benefits and borrowing money from family or friends.
    • Following an initial wage increase, hospital workers experienced fewer hardships and relied less often on strategies to make ends meet.

     


    Public Transit Helps Essential Hospital Workers Get to Work:: April 2020

    • Over a fifth (23%) of hospital workers rely on public transportation to get to work.
    • African American hospital workers (43%) are more likely to use public transportation than White workers (10%).
    • Hospital workers who take public transportation earn less than hospital workers who do not take public transportation.
    • Hospital workers who take public transportation experience more hardships than workers who do not.

     

     


    Can Healthcare Workers’ Family Incomes Support Their Families?:: March 2020

    • The majority (60%) of hospital service workers resided in households with incomes below the Family Budget* threshold.
    • Hospital service workers residing in households with incomes below the Family Budget threshold…
            • Tended to be younger and/or those with larger households;
            • Experienced more hardships than those living in households with incomes at or above the threshold.
    • Most hospital service workers residing in households with incomes at or above the Family Budget still struggled to make ends meet each month.
     
    *The Economic Policy Institute’s Family Budget Calculator was used to determine a modest standard of living in Allegheny County. Learn more at the EPI Website.

    “Without Us the Hospitals Wouldn’t Stay Open”: Essential Contributions of Service Workers:: March 2020

    • Service, clerical, and technical hospital work is essential for a well-functioning hospital and a healthy community.
    • Hospital work is difficult, demanding, and requires a high level of responsibility.
    • Through their dedication and hard work, service, clerical, and technical hospital workers contribute to a positive hospital climate and quality patient care.

     


    Is $15 Enough? Understanding the Struggles of Low Wage Workers:: January 2020Click here to see our research brief working to understand $15 minimum wage proposals

    • The goal of this research brief is to hep understand whether or not $15 an hour is sufficient to help lower wage workers make ends meet, without detracting from efforts to push hourly wages to $15.
    • Workers paid $15.16 – $18.76 per hour did not experience fewer material hardships than workers paid less on most measures.
    • Despite their material hardships, workers paid $15.16 – $18.76 per hour received fewer public benefits than workers paid less and thus relied on private strategies (e.g., payday loans) to get by.
    • Workers paid $18.77 an hour and above had fewer hardships, less stress, higher life satisfaction and better self-reported health than all groups of workers paid less.

    Hospital Service Workers & Housing Hardships:: September 2018

    • This research brief focuses on data collected after the first wage increase and focuses on housing hardships among hospital workers
    • Wage increases may be associated with reduced housing hardships
    • Even after raises, workers report concerns about affording housing and utility costs

     


    Click here to see the research brief on medical hardshipsHospital Service Workers and Medical Hardships:: September 2018

    • This research brief focuses on data collected after the first wage increase and focuses on medical hardships among hospital workers
    • Some medical hardships may have been reduced by wage increases
    • Reliance on Medicaid remained similar, while CHIP use may have decreased
    • Still, high co-pays and deductibles may limit access to medical care even for insured workers

     


    Click here to see the research brief on food insecurityHospital Service Workers and Food Insecurity:: September 2018

    • This research brief focuses on data collected after the first wage increase and focuses on food insecurity among hospital workers
    • Wage increases may be associated with reduced food insecurity
    • Wage increases may reduce need for or access to strategies for addressing food insecurity, including public benefits

    Reports

    Click here to read our preliminary report

    Pittsburgh Wage Study Preliminary Report:: December 2017

    This report outlines the data found in the first wave of data collection. The presented data were collected between 2016 and 2017 from over 50 in-depth interviews and 235 surveys from hospital workers who had received at least one incremental wage increase as part of a recently negotiated union contract.

    Key findings are summarized below while more details can be seen in the linked report.
    • Hospital workers in our sample are full-time workers and many work overtime to make ends meet. They are high school graduates and the majority have advanced training. Many are raising or have raised families, and many have worked throughout their careers for relatively low wages.
    • Workers know the importance of the work they do and take pride in this work. Despite their own struggles, these workers put on a professional face and devote themselves to their jobs.
    • A large percentage of hospital workers in our sample experience financial hardships, food insecurity and medical hardships.
    • The wage increase these workers received seems to have somewhat alleviated their struggles. Unfortunately, the prevalence of hardships faced by workers remains high.
    • Workers making above $15 per hour experience fewer hardships than those making below $15 per hour, although both groups saw decreases in hardships after their wage increases.
    • Workers employ a variety of strategies for dealing with these hardships. Those making below $15 per hour utilize these strategies at higher rates than those making above $15 per hour.
    • While public benefits are one strategy used by workers, levels of public benefit receipt are low overall and lower than those found in other studies of low-wage workers.

    Presentations

    Relationships among material hardships, perceived stress, and health among low-wage workers. Woo, J., Ballentine, K., Engel, R., Shook, J., & Goodkind, S. (2020, November). [Paper presentation]. CSWE 66th Annual Program Meeting.

    More money? More problems? Good jobs do not prevent workers` stress from spilling over to their health. Woo, J. & Ballentine, K. (2020).  [Paper presentation]. Work Family Research Network 5th Conference.

    A qualitative study of work-family interaction among low-income hospital workers with a “high road” employer. Ballentine, K. & Woo, J. (2020). In Henly J. R. (Chair), Bringing new perspectives to the understanding of work hour interferences with family life [Symposium]. Work Family Research Network 5th Conference.

    Raising wages of low wage workers: Does it help? J. Shook, S. Goodkind, R. Engel, K. Ballentine, S. Wexler, & H. E. Petracchi.  A paper presented at the 24th Society for Social Work Research Annual Conference, January 2020, Washington, D.C.

    The social construction of deserved wage: How do low-wage hospital workers respond to income inequality? S. Goodkind, K. Ballentine, S. Wexler, A. Waton, J. Shook, & R. Engel.  A paper presented at the 24th Society for Social Work Research Annual Conference, January 2020, Washington, D.C.

    Is $15 enough: Understanding the struggles of low-wage workers – S. Kim, J. Woo, J. Shook, K. Ballentine, S. Goodkind, & R. Engel.  A paper  presented at the 24th Society for Social Work Research Annual Conference, January 2020, Washington, D.C.

    Low-wage workers’ perceptions of their union: Variation within unionized workers J. Woo, J. Shook, & S. Goodkind.  A paper presented at the 24th Society for Social Work Research Annual Conference, January 2020, Washington, D.C.

    “I could have been there to help him more”: A qualitative study of work-family conflict among low-wage hospital workers with dependent children Ballentine, K. A paper presented at the 24th Society for Social Work Research Annual Conference, January 2020, Washington, D.C.

    What happens when the Fight for $15 is won? Strategies to cope with hardship among parents earning low wages K. Ballentine, K. MacKenzie, & S. Goodkind.  Paper presented at the 23rd Society for Social Work Research Annual Conference, January 2019, San Francisco, CA.

    Raising wages of low wage workers: Does it help?  J. Shook, J. Woo, R. Engel, S. Goodkind, S. Wexler, K. Ballentine, & H. E. Petracchi.  Paper presented at the 23rd Society for Social Work Research Annual Conference, January 2019, San Francisco, CA.

    Academic Articles

    From Scarcity to Investment: The Range of Strategies Used by Low-Income Parents with “Good” Low-Wage Jobs – Kess Ballentine, Sara Goodkind, & Jeffrey Shook. (2020). Families in Society: The Journal of Contemporary Social Services, 101(3), 260-274.

    Abstract:

    Low-wage workers have borne the brunt of the changing labor market, including wage stagnation, growing income inequality, and increasingly unstable work environments. Most research on low-wage workers focuses on precarious minimum wage employment; however, some low-wage workers hold jobs earning more than minimum wage with consistent, full-time hours. This study explores strategies parents in these “good” low-wage jobs use to provide for their children, using data from in-depth interviews with hospital workers. We find workers use multiple strategies, which we categorized as scarcity, maintenance, and investment strategies to highlight the distinct types of resources and varying amount of stress associated with them. Finally, we compare the types and number of strategies parents use by hourly wage versus net household income.

    Relationships among material hardships, perceived stress, and health among low-wage hospital workers – Woo, J., Ballentine, K., Shook, J., Engel, R., & Goodkind, S. (In press). Health and Social Work.

    Abstract:

    Many service, clerical, and technical hospital workers deemed essential during the pandemic have wages that do not reflect the essential nature of their work and do not provide enough income to pay basic expenses. Thus, many experience material hardships related to food, housing, and medical care. Previous studies have shown strong relationships between material hardships and health; however, they do not fully explain the role of stress as an intervening mechanism. This cross-sectional study analyzes an online survey with 257 lower-wage hospital workers to examine the relationships between material hardships and health, and how perceived stress mediates these relationships. Path analyses revealed that financial and food hardships were associated with both mental and physical health via perceived stress. Analyses also found that medical hardship was directly associated with physical health. These findings add to the evidence that stress resulting from workers’ material hardships contributes to negative mental and physical health outcomes. Future investigations should further examine relationships among material hardships, stress, and health, and advocacy efforts should focus on raising wages for essential hospital workers.