Unions appear to offer nurses protection to demand, "that the standards of their profession be respected and enforced. When [nurses] do not have the protection to speak out on behalf of patients, the patient care provided and the patients lose" (Clark et al., 2000, p.95). A recent study by Seago and Ash (2002) comparing patient outcomes of union and non-union hospitals in California supports Clark’s contention. A 5.7% lower risk-adjusted mortality was found among acute myocardial infarction patients in hospitals with unionized nurses compared to non-union hospitals even after controlling for wages and RN hours, which were higher in union hospitals..