Why Healthcare Employees Are on Strike

Union labor actions are facts of life in America’s healthcare industry these days. Since 2021, about 50 percent of the 140,000 employees who went on strike in the United States work in the healthcare sector. And right now, there are only two kinds of health systems where MHA and healthcare MBA grads are likely to interview for internships and jobs: hospitals vulnerable to a strike within the next 12 months, and those where a walkout is currently underway.

According to the Labor Action Tracker database maintained by Cornell University’s School of Industrial and Labor Relations (ILR), between January 2021 and September 2022, the healthcare industry witnessed 64 strikes in 134 locations across America, among a total of 245 labor actions in 360 locations. Non-strike labor actions like these 181 are often more significant than the legacy media reports because such actions can indicate significant union mobilizations foreshadowing strikes that may be imminent.

During 2022, 14 strikes were large enough to receive coverage from Becker’s Hospital Review. Probably the most significant of these was the largest private sector nurses’ strike in U.S. history, when in September, about 15,000 Minnesota Nurses Association members walked off their jobs at 15 large hospitals across the state. That action was preceded by a one-day strike by 22,000 Kaiser Permanente employees across Northern California, whose contract expired August 31. A strike was also launched against Kaiser by 2,000 mental health clinicians in California and Hawaii.

Other notable strikes during 2022 impacted these high-profile medical centers:

• 15 Sutter Health hospitals across Northern California where 8,000 employees walked off their jobs
• Stanford University Medical Center and the Lucile Packard Children’s Hospital in Palo Alto, California, where 5,000 employees took up picket lines
• The Cedars-Sinai and Kaiser Permanente medical centers in Los Angeles, struck by 3,200 workers

In addition, about 1,800 employees delivered an October 1 strike deadline to Johns Hopkins Medicine in Baltimore. And pediatric physicians at UCSF Benioff Children’s Hospital of Oakland voted in late September to authorize their first strike against that facility in three decades.

Many of us assume that we understand the causes of these labor actions because of the general public perception, based on strikes in other industries, that wage rate issues form the core of these disputes. However, because of the pandemic, more issues are now in play, and they are more complex than most realize.

Workplace safety concerns, understaffing, and inflexible or excessively-demanding work schedules are prominent collective bargaining issues in many of these negotiations. For example, in the current strike by Kaiser Permanente’s mental health clinicians, it wasn’t pay but understaffing that actually prompted the walkout.

Dr. Kate Bronfenbrenner, the director of labor education research at Cornell’s School of Industrial and Labor Relations, who testified on Capitol Hill before the House of Representatives’ Committee on Education and Labor in September 2022, told NBC News that the pandemic played a pivotal role in prompting many of these strikes:

Covid was a wake-up call because it wasn’t just you could get injured on the job, but going to work could kill you. Workers are feeling like they’re working harder than ever, and they put themselves out there during Covid and risked their lives for what?

Although shortages in personal protective equipment no longer exist, healthcare employees continue to face risks from Covid infection. In fact, two-thirds of registered nurses in hospitals fear they’ll contract Covid, and three-quarters fear infecting a family member.

If that wasn’t enough of a worry, many workers have concerns about a growing threat that seems difficult to understand for many of us working remotely or in secure offices: workplace violence. This is especially true for nurses. According to the Minnesota Republic, “healthcare workers across the country are facing attacks from patients or family members, and as nurses are often the ones dealing directly with patients, they face the brunt of the impact.”

Why violent incidents in hospitals seem to have increased isn’t clear. However, two recent reports found substantial evidence of this problem.

In an April 2022 survey of 2,500 registered nurses by National Nurses United (NNU), 48 percent reported increases in workplace violence. That proportion climbed from previous survey results of 31 percent in September 2021, and 22 percent in March that year. That’s a 55 percent increase from September 2021 and a 118 percent increase from that March.

Second, a September 2022 analysis by the healthcare consulting firm Press Ganey Associates revealed that 5,217 nurses nationwide were physically assaulted at work during the second quarter of 2022 alone. That works out to a rate of two assaults every hour; 57 each day; and 1,739 every month.

The firm derived its analysis based on 483 facilities that submit reports to its National Database of Nursing Quality Indicators (NDNQI). Most of the assailants were patients in emergency, psychiatric and pediatric departments.

“We’re drowning. There’s just not enough staff,” said Jennifer Stone, an emergency room technician at Sutter Delta Medical Center in Antioch, California:

We’re wearing too many hats. We’re talking down angry Covid patients, then we’re rushing to a code, then we’re talking to family members who just lost a loved one. We can’t give adequate care. We feel like management is ignoring our concerns and is leaving us to fend for ourselves. We can’t do it all anymore.

Insufficient staffing that leads to inadequate care Stone describes is dangerous for patients. One study of hospital care in nine European nations revealed that for each additional patient assigned to a nurse, deaths increase by 7 percent.

Axios points out that low staffing levels frequently drive healthcare strikes. That was the situation long before Covid, but the pandemic has made that situation even worse.

According to the April 2022 NNU survey, 69 percent of hospital registered nurses report that staffing has worsened recently, a 20 percent increase from the union’s September 2021 report and a 48 percent increase from the results in March 2021. The situation has become so dire that one in four said they were reassigned to care for patients in a clinical care area requiring new skills or outside their competency, and 46 percent of those nurses reported that they received no training before such reassignments.

In addition, two-thirds of hospital nurses reported that their facilities are employing excessive overtime in staffing units, up from 49 percent in the group’s September survey—a 36 percent increase. What’s more, 72 percent reported an increase in the use of travel nurses in the prior month.

In sum, this data is consistent with the Advisory Board’s insightful October 2021 analysis. The healthcare consulting firm pointed out:

Increased RN turnover has created intense competition for labor resulting in a severe shortage of bedside nurses. This comes at a time when nurses report their intent to leave their current positions due to staffing and workload concerns.

Turnover is especially acute in states that do not regulate hospitals’ minimum nurse-to-patient ratios. A June 2022 analysis released by the School of Labor and Employment Relations at the University of Illinois at Urbana-Champaign titled Registered Nursing in Crisis reported that in these states, 52 percent of nurses are thinking about leaving their jobs during the next year. Furthermore, a third of that survey’s sample had quit a nursing position to accept their current job during the previous six months.

This acute shortage of hospital nurses isn’t likely to abate anytime soon. That’s according to a September 2022 analysis by the human resources consulting firm Josh Bersin Co. and Eightfold, a software developer.

Using a data set provided by NSI Nursing Solutions and described in that firm’s “2022 NSI National Health Care Retention & RN Staffing Report,” the analysts concluded that the shortage of qualified American nurses would reach a whopping 2.1 million by 2025. In deriving that result, the authors cited nurse turnover rates of up to 60 percent reported by some hospitals.

In contrast to NSI’s nurse turnover calculation of 27 percent, the Bersin team estimated a lower annual overall nurse turnover rate of 17 percent. However, they compared that 17 percent with a projected entry rate of only 6 percent, forecast during a period when they predict rapidly intensifying demands on hospital care delivery systems.

Along with the chronic understaffing, the Advisory Board also notes that because of the pandemic, many nurses have faced work schedules that were unpredictable, constantly changing, and at times extremely demanding. The firm points out that “scheduling stress and the increasingly heavy workload have contributed to widespread fatigue,” resulting in nurses being burned out by the pandemic.

One way excessively demanding work schedules have manifested is through mandatory overtime requirements. Union leaders argue that these requirements violate federal labor laws. Mandatory overtime is a key issue that prompted the notice of an impending strike against Hartford HealthCare’s Windham Hospital in Willimantic, Connecticut in September 2022.

Just because healthcare workers went on strike over so many non-compensation issues doesn’t mean that the perennial issue of pay isn’t a factor in many of the current disputes.

For example, nurses in the Minnesota strike originally requested pay increases between 27 to 30 percent over three years. But the sides remain far apart since the hospitals only responded with offers in the range of 10 to 12 percent.

In recently resolved open-ended healthcare strikes, the deals typically involved pay increases far lower than what the Minnesota nurses want. For instance, the January 2022 agreement that ended the 301-day strike against Saint Vincent Hospital in Worcester, Massachusetts—the longest nursing strike in that state’s history—only gave those nurses 2 percent across-the-board increases during each year of the four-year contract.

Moreover, one of the more generous deals ended the open-ended strike against Dignity Health’s Sequoia Hospital in Redwood City, California. That July 2022 agreement gave employees a 16 percent raise over the contract’s life and a signing bonus.

“Compensation has evolved as a flashpoint,” notes the Advisory Board. High inflation is one reason, but another is that pay has exploded for new hires and travel nurses. And it’s not difficult to see why most of America’s 5.8 million nurses who work in hospitals feel underpaid by comparison.

For example, a registered nurse in the United States earns, on average, about $82,000 annually. However, a travel nurse can earn much more than that.

That means that a salaried nurse working alongside a travel nurse will collaborate with a professional with roughly the same training and experience, but who is better-paid by the same employer.

Incidentally, what about travel nurses willing to betray their colleagues by crossing their picket lines? Across America, it’s perfectly legal for hospitals to replace employees on strike with exorbitantly-paid travel nurses, or in the case of Kaiser Permanente’s striking mental health clinicians, with the contract psychotherapists Kaiser is currently recruiting through email campaigns. Dr. Jane McAlevey, a senior policy fellow at the UC Berkeley Labor Center and author of the 2020 book A Collective Bargain: Unions, Organizing and the Fight for Democracy, told the Sacramento Bee that this is a “normal” union-busting strategy in the United States.

Across America, “employers are suddenly willing to shell out outrageous premium pay to striker replacement workers instead of investing these funds. . .where the workers on strike are demanding it, in this case, to help patients get better care,” McAlevey said. However, she also pointed out that the constitution in Germany, where she does consulting work for labor unions, forbids companies from replacing workers that way.