Over 7,000 nurses, represented by the New York State Nurses Association (NYSNA) and employed by two major hospitals in New York City, ended their strike in the wee hours this week on January 12. Management had returned to the negotiating table to meet the nurses’ primary demands for increased staffing and wage increases. These nurses, from Montefiore Medical Center and Mount Sinai Hospital, were part of the last two bargaining units to settle their contracts in the city. They went back to work bright and early for the 7 am shift.
Though the historic strike has ended, its ramifications will continue to be felt across the state. The strike was the largest nursing strike the city has experienced in decades, and experts and advocates agree it was years in the making.
Mark Hannay — the longtime director of Metro NY Health Care for All, a coalition of community organizations and labor unions (including NYSNA) that has fought for health care reform in the state since 1995 — told Truthout that the issues of “safe staffing and nurse-patient ratios [have] been hanging out there for quite some time.”
Hannay added that NYSNA and other union allies have been working on issues of staffing and nurse-patient ratios for a long time,” too. Two years ago, the groups “made a breakthrough in the state budget negotiations,” when the state legislature signed a bill that set new staffing limits. But its implementation was delayed, and then poorly enforced. “It hasn’t worked out well,” Hannay said.
The state’s nurses did not give up on the issue. “Particularly in the wake of the pandemic,” Hannay reminded me, “nurses have gone far beyond the call of duty.” Indeed, the COVID-19 pandemic has taken a toll on the profession. Many nurses have burned out; others have left the profession, either temporarily or for good. Many have refused to tolerate the poor staffing conditions brought on by perpetual understaffing. Nurses “had no choice,” Hannay said, “but to carry [the issues] into their contract negotiations.”
The result has been “monumental,” Erin Hogan, a nurse at Mount Sinai’s main hospital on the Upper East Side of Manhattan, told Truthout on January 12. Hogan, an active member of her union for the past four years and a union delegate for the emergency department, began working at Mount Sinai more than six years ago, when she was stationed in inpatient oncology. Just “one month into starting at Sinai,” she said, “I felt that something wasn’t right.” Then she moved to the emergency room.
Mount Sinai’s ER, Hogan said, has a “reputation of being incredibly understaffed, incredibly crowded. The working conditions were atrocious. Patients were on top of each other. It was dangerous and unmanageable.” Hogan’s claims are nothing new. In 2019, the New York Post published an exposé of the hospital’s emergency department, in which employees of the hospital called it a “war zone.” At the time, the exposé prompted a probe by the state health department. Mount Sinai did not respond by press time when contacted for comment in response to these claims about chronic understaffing.
Hogan described how she began to feel “helpless and hopeless” as an ER nurse.
“Our position is unique,” Hogan reminded me. “We’re the first ones to see patients. We stabilize people; we greet the ambulances; we see mass casualties and traumas. But you’re only one person, and you can’t really give patients the attention they deserve.” She said the majority of nurses go into their field out of a desire to care for patients, but under these conditions, the reality of the work looks very different.
Eventually, the ER environment began to wear on Hogan. Her mental and physical health began to suffer; she developed insomnia, panic attacks and migraines. Some nights, she had nightmares “where a patient reaches out for [her] hand and [she] can’t take it.”
“It became way too much,” she said. In October 2021, Hogan decreased her hours, becoming a part-time nurse.
Hogan recalled how these sorts of staffing issues are longstanding, predating even the pandemic’s arrival. Her union expressed the “exact same concerns” in negotiations for their last contract, when they also put in the 10-day notice of intent to strike required by the National Labor Relations Board for health care employees. “Unfortunately,” Hogan remembered, “we didn’t strike.” That contract included new language about staffing “grids” — planning tools that help set nurse-patient ratios — but it was “definitely not enforceable, and nothing really changed.” Nurses were left with few protections for safe staffing. “We’ve been doubling, tripling up on patient load. Every [bargaining] unit, we would bring this up to management.”
But little changed. Hogan said management had been “disrespectful to our nurses, and even to the public.” Management, meanwhile, called NYSNA’s actions ahead of the strike “reckless” behavior. Even as a strike loomed, the nurses union said that Mount Sinai walked away from the bargaining table. The hospital also began making preparations for a strike, moving at least 100 patients, including infants in the NICU, from the main hospital to others in the system.
Hogan stressed the fact that both Mount Sinai and Montefiore have hundreds of nursing vacancies — Mount Sinai, around 500; Montefiore, around 700. Vacancy numbers are considerably lower at other hospitals in the city, which are also smaller institutions than either Montefiore or Mount Sinai’s main hospital. Nurses at several other hospitals, including some of Mount Sinai’s other locations, came to agreements days and hours before the strike was set to begin.
Early on January 12, Mount Sinai and Montefiore ultimately agreed to staffing ratios similar to the ones included in the tentative agreements forged at the other hospitals. The contracts include clearer enforcement language compared to prior years, including penalties for short staffing. Montefiore, meanwhile, announced it would create at least 170 nursing positions, with a focus on the emergency department. (This staffing increase does not directly address the hospital’s 700 nursing vacancies.) Ideally, the new contracts will also help the hospital retain current nurses and hire new ones.
Hogan called the Mount Sinai agreement a “wonderful starting point to get New Yorkers the care and quality and love and passion that they truly deserve.”
Hannay, too, discussed how the strike marks a starting point for New York state to step in — in a big way. The state, he said, needs to offer “more support for all hospitals, but in particular, safety net hospitals,” which serve “disproportionate numbers of low-income and uninsured patients compared to other hospitals that primarily serve commercially insured patients.” Hannay argues that safety net hospitals have been neglected in recent decades.
After years of a laissez-faire approach to the state’s hospitals, which were deregulated under Gov. George Pataki in the late ‘90s and early 2000s, Hannay argues that the state also needs to “make a more intentional effort to provide oversight of hospital systems.” In the last decade, Gov. Andrew Cuomo pushed cuts to safety net hospitals and outsourced oversight to the major hospital systems themselves. “They’ve been running the show,” Hannay said. These large systems, based at academic medical centers like Mount Sinai, have “dominated health care policy in New York for years and years. They suck up the vast majority of resources, and everyone else is left fighting over the crumbs. That has got to stop.”
Nonprofit hospitals across the country avoid paying taxes by providing so-called charity care to those who can’t afford it. But many of these institutions have steadily moved away from their charitable missions. Montefiore and Mount Sinai are no exception; reports show that although the hospitals have also received generous pandemic aid from the state, they have spent recent years slashing charity care, boosting executive salaries and investing millions in private equity.
Meanwhile, smaller safety net hospitals, which rely on Medicaid reimbursements from the state, are going to continue to struggle, Hannay went on, “unless the state puts money on the table” and raises Medicaid rates, rather than continues to slash them. But that will require new sources of state revenue –– a shift that will unsurprisingly necessitate an about-face from “neoliberal austerity politics” toward requiring “large corporations and wealthy people to pay their fair share of taxes.” That shift will be a “heavy political lift for the governor and state legislature,” Hannay cautioned. “But the public is behind this effort to rebalance our tax system.” Indeed, in 2021, a poll conducted by Data for Progress found that 73 percent of New York voters — including 66 percent of Republicans and 81 percent of Democrats — prefer taxing rich individuals and corporations over adopting an austerity budget.
It makes perfect sense that the public wants this sort of overhaul — both to the overarching tax system that funds hospitals as well as to the conditions inside them. Those conditions, after all, affect patients and nurses in equal measure. The city’s nursing strike itself “opens up a huge conversation about patients’ individual experiences,” reflected Hannay. “The public is enormously trusting of nurses on health care issues,” he said, echoing polls that show Americans consistently rank nurses as the most trusted profession. In media interviews, patients at Mount Sinai and Montefiore expressed support for the strike, saying the striking nurses “deserved all they’re asking for” after their work during the pandemic. Others felt that staffing shortages had affected their own families.
“Everyday people care about hospital care in their communities,” Hannay said. Even as the industry has continued to consolidate, and as larger and larger networks like Montefiore and Mount Sinai have formed, patients “value their local hospitals as institutions.”
But hospitals can’t be truly local, community-driven institutions as they currently exist. Though hospitals like Mount Sinai and Montefiore, for instance, are legally nonprofits, “they’re acting like for-profits,” Hannay said. That reality is “adversely affecting patient care and quality of care.” The crisis of nurse understaffing is simply a prime example of the wider issues at play in U.S. health care.