1. McSpedon, Corinne


Strikes highlight common nursing challenges and concerns.


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Although the influence of unions in the United States has dropped significantly since the middle of the last century, there's been a noticeable rise in the number of strikes and other major labor actions in the past few years. This has been particularly noteworthy in the health care and social assistance sector, where workers have participated in 33 labor actions from January through October of this year, according to Cornell University's Labor Action Tracker. That's up from 22 such actions during the same time in 2021.

Figure. Nurses with ... - Click to enlarge in new windowFigure. Nurses with the Minnesota Nurses Association outside Methodist Hospital in St. Louis Park during a three-day strike in September. Photo courtesy of the Minnesota Nurses Association.

Included in these numbers are labor actions by nurses, ranging from protests to work stoppages. About 17% of RNs are union members, a number that hasn't changed significantly in recent decades. But growing dissatisfaction appears to be driving a rise in these labor actions by nurses, who are demanding changes to what they describe as unsafe and unfair work conditions that have worsened during the COVID-19 pandemic and are adversely affecting patient care.



A 2021 study of nurses' work environments by the American Association of Critical-Care Nurses and published in the October issue of Critical Care Nurse revealed that only 40% of the more than 9,300 RNs surveyed were very satisfied being a nurse, a significant drop from 62% in the organization's 2018 study. Approximately 67% said they plan to leave their position in the next three years. A June survey by the Illinois Economic Policy Institute of more than 2,200 RNs also points to high levels of dissatisfaction: "51 percent of nurses were considering leaving the profession within the next 12 months-and the top reasons why were 'unsafe staffing' and 'unresolved moral distress.'"


These issues have been cited repeatedly in nurses' recent labor actions. By late September, Becker's Hospital Review reported there had been 14 strikes by U.S. health care workers in 2022, nine of which involved nurses. The work stoppages varied greatly in size and longevity, but the underlying reasons were markedly similar: most nurses on strike sought action on pay, health and safety concerns, and staffing issues, according to the Labor Action Tracker, which noted that additional demands in some strikes were related to "COVID-19 protocols," "measures to address nurse burnout," "adequate meal and break time," and "more supplies."



In Massachusetts, approximately 800 nurses walked out for 301 days in one the longest strikes in state history. It was the nation's longest nursing walkout in the past 15 years. The strike ended in early January, when the nurses ratified a contract with St. Vincent Hospital in Worcester, owned by Tenet Healthcare, that guaranteed staffing improvements on several units, ensured striking nurses returned to their positions, and offered greater protection from workplace violence. In March, more than 200 nurses at Armstrong County Memorial Hospital in Kittanning, Pennsylvania, held a five-day strike citing staffing and retention issues after 40 nurses left the facility in the previous year. Five nursing strikes occurred in California this year-two at the same facility, AHMC Seton Medical Center in Daly City. Nurses walked out for one and two days in March and June, respectively, to protest understaffing, a lack of supplies, patient care issues, and unit closures.


In what is believed to have been the largest strike of nurses in the private sector in U.S. history, approximately 15,000 members of the Minnesota Nurses Association (MNA) held a three-day strike in September at 15 hospitals across several health systems. The nurses walked out over pay and staffing issues that the MNA says are adversely affecting nurses' working conditions and patient care.


Mary C. Turner, RN, president of the MNA and an ICU nurse at North Memorial Health Hospital in Robbinsdale, explains that the union wants hospitals to ensure at least half the nurses on a unit agree to staffing changes. "If you can't convince 51% of your nurses that a change is okay, then maybe you shouldn't be making it," she says. Allina Health, one of the health care systems participating in negotiations with the union, said in a September statement that demand for "veto power over staffing decisions . . . is incompatible with our ability to manage the overall complex operations of hospitals and deliver care to our patients and communities."


Turner points out that nurses' staffing concerns are intertwined with other workplace issues. "Optimal staffing goes hand in hand with keeping [nurses] safe," she says. "That's why we always put those two issues together and why they're the most important." Optimal staffing is also essential for work-life balance, which is difficult to achieve when nurses are expected to work multiple day and night rotations, she adds. Yet hospitals continue to prevent nurses from having more control over their scheduling or alternatives, such as block schedules or less frequent day-night rotations, according to Turner.


"If it were all about money, this would be settled," she says. "What it's about is control . . . and that's what makes this fight everywhere for all nurses so hard."



Demands for improvements in staffing, pay, and working conditions are echoed by nurses around the world, many of whom describe worsening work conditions during the pandemic. In Finland, where there's a nursing shortage and health care workers are reportedly leaving their professions at rates 20 times higher than normal, nurses repeatedly engaged in labor actions this year to challenge wages and working conditions. Nurses in Israel's national health care system walked out for a day last year to protest a failure to address violence against health care workers. Members of the Uganda Nurses and Midwives Union went on strike in May for several days to protest low wages. Nurses, physicians, and other health care workers in Zimbabwe's public health system held a pay strike in June amid a lack of supplies and record-high inflation.


In the United Kingdom, Royal College of Nursing members are currently voting on whether to authorize a strike to protest unsafe staffing levels and a lack of nursing staff retention. It would be the first nationwide strike in the union's 106-year history.


"We saw conditions deteriorate significantly throughout the past two and a half years in many locations, and nurses have made clear they will not accept returning to a prepandemic environment, where they don't feel valued, their voices fall on deaf ears, and employers don't take seriously the need to protect their well-being, including providing adequate staffing and fair pay," says Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the International Council of Nurses and a professor at the University of Virginia School of Nursing. "COVID has pushed nurses over the edge and nurses will no longer tolerate being taken for granted."



In addition to increasing support among nurses for labor action, U.S. public support for such protests is stronger than it's been in more than half a century. Gallup's annual work and education survey revealed in August that public approval for labor unions has risen to 71% in the United States-the highest it's been since 1965.


Yet an increase in the number of labor actions and growing public support doesn't always mean nurses' demands are being met, at least immediately. In Minnesota, for instance, the historic walkout in September ended without agreement on wage increases, safety issues, or staffing improvements. As we went to press, contract negotiations are ongoing, with the union continuing to ask for "a seat at the table" regarding nurse staffing decisions.


One issue that did gain traction after the strike, according to Turner, was the addition of panic buttons to certain mental health units, providing nurses with a way to quickly request emergency assistance. But, she points out, it's discouraging how long it took to make that change. "You shouldn't have to wait eight months and go out on a three-day strike for them to come back and say yes to panic buttons."


In the absence of sufficient improvements to nurses' working conditions and safety, Cipriano expects nurses globally to continue demanding that governments and employers take more action. "It's very likely we'll see more industrial action (the term used internationally), including demonstrations and strikes," she says. "It should not be a surprise that there cannot be health without a health workforce and there can't be a health workforce without nurses. It's time to move from calling nurses heroes to taking action to support them to heal the health system."-Corinne McSpedon, senior editor