What Happens When Nurses Strike? Exploring the Aftermath
- U.S. healthcare faces a crisis as nurses continue to leave the field in the thousands.
- There has been a significant increase in labor rights organizing in nursing, including strike actions, since the COVID-19 pandemic began.
- Nurses have gone on strike more than ever before in 2022, which will likely continue as there is no end in sight to the complex issues nurses face today.
What is the single biggest issue facing nurses today? Ask many bedside nurses across the U.S.; they'll tell you it's the nursing shortage.
While this labor shortage is complex and often misunderstood, the truth remains that nurses are leaving their jobs — particularly those in the hospital setting — at never before seen rates.
According to a 2022 National Nursing Workforce Study, 20% of the U.S. nursing workforce indicated they will likely leave the profession by 2027. An older nursing workforce compounds this figure. With the median age of nurses in 2022 being 46, this shortage will only worsen as these nurses retire.
The COVID-19 pandemic accelerated the issues nurses have faced for decades and led to nurses organizing like never before.
Nursing unions empower nurses and offer channels for professional self-advocacy, the ability to push back against labor rights violations, and the power to improve their working conditions.
Initiating a labor strike is just one tool available to unions, but it's the most heavily covered by the media.
Learn why nurses strike and how these strikes affect patient care.
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Reasons Nurses Strike
There are several reasons why nurses strike. A strike is always a last resort after all other avenues of negotiation have failed and work conditions have become untenable.
It’s important to note that while it may be legal to strike as a non-union member, there is very little precedent, and it may get you fired in some states. That’s why union members have conducted the vast majority of labor strikes throughout U.S. history, as they have more rights and protections than non-union members.
We spoke to Abigail Donley, BSN, RN, an SEIU RN union organizer and the executive director of IMPACT in Healthcare, an organization dedicated to improving healthcare access for patients and improving the lives of all healthcare workers.
Donley says that strikes are most likely to occur during a contract negotiation or re-negotiation as most union contracts contain a no-strike, no-lockout clause preventing union members from striking during the contract's life.
A strike can be voted on and initiated when the union's demands are unmet.
Strikes are highly effective because they remind hospital systems and executives of how essential nurses are and the power of collective action. Still, it's not something union members want to do.
"Strikes place a big strain on the local union and require lots of resources. Workers can lose their benefits depending on the strike length, so it's always a last resort," says Donely.
Mistreatment of Healthcare Workers
When asked why the number of labor actions has increased so much since the pandemic, Donley believes that the hospital's mistreatment of healthcare workers was so shocking and consistent that a labor movement was inevitable.
Unsafe Staffing Ratios
One of the most significant issues nurses face today is the need for mandated safe staffing ratios. Each type of nursing has an evidence-based staffing ratio that improves
patient outcomes, reduces patient morbidity and mortality, and reduces nurse burnout.
However, because of the fee-for-service model of healthcare in the U.S., hospitals view nurses as a cost rather than an essential service. So hospitals run with paper-thin staff margins to
Other significant issues nurse unions can negotiate include:
- Securing a living wage and benefits
- Instituting policies that promote staff safety
- Increasing access to mental health resources
Healthcare workers face incredibly high rates of violence in the workplace compared to other professions, which also takes a toll on their health and contributes to nurse burnout and attrition.
These issues faced by nurses across the country have been around for decades, but the pandemic rapidly worsened working conditions for nurses. Now, many nurses are choosing to unionize and use their right to strike to change the system and protect their patients.
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What Happens When Nurses' Demands Aren't Met
If the nurse union's attempt to negotiate with the hospital fails and a strike is authorized, there are consequences for all parties involved.
Increased Costs for Hospitals
Unions must give the hospital fair warning before a strike can begin, often 10 days. During this time, the hospital must develop a plan so that patients receive appropriate care during the strike period.
Hospitals can send patients to other facilities, hire travel nurses to fill these positions temporarily, or some combination of the two.
Another measure often includes rescheduling routine or non-emergent procedures, which costs the hospital significantly.
Nurses Lose Income and Benefits
When nurses go on strike, they do so knowing they will most likely not get paid during that time. However, some unions use a strike fund to pay their staff.
In addition, sometimes hospitals retaliate further by cutting nurses' benefits. They typically use this tactic when strikes last for an extended period.
Patient Care Disruptions
While researchers have largely debunked the myth that nurse strikes dramatically increase patient safety risks, strikes cause disruptions to patient care in several ways.
If hospitals choose to cancel procedures and reschedule appointments, care is delayed for patients. These delays can lead to worse patient outcomes if essential preventative care services, such as cancer screenings, are also delayed.
What Happens When Nurses' Demands Are Met
If a strike occurs and all parties eventually reach an agreement, the benefits to nurses and patients are significant.
Higher Nurse Wages
Most headlines during the pandemic focused on the high wages earned by a select few travel nurses. This news coverage even led to politicians trying to cap travel nurses' pay in some states.
However, many more staff nurses were fighting the pandemic without adequate PPE or hazard pay, and hospitals also chose to cut their benefits and annual cost of living pay increases during this time.
Strikes in the last two years have demonstrated their effectiveness as nurses raised their wages in nearly every one of the eight actions. And this lines up with data from the U.S. Bureau of Labor Statistics showing that unionized healthcare workers earn higher wages than their non-unionized peers.
Improved Patient Care
Ample evidence has shown that nurses who feel they are paid appropriately and have safe staffing ratios report less burnout and provide better patient care, which results in safer patients and better outcomes.
Improved patient care is due to several factors, such as reduced fatigue, lower stress levels, and increased feelings of safety — all of which contribute to reducing preventable medical errors.
When nurses have a seat at the negotiating table, they are empowered and invested in their jobs, and patients are safer for it.
Higher Nurse Retention
According to that same National Nursing Workforce Study, of those 800,000 nurses planning to leave the nursing profession by 2027, about 45% reported feeling burned out multiple times a week, and 23% reported an unsafe work environment.
Striking is one tool of many available to unionized nurses. When nurses strike and negotiate directly with their employers regarding the issues that matter to them most, they are more invested in their jobs and stay in their positions longer. Improved retention leads to happier nurses, better patient care, and safer hospitals.
Meet Our Contributor
Abigail Donley, RN-BSN, and Executive Director of IMPACT in Healthcare
Abigail Donley has been a nurse for more than 14 years. She ended her bedside career after working in a Manhattan ICU during COVID-19 in 2021. She transitioned to union organizing after leading a “Safe Staffing Campaign” on her unit.
Abby has worked as an SEIU RN organizer in New York City before joining the Los Angeles team. She is also enrolled in a master's degree in healthcare policy to further her fight for nurses. Abby is passionate about intersectional feminism, LGBTQ liberation, income equality, and racial justice.
Cox, H. (2013). Some States Are Trying to Cap Travel Nurses' Pay. Here's Why That's a Bad Idea. FEE
Donley, A. (2023). Personal Interview
Garcia, C et al. Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. NIH
Larkin, H. (2021). Navigating Attacks Against Health Care Workers in the COVID-19 Era. JAMA
Median weekly earnings of full-time wage and salary workers by union affiliation, occupation, and industry. (2023). U.S. Bureau of Labor Statistics.
National Nursing Workforce Study. (2022). NCSBN
Tulchinsky, T et al. (2014). Measuring Costs: The Economics of Health. Science Direct
Youssef, N et al. (2021). The effect of a nursing strike on emergency department operational metrics. The American Journal of Emergency Medicine
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