What rising tensions mean for hospital workers in 2023

Hospital and union labor disputes have intensified in recent months as workers call on hospitals to improve staffing levels and provide competitive pay and other benefits. 

Take the recent strike by about 7,000 New York City nurses, for example. 

Members of the New York State Nurses Association went on strike for three days in January at two New York City hospitals: Mount Sinai Medical Center on the Upper East Side of Manhattan and Montefiore Medical Center in the Bronx.

Staffing was a key issue raised by the union during the strike and was part of the tentative deals, which had not been finalized as of early Jan. 17. 

At Mount Sinai, the tentative contract includes "wall-to-wall safe staffing ratios for all inpatient units with firm enforcement" to ensure improved staffing levels, the union said. At Montefiore, the tentative contract includes new staffing ratios in the emergency department. 

The tentative contract at Montefiore also includes a 19.1 percent wage increase over three years, as well as increases in registered nurse and nurse practitioner staff. 

New York City is only among the latest examples of labor disputes amid heightened workplace tensions. 

Nurses have also protested, gone on strike or threatened strikes in states such as California, Oregon, Michigan and Minnesota, The Washington Post reported Jan. 14. And Bureau of Labor Statistics data cited by the newspaper showed that nurses led a quarter of the top 20 major work stoppages tracked by the agency last year.

It's not just the money

Staffing has been a key point of contention in labor disputes. Last week, members of the Service Employees International Union called on Nashville, Tenn.-based HCA Healthcare to boost staffing levels at more than 150 hospitals across 19 states owned and operated by the company. 

"Three years into the COVID-19 pandemic, and grappling with this winter's record-setting flu and RSV waves, dedicated HCA care teams have reached their breaking point," SEIU said in a news release shared with Becker's.

The union's remarks come as labor contracts at HCA's four Southern California facilities — West Hills, Riverside Community Hospital, Los Robles Hospital and Medical Center in Thousand Oaks, and Thousand Oaks Surgical Hospital — will expire in September, the Orange County Register reported Jan. 9.

HCA disputes the union's claims of understaffing facilities to focus on profits. 

"The reality is, against the backdrop of a national nursing shortage exacerbated by a pandemic and continuing patient surges, HCA Healthcare's staffing is safe, appropriate, in line with other community hospitals, and in compliance with applicable regulations," an HCA spokesperson told NBC News.

A disappearing workforce

Staffing, along with pay to recruit and retain workers, has come even more to the forefront of hospital-union negotiations as nurses have left healthcare, retired early or switched jobs. At the same time, the nurse deficit could reach 2.1 million by 2025, according to the Global Workforce Intelligence Project, an analysis conducted by The Josh Bersin Co., a workforce strategy research and advisory firm, and Eightfold, a talent management software company.

This tight labor market means more leverage for nurses to unionize and even strike, according to The Washington Post.

On the heels of the New York City strike, nurses at Mount Sinai South Nassau in Oceanside, N.Y., voted to join the New York State Nurses Association.

The vote covers about 800 nurses at South Nassau.

"The South Nassau nurses worked for too long without a voice, without adequate compensation, and without a seat at the table to improve care and uplift standards at the hospital," NYSNA President Nancy Hagans, BSN, said in a union news release shared with Becker's. "When nurses are in unions, we find standards rise and quality care increases. The nurses at South Nassau have banded together to make their lives and their patients' lives better in the long run. We welcome them to the NYSNA family."

In a separate statement shared with Becker's, South Nassau said it respects this decision.

"Our focus remains on supporting Mount Sinai nurses — and all our employees — in delivering the excellent patient care we are known for and that our community has come to expect from us, ensuring that Mount Sinai South Nassau continues to be one of the best places to work," the statement reads.

"We recognize the tremendous sacrifices Mount Sinai South Nassau nurses have made during the pandemic and the challenges posed by a nationwide nursing shortage. Mount Sinai South Nassau nurses received 17 percent in pay increases and other enhancements during the last 15 months to recognize their experience. Nurses at MSSN also have always played an active role in governance issues, including in helping to find solutions to the nursing shortage and achieving Magnet-level nursing care for our patients. The hospital hired 250 nurses last year. We look forward to continuing to work together to provide the high level of nursing care our patients have come to expect."

Some strikes averted

While healthcare workers have unionized and participated in labor strikes across the U.S., citing concerns about staffing, patient care, working conditions and employee retention, there are situations where workers averted such walkouts, just days or weeks before they were scheduled to occur.

For example, members of the California Nurses Association reached a tentative agreement with Kaiser Permanente Nov. 17, averting a planned two-day strike by more than 21,000 registered nurses and nurse practitioners in Northern California. Union members were set to strike Nov. 21 and Nov. 22. They approved the tentative deal during voting that began Nov. 22 and ended Dec. 2.

The four-year deal boosts wages for Northern California nurses by 22.5 percent over the life of the contract, according to a statement Oakland, Calif.-based Kaiser shared with Becker's. Kaiser had previously proposed 21.25 percent in wage increases over four years.

Looking forward

Labor disputes are sure to continue this winter over staffing, pay and other issues. It is unclear whether these disputes will reach the strike level. 

Hospitals have noted the workforce and financial challenges at organizations across the U.S., while continuing to reiterate their commitments toward reaching fair agreements before a strike is on the table. Unions have continued to express their desires for improved staffing and workplace conditions. 

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