Why nurses are striking and quitting in droves

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This flu season, Benny Matthew — an emergency room nurse at Montefiore Medical Center in the Bronx — has often been in charge of 15 to 20 patients at a time.

By 3 p.m. most days, the emergency room is often bursting with patients, Matthew said. Hospital groups stand inches apart. When the beds run out, patients are squeezed into tightly packed chairs. When the chairs run out, patients must stand. The waiting time to see a doctor can be up to six hours. At the same time, the hospital advertises more than 700 nursing positions.

“We go home feeling like failures,” Matthew said. “There are times when you can’t sleep because you’re thinking, ‘Did I do something wrong today?’

Matthew is one of more than 7,000 union nurses who went on strike in New York City last week, protesting staffing levels that prompted two of the city’s largest nonprofit hospital systems to agree to strengthened staffing ratios in some hospitals. On Thursday, hundreds of health care workers from across the country protested understaffing at HCA Healthcare, the nation’s largest hospital system. That included an El Paso worker who recently admitted herself to her emergency room for dehydration and exhaustion after working four 12-hour days in a row, her union said.

Those tensions have continued to play out over the past month, as nurses have also protested, gone on strike or threatened to strike in California, Oregon, Michigan and Minnesota.

Concerns about staff shortages have been at the center of labor disputes in a host of industries in recent months, including an averted threat from a national rail strike, but perhaps nowhere have these tensions been more pronounced than in health care and nursing. Nurses led a quarter of the top 20 job cuts tracked by the Bureau of Labor Statistics in 2022.

While staff shortages have plagued some hospitals and medical centers nationwide for years, the pandemic added new layers of stress as nurses worked through successive coronavirus outbreaks that killed and disabled thousands of health care workers. The increase in flu and respiratory illnesses in recent months has only worsened the situation.

With no end in sight, legions of nurses have left the field, retired early, or changed jobs. About 100,000 nurses left the industry between 2020 and 2021, according to an industry trade journal estimate. Although there were 4.4 million registered nurses with active licenses as of 2021, according to the National Council of State Boards of Nursing, only 3 million people were employed as nurses, according to the Department of Labor.

Those who remain are faced with increasingly heavy workloads. They also gained more influence in the tight labor market, prompting nurses to organize new unions and even leave their jobs to join the ranks of traveling nurses who parachute in from out of town to fill staffing gaps and tend to be paid more.

“The issue is that we are understaffed, not just at my facility, but really across the country,” said Cathy Kennedy, president of the California Nurses Association, which represents 100,000 nurses in the state. “We’re seeing an increase in nurses saying, ‘We’ve had enough. We want to organize. We really want our hospital to listen to what we have to say.’”

New York-based hospital company Montefiore did not respond to a request for comment about staffing levels. But the company defended the deal reached by negotiators and the hospital late Wednesday that ended the strike, with some major concessions for nurses. The deal includes a 19.1 percent increase over three years, 170 new nursing positions and emergency room staffing ratios based on the severity of patient needs.

Harlow Sumerford, a spokesman for HCA Healthcare, said Thursday’s strike was “an expected tactic as we are set to begin our regular bargaining cycle with the unions in the coming weeks”. He noted that the hospital system staffs its teams “appropriately and in accordance with state regulations.”

In the years leading up to the pandemic, there were roughly enough new nurses entering the pipeline to replace those who retired, according to a 2022 McKinsey & Co. report titled “Assessing the Continuing Impact of COVID-19 on the Force nursing worker”. But Covid changed everything. “Over the past two years, McKinsey found that nurses consistently, and increasingly, report that they plan to leave the workforce at higher rates than in the past decade,” the report said, a trend that continued even with the decline. of Covid cases.

From coast to coast, growing nursing shortages have caused a number of widespread issues for nurses and patients, according to interviews with nine nurses. Nurses say there have been significant declines in patient care, including delayed cancer treatments and critical checks for expectant mothers. Medicines are administered late or not at all. The absence has also affected the mental and physical health of nurses, as they are forced to skip meal and rest breaks and have little recovery time between shifts.

Organized strikes, and even the threat of a strike, have managed to get some hospitals to agree to address some staff concerns. This winter nurses have won guarantees for investment in new hires, a greater role in shaping the nurse-patient ratio and strong pay gains that could help keep them.

In Kalamazoo, Mich., 300 nurses — part of the Michigan Nurses Association — won a 20 percent raise in the first year of their contract after threatening to strike Ascension Borgess Hospital over staffing levels in December. Night nurse Lori Batzloff said the pay increase should help retain nurses. But she is worried about her hospital’s ability to cope with another Covid outbreak.

Last September, in Minnesota, 15,000 nurses went on strike for three days over staffing concerns, the largest private nursing strike ever. When the hospitals still refused to accede to their demands, the nurses threatened to walk out a second time, for three weeks in December. With days before the strike deadline, more than a dozen hospitals, for the first time, agreed to give nurses a say in staffing levels, avoiding a strike.

“I think the hospitals looked around and realized they couldn’t afford, frankly, a three-week strike of 15,000 members in Minnesota,” said Chris Rubesch, vice president of the Minnesota nurses union. “That would be crippling.”

A spokesman for the Twin Cities Hospital group said in a press release when the agreement was reached that the new agreement shows hospitals and labor can work together to “develop staffing language that meets the unique needs” of hospitals, nurses and patients.

For other health care workers who typically earn less than nurses — such as health care technicians, dietitians and nursing assistants — the impacts of the understaffing are just as bad.

“There’s no morale left,” said Gregorio Oropeza, an admissions representative who enrolls patients at Cedars-Sinai Hospital in Marina del Rey, California. Oropeza has colleagues who have had to leave the workforce after suffering severe symptoms from COVID. “Everyone is there because they need a paycheck. They are afraid of getting sick, but this is a job and they have to support a family.”

Oropeza and 400 of his colleagues went on a five-day strike with SEIU-United Healthcare Workers West in December over staff shortages and wage concerns, but the union’s contract negotiations remain stalled.

Marni Usheroff, a spokeswoman for Cedars-Sinai Marina del Rey, said the hospital recognizes that its employees are its “most important asset” and that during contract negotiations, the hospital has demonstrated its “commitment to maintaining the levels of staff who provide important support to our healthcare workers.”

During the coronavirus pandemic, nurses have organized and won union elections, even as unionization rates in the United States have declined.

“I remember in the middle of the pandemic, predicting that once the dust settled, there could be an explosion of new organizing and strikes to achieve safe staffing levels,” said Sal Rosselli, president of the National Union of Health Care Workers. which represents 15,000. health care workers in California. “And that’s what’s happening now.”

While some nurses are organizing, many have left the field entirely or plan to leave the industry. A 2022 study by staffing agency ShiftMed found that two-thirds of nurses say they are likely to leave the profession within the next two years.

Some nurses have left their full-time jobs to take up highly lucrative contract work, traveling to other parts of the country and temporarily filling in for short-staffed hospitals. The option has become popular among young nurses, especially many who are looking to pay off student loans. Demand for travel nurses is about double what it was at the beginning of the pandemic, though it has moderated since the peak of the outbreak, according to April Hansen, an executive at Aya Healthcare, the nation’s largest travel nurse agency.

Nurses’ unions say hospitals are to blame for nursing shortage problems, noting that health care companies made a deliberate choice not to devote resources to hiring more nurses. Many hospitals profited during the pandemic, receiving millions in Covid-related aid, rewarding investors with generous stock buybacks and paying executives seven-figure salaries. In the Bronx, Montefiore CEO Philip Ozuah earned $7.4 million in 2020.

“I think the hospital administrators are hypocrites,” said Zulma Gutierrez, 42, an intensive care unit nurse at Montefiore who went on strike this week. “They’re going home making millions and we’re going home guilty.”

But a growing and aging population, combined with ongoing waves of Covid, means the demand for nurses will continue to grow in the coming years. According to the McKinsey report, by 2025, the United States is projected to have between 200,000 and 450,000 nurses.