More nursing strikes are likely, and it’s not solely about pay

It’s not just about the money.

Nurses in some areas have gone on strike, or threatened to walk out, because they are demanding better staffing and improved patient care, says Anne Dabrow Woods, chief nurse of Wolters Kluwer, the information services firm.

She expects to see more labor battles, and more strikes, between hospitals and nurses’ unions over the course of the year.

“I think that the battle is not over,” she says. “Actually, I think it's really just begun simply because, you know, hospitals for years have cut things so close to their margins … They're really trying to keep themselves in the black, and they're really, really bleeding into the red.”

In an interview with Chief Healthcare Executive, Woods talks about the frustration of many nurses, which include staffing and workplace violence. With hospitals struggling to recruit and retain nurses, she talks about what hospitals can do to keep their nurses at the bedside.

But she says that it’s likely that more nurses will be going on strike this year.

“People think it's all about nurse compensation,” Woods says. “I mean, that's certainly a little part of it. But when you ask a nurse, ‘why do you really go on strike?’, it’s because they feel like they're not able to provide that safe patient care, because there simply aren't enough nurses to do that.”

(See part of our conversation with Anne Dabrow Woods in this video. The story continues below.)

• Read more: Nursing profession is ‘beyond burnout’ and needs greater attention

‘We can’t do this anymore’

Healthcare industry analysts have projected that more nurses are likely to go on strike this year. Many health systems are struggling financially, and for hospitals, 2022 was the most difficult year financially of the COVID-19 pandemic, according to Kaufman Hall, the healthcare consulting firm. Hospitals have been paying more for expenses, including labor.

Now, for some hospitals, contracts negotiated before the pandemic are expiring.

In Minnesota, 15,000 nurses engaged in a three-day strike in September. The nurses planned a second strike affecting 16 hospitals in December, but the union and health systems reached an agreement on a new contract and the walkout was averted.

Thousands of nurses in New York City went on strike for three days in January before securing a new contract. In that dispute, health systems and nurses had agreed on the salary questions - raises of around 19% over three years - before coming to terms on staffing demands.

Nurses at South Shore University Hospital reached a deal on a new contract with Northwell Health last week, just days before a strike was set to begin. Hundreds of nurses in Maui went on strike last week.

Around the country, nurses say they’re frustrated with being asked to care for more patients than they can safely manage, Woods says.

“The main reason nurses are striking and their unions are saying we can't do this anymore, is because there's simply not enough nurses to take care of the number of patients that are there,” Woods says.

“Sure, money's important to everybody,” she adds. “We’ve got to pay the bills, right? But the true reason nurses are really walking out on strike is because they just don't feel safe. And they're walking out to really stand up for their patients, so that the patients that they care for are able to get the level of care they deserve.”

Most hospitals tend to be competitive in salaries, largely because they have no choice if they want to recruit and retain nurses, Woods says. Some hospitals are putting a greater effort in adding nursing staff, she says.

“I think that some hospitals are really trying to do that, but others aren't,” Woods says.

Walking away

Many nurses have left bedside roles at hospitals, especially with the stresses of the COVID-19 pandemic, healthcare leaders and analysts say. But the workforce could lose more nurses in the near future.

Almost half of America’s registered nurses are over the age of 50, according to federal statistics. “They’re going to be retiring,” Woods says.

But she says it’s “really frightening” to see nurses in their 20s and 30s leaving the profession.

“To me, that's really concerning, because they're our next generation of nursing leadership within our organizations,” she says. “And they're saying, ‘We can't do it.’”

Hospitals need to look at nurse staffing levels more comprehensively, Woods says. In determining staffing, health systems need to consider the acuity of the patients.

Hospitals also must weigh the experience level of the nurses. If one nurse on a given shift is new, that shift may need anotherl experienced nurse to assist with training and patient care, Woods says.

“Unfortunately, it's become a numbers game where it's all about patient-to-nurse ratio,” she says. “And staffing cannot be that way.”

Nurses are also distressed by the rising violence they are enduring in hospitals, including the fatal shooting of a nurse and a social worker in Texas last October.

Hospitals are also seeing, and housing, more patients with behavioral health issues due to a lack of beds at facilities for patients with mental illness.

“You want to deliver safe care,” Woods says. “As a nurse, you want your patients to get safe care, but you want to feel safe when you go to work. Everybody deserves to feel safe.”

While healthcare leaders have talked at length of building more resilience among nurses and doctors, Woods says the focus should be on the well-being of clinicians.

“To really build resilience in our staff, and amongst health care workers, we need to change the environments in which we work and make them healthier, and really focus on well-being,” Woods says.

And that involves helping nurses and doctors see the value of self-care, including taking care of mental health.

“We need to teach those of us who are care providers, that if we don't start taking care of ourselves first and invest in our own well-being and self care, we're not going to be able to care for others,” she says.

The need for flexible schedules

Hospitals will have more success at keeping nurses if they shift to more flexible scheduling options, Woods says.

• Read more: Should hospital nurses be working 12-hour shifts?

During the height of the COVID-19 pandemic, hospitals incorporated more flexible scheduling options, largely out of necessity due to the high volume of patients. Instead of relying on 12-hour shifts, hospitals would have 8-hour shifts, or even 6-hour shifts, Woods says.

Now, many hospitals are returning to 12-hour shifts, which can be more difficult for older nurses and nurses with younger children, Woods says.

Hospitals that are using more flexible scheduling options are also having less difficulties with staffing, she adds.

“We need to remember that nurses have their family responsibility, and care of their elders,” Woods says.

“So what we're finding is that hospitals that are going back and being more flexible with their workforce … Those hospitals tend to have a little bit better staffing because they are more flexible. And those organizations that allow more flexibility are going to attract more nurses.”

Health systems need to show nurses that they are valued. Part of that is investing the money to ensure adequate staffing so nurses can do their jobs safely, Woods says.

But Woods also offered another suggestion that doesn’t involve any money. Hospital leaders must talk more with nurses and listen to their concerns.

“We have to have better communication between the leadership in the C-suite with the people who are boots on the ground, taking care of the patients,” Woods says. “And the people in the C-suite need to come out of their offices and see what's really going on. And they have to recognize the value that nurses bring to health care.”

“I think the biggest thing is they need to start to listen to the people who were on the front line,” Woods says. “And they need to be willing to invest in keeping the talent they have within their organization.”

Nurses, working with healthcare organizations, have the ability to make a difference, she adds.

“The question will be, do we as nurses, and do organizations have the courage to really work together to see a change in health care?”