The walkout in New York City this week is likely foreshadowing many contentious labor battles hospitals will see in 2023.
Thousands of New York City nurses went on strike this week, marching on picket lines for a better contract.
More than 7,000 nurses walked out at Montefiore Medical Center and Mount Sinai Hospital, and they were on strike for three days before reaching an agreement with the health systems Thursday.
The New York State Nurses Association, the union which represents the nurses, said the agreements will provide better staffing levels and higher wages to recruit and retain more nurses. The hospitals said they were pleased with the agreements and said they recognized the value of their nurses.
Industry analysts and nursing leaders have said the New York strike is foreshadowing other intense labor battles in 2023.
“I expect we will see more strikes, more contentious negotiations,” Kevin Holloran, senior director and sector leader for the non-for-profit healthcare group at Fitch Ratings, said in a conference call this week.
“I do think we will see very contentious labor negotiations and the potential for strikes is much more elevated than it used to be,” he said.
Health systems are going to have to plan for higher labor costs, said Ash Shehata, KPMG’s national sector leader in healthcare and life sciences. With hospitals struggling financially and nurses demanding better wages, there are going to be more battles in the near future.
“The industry has seen this before, and what tends to happen is, you get wage inflation, and that kind of sets into motion some of the organized labor actions,” Shehata said.
“I think you're going to see it in the major metro areas across the country. And that's going to be another area, a risk area, that many of our leaders need to begin to prepare for.” (See excerpts of our interview with Ash Shehata of KPMG in this video. The story continues below.)
Nurses have complained about working conditions at hospitals across the country.
Many nurses have said they don’t feel valued by their employers, and they have been physically and mentally exhausted working long shifts due to staffing shortages. Some nurses have left hospitals due to the stresses of the COVID-19 pandemic. Nurses have also said they don’t feel hospitals are doing enough to keep them safe as they have encountered more workplace violence in the pandemic.
And many nurses have said they don’t feel fairly compensated for all they contribute to patient care.
Many nurses are losing the love of nursing, said Beth Ulrich, a professor of nursing at the University of Texas Health Science Center in Houston and a longtime healthcare executive. She was the lead author of a study on nursing released by the American Association of Critical-Care Nurses last August.
“We asked nurses what might get you to stay, and they’re very clear. Staffing. Respect,” Ulrich told Chief Healthcare Executive in August. “They want additional salary, not unreasonable when you look at comparative salaries for what people do.”
Nurses are looking at more than compensation in their new contracts, Jill Lashay, a healthcare attorney at Buchanan Ingersoll & Rooney, told Chief Healthcare Executive.
“Staffing is as big an issue, if not more, than wages, in many instances,” Lashay said.
“Wages are always going to be an issue but staffing remains particularly acute and challenging in the healthcare field,” she said. “There were a lot of nurses who left during the pandemic … That mass exodus from the industry, coupled with the shortage we had in the industry before the pandemic, is like a perfect storm.”
At the same time, many hospitals are losing money.
Hospitals suffered severe financial difficulties in 2022, as their labor costs rose and federal COVID-19 relief dried up, making it one of the worst years on record for healthcare. Health executives have also complained about the soaring costs of nurse staffing agencies they have relied on to fill vacancies.
Fitch Ratings revised its outlook for the non-profit hospital sector as “deteriorating” in August. Fitch projects hospitals will see continued financial difficulties in 2023, but also expects that hospitals may begin recovering later this year.
But hospital leaders are going to have to realize higher labor costs are here to stay, analysts have said. And unions are showing they are ready to fight.
Hospitals bear significant costs from strikes. They have to spend more to hire temporary nurses to care for patients during a strike, and contract labor tends to be much more expensive, Holloran noted. Even a relatively short strike can be costly.
Even if hospitals can reach an agreement with staff before a strike begins, the threat of a walkout is going to have an impact on a health system’s bottom line. With an anticipated strike, hospitals are lining up temporary staff and postponing elective surgeries and procedures, “and that’s surgeries you want,” Holloran said, because they bring in revenue.
“You’re already seeing the financial impact” before the strike, Holloran said. “It’s meaningful even before it happens.”
‘A warning shot’
Many hospitals that last negotiated contracts before the pandemic are seeing those pacts expire. Some recent negotiations have led to prolonged battles.
The Minnesota Nurses Association led the largest nursing strike in U.S. history in September, when 15,000 nurses engaged in a three-day strike. 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. Minnesota nurses secured a greater say in staffing and received raises of 17%-18% over the next three years.
More than 21,000 nurses and nurse practitioners in northern California threatened to hold a two-day strike in November, but they scrapped the planned walkout when they reached a deal with 21 Kaiser Permanente facilities.
Jennifer Mensik Kennedy, president of the American Nurses Association, spoke out this week in support of the New York nurses, saying they are working to protect patients.
“When nurses choose to strike, it is a last resort,” she said in the statement. “Ultimately, this is about the quality of patient care as we know that patient safety and nurses’ work environment are inextricably linked. A supported and protected nursing workforce yields quality and safe patient care. Nurses everywhere need definitive and transformational action immediately.”
Across the Atlantic, about 100,000 nurses in the United Kingdom went on strike in the United Kingdom in December. The strikes were the biggest ever in the history of the National Health Service, the British health system, BBC News reported. Nurses in Britain are planning to strike again next week, CNN reported.
Rebecca Love, chief clinical officer at IntelyCare, has been pushing for healthcare leaders to do more to care for their nurses. She told Chief Healthcare Executive in November that the strikes in the United Kingdom, which had just been announced, would be repeated in America.
“It will be a warning shot to the United States,” Love said. “What is going to happen there, will also happen here.”
‘You’re seeing it work’
Nancy Hagans, a registered nurse at Maimonides Medical Center and president of the New York State Nurses Association, jubilantly declared victory in a news conference Thursday.
She said nurses were willing to do whatever was needed, and remain on strike as long as necessary, to get the contract they wanted. “Nursing has to become a sustainable profession that keeps us at the bedside,” Hagans said.
“What this strike has shown is when we fight, we win,” Hagans said.
Lashay, the healthcare attorney, said she expects to see more nurses’ unions that are willing to go on strike. Unions see themselves in a better bargaining position, and they are taking lessons from other labor battles in recent months.
“It’s certainly going to be an increased number of threats of strikes and strikes themselves,” Lashay said. “You’ll likely see more of them because you’re seeing it work.”