What the NYC Nurse Strike Means For Your Care

Over 7,000 nurses at two New York City hospitals went on strike this week, citing exhaustion and burnout as motivating factors for walking out.

The nurses, represented by the New York State Nurses Association (NYSNA), refused a nearly 20% pay increase before going on strike. They told their employers, Mount Sinai Hospital and Montefiore Medical Center, they wanted more nurses and safer nurse-to-patient ratios to lessen their excessive workloads instead.

"From the beginning of the negotiation, it was never about wages. It was always about safe patient care," Nancy Hagans, RN, BSN, CCRN, President of the NYSNA, told CNN.

The strike ended Thursday, January 12, after hospital and union representatives reached a tentative but unprecedented agreement that secured better nurse staffing ratios. The hospitals conceded to pay a fine if nurses must take on more patients than the contract allows. Both hospitals committed to a 19% wage increase for nurses over three years.

Other contract terms, negotiated separately with each facility, include adding more nursing positions, increasing float pool nurses to fill open shifts, fully paid health insurance, and pension payments.

While hospital systems were able to plan for the strike, reschedule appointments, and reallocate resources in the short term, patient care does temporarily suffer during a walkout. However, nurses say fighting for safer workloads is the only way to protect patients in the long run.

"These nurses were fighting for the survival of nursing and to save patient lives," Rebecca Love, RN, MSN, Chief Clinical Officer for the healthcare workforce management platform IntelyCare, told Verywell. "There will be no nurses left to care for patients if we do not address nurse-to-patient ratios."

How Nursing Strikes Impact the Local Community

Mount Sinai and Montefiore urged the public not to avoid using their facilities if necessary, but still struggled to meet their communities' health needs during the walkout.

The Associated Press reported that each hospital canceled scheduled procedures and transferred NICU babies to other nearby hospitals in anticipation of the strike. They called upon temporary travel nurses to fill in for staff nurses on the picket line.

Still, individuals who came to their emergency rooms experienced even longer wait times than usual as patients stacked up waiting for a hospital bed.

Healthcare Provider Shortages are a Growing Problem

The pandemic pushed an already tenuous healthcare system to its brink. Nurses and other healthcare providers across the country say working conditions have become untenable. They feel that patient care is suffering because they are overworked and worn out, and they want to force lasting change.

Nursing shortages and healthcare worker burnout are widespread problems. A 2022 survey by consulting agency Bain & Company showed that 25% of physicians, physician assistants, nurse practitioners, and nurses are considering leaving health care altogether. Of those looking to change careers, 89% said burnout was their primary reason for wanting to leave.

Nursing Shortages Compromise Patient Care

Nursing shortages are not only demoralizing to nurses and others who work with patients. They also compromise safe, timely, and quality care.

"In the last five years, I've seen a change in the number of patients we board in the ER," said Nicole Hill, BSN, RN, nursing supervisor at Good Shepherd Health Care System in Hermiston, Oregon. She told Verywell it can be difficult to transfer a patient from a small hospital to one that offers a higher level of care because they often have patients in their own emergency rooms that have been waiting for days to be admitted to the hospital.

"It's terrible for the patients, the doctors, and the nurses," Hill said. "When they've got 40 people in the waiting room, the patients can't possibly get the level of care they need."

Nurses who join walkouts, including the one in New York, do so to ensure better patient care. Having fewer nurses in hospitals increases patient mortality. The more patients a nurse has, the more likely they will miss a change in patient status or make a critical error. When nurses burn out and leave the bedside, the nurses that remain are stretched even further.

Addressing the Way Facilities Are Paid for Nursing Services

Hill explained that hospitals bill and receive reimbursement for each encounter a physician, dietitian, physical therapist, or other care provider has with a patient. However, the cost of nursing labor is included in the hospital's per diem or lump sum reimbursement for a patient's stay. This makes it hard for hospitals, which must find ways to maximize revenue in order to survive, to quantify the value of nursing care.

"Until we rectify the problem of viewing nurses as a cost and change their labor to a reimbursable model, there will never be enough money for more nursing services," said Hill. "It devalues what nurses do for our healthcare system."

Even though facilities are not directly reimbursed for nursing services, Hill said a shortage of nurses can still impact a hospital's bottom line in other ways. A patient's length of stay may extend beyond what the hospital is reimbursed for providing. Shutting down a unit or canceling surgeries leads to lost revenue. And a reliance on travel nurses or staffing agencies to fill the gaps is quite costly.

Ultimately, keeping nurses is more cost-effective for hospitals than replacing them.

"There is no short-term solution to the nursing shortage. We cannot produce enough nurses, and the ones we produce are not staying," said Love. "Hospitals need to get smart about retention."