Nursing Unions Are a Symptom. Here's the Problem.

In light of the recent nursing strikes in New York and California, it's time to dive into the surge in union activity.

In January, two separate sizeable healthcare strikes began on the east and west coasts.

In New York, the members of the New York State Nurses Association (NYSNA) began the largest nursing strike in NYC history on January 12, when about 15,000 nurses formed the picket line to call for better staffing, safety measures, and healthcare benefits. The strike involves nurses from Mount Sinai, Montefiore, and New York Presbyterian.

On the other side of the country, over 31,000 nurses and healthcare workers at Kaiser Permanente started to strike on January 26 to demand higher wages and safer staffing levels. The participants include nurses, physician assistants, pharmacists, and other clinicians who are members of the United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP).

So, why is this happening?

Why nurses strike

Oftentimes, the issues that nurses are striking for have been the same for years. Higher wages, better working conditions, and patient safety are dynamic problems, and as the times change, so do the solutions for those problems. As cost of living rises, so does the demand for better compensation. As patient acuity worsens and workplace violence incidents increase, so must the solutions for safe staffing, which in turn is made more difficult by nursing shortages. Issues in healthcare are cyclical, and there is no perfect place to begin.

From a leadership perspective, strikes are costly, and unions can complicate contract negotiations and everyday workflows. For some, the reasons that nurses decide to go on strike can get lost in the conversation when looking at the financial losses, staffing gaps, and concerns about care delivery and patient safety.

From the frontline perspective, strikes and unionization occur when many of these core issues go unaddressed, or when nurses feel as if their concerns are being disregarded. According to a NYSNA article from 2019, former president Judy Sheridan-Gonzalez believes that nurses usually go on strike as a last resort.

"Nurses decide to strike when it becomes a matter of life and death for our patients," Sheridan-Gonzalez wrote. "When months and years of meetings, documentation, evidence, petitions, letters, research, protests, speeches, essays, negotiations, pickets, rallies, and media outreach fail to achieve these goals, our employers leave us with no other choice."

Katie Boston-Leary, senior vice president of equity and engagement at the American Nurses Association, and HealthLeaders Exchange member, previously told HealthLeaders that unionization in health systems does not impact the dedication that nurses have to their profession.

"Nurses have a right to voice their concerns," Boston-Leary said, "and [they] find a number of different ways to do that through shared governance, through leadership, and in some cases through unions."

CNOs must stay alert

Despite the ever-changing nature of the healthcare system, CNOs and other nurse leaders must remain vigilant about what nurses are concerned about in their own health systems.

The goal for CNOs should be to understand where nurses are coming from and to communicate with them to work towards common goals. Trust and open dialogue are key ingredients for making sure that nurses feel heard and valued, and that leadership is taking their feedback into account.

Dr. Chaudron Carter Short, executive vice president and chief nurse executive at Temple Health, and HealthLeaders Exchange member, previously told HealthLeaders that the key is to spend time listening and talking to nurses to understand their pain points.

"If you could develop a strategy before you get to go into negotiations around what those topics may be, and the organization develops a strategy on how to combat those issues," Carter Short said, "I think you’ll position the organization better as it relates to going into negotiations and averting a strike."

For more information on how to plan for strikes in unionized healthcare environments, read here.