Health care is in crisis. New York’s nurses strike is just the latest sign

By Chris Isidore, CNN

Naniaka Camara grew up near Montefiore Hospital in the Bronx in New York and remembers going there for her own medical care. A Montefiore nurse for the past three years, she still lives only minutes from the hospital and often knows the patients from her neighborhood she cares for.

She loves her job, she said, but she’s been on strike since early Monday morning, out of the frustration she feels for not providing patients with the care they deserve.

It is just the latest in a series of job actions across the nation by nurses’ unions and other health care workers who say they had to strike in order to provide patients with quality health care.

“Sometimes I feel like what I did was pointless, I’m apologizing for stuff that has nothing to do with me,” Camara said from the picket line in front of her neighborhood hospital. She said she’s often late providing medication or other services that patients need due to staffing shortages that can stretch her shifts to 12 or 14 hours. She goes to bed as soon as she gets home.

“I don’t like to think about the previous shift because I won’t want to come in for the next one,” she said.

The strike by 7,100 nurses started Monday at Montefiore’s three hospitals, which provide about half the hospital beds in the Bronx, and at Mount Sinai hospital on the Manhattan’s Upper East Side.

Staffing shortage cause healthcare strikes to surge

Last year, 5,000 nurses went on strike in Minnesota, as did 2,000 mental health professionals in California and Hawaii. Of the 20 major strikes tracked by the Labor Department over the first 11 months of 2022, seven of them, or 35%, were in health care. Five of those, or 25%, were nurses strikes.

A major issue in all of them? Staffing.

The surge in health care related strikes comes despite the fact that only 3% of union members nationwide work at private sector health care jobs.

“It’s extraordinary that number of [registered nurses] are striking,” said Bob Muehlenkamp, a retired union organizer for Local 1199, who spent much of his career organizing and negotiating on behalf of nurses. The issue isn’t wages, he said. The nurses are striking because they want to do their jobs the way they believe they should be done.

“There is trauma every single RN goes through in deciding to walk away from patients,” said Muehlenkamp. “It’s against every instinct they have.”

Only about 10% of nurses are in unions and able to strike. But for many of them, walking out doesn’t mean going on strike, it means quitting the profession they love, exacerbating the shortage.

Trouble filling jobs

There are 3.1 million registered nurses’ jobs nationwide, according to the Labor Department, with about 60%, or 1.9 million, at hospitals.

“One indication of how hard it is to get nurses is the number of traveling nurses,” said Joshua Gottleib, professor of public policy at the University of Chicago, referring to an estimated 67,000 nurses, or one out of every in 20 working at hospitals, who work for temporary staffing services. “That’s been historically high.”

The hospitals being struck are using traveling nurses as fill-ins for the strikers, but that’s an expensive alternative — those nurses are typically paid far more than the staff jobs they’re replacing. Traveling nurses fill in at hospitals nationwide since the hospitals can’t fill all their own staff jobs.

Hospitals have a financial incentive to get by with as few staff nurses as possible, according to experts who study healthcare issues.

“Labor is the main expense in health care, so how do you make money? You squeeze your labor costs,” said Janette Dill, professor of health policy and management at the University of Minnesota. “Your nursing work force is your biggest work force.”

The New York hospitals being struck insist they’re doing everything they can to address their own staffing shortages.

Mount Sinai says that it has hired more than 4,000 new nurses over the last three years, and now has 503 more nurses working today than four years ago, exceeding the hiring commitment it made in 2019 during the last round of union negotiations.

And it has offered what it calls a “robust” staffing enforcement plan to the union to improve the ratio of nurses to patients, it said, but that when it offered to add 50 additional nursing positions, the union said it wanted the money for those additional positions to go to wage increases for existing staff.

The union denies this, saying that improved staffing, not pay, is its top priority in these talks.

“We’re in a workforce crisis, post this pandemic,” said Fran Cartwright, chief nursing officer at Mount Sinai, in an interview on CNN Monday. “It’s especially true in our academic medical centers and it will take some time to strengthen the bench.”

Nursing shortage put patients at risk

Nursing shortages and work conditions have created a surge in strikes and union organizing efforts, said Sal Rosselli, president of the National Union of Healthcare Workers. While the staffing shortage predates the pandemic, the pandemic was the tipping point for many nurses.

“They learned during the pandemic that their employer was not worried about their safety, or the safety of their patients,” he said.

ECRI, an independent healthcare research firm, ranks the industry’s staffing shortage as the greatest risk to US patients today. It doesn’t expect that to change any time soon.

“Unfortunately, there’s not a short-term fix for this issue,” said Dr. Marcus Schabacker, ECRI’s CEO.

Beyond the aging of the US population, some of the current surge in hospital stays comes from “demand that was pent up during pandemic, with patients coming back to hospitals for elective procedures.”

In addition, there’s the increasing “need to treat patients with post-covid complications. That all puts additional pressure on a system that for a long time was understaffed.”

The nursing shortage will worsen, he said. “A few years ago we estimated that by 2025 there would be a shortage of 1 million nurses nationwide,” Schabacker said. With those who left the field during the pandemic, that could be an undercount.

ECRI data shows the median age of a registered nurse is 52 years old, with 20% of them 65 and older. The dearth of nurses also has created a scarcity of nursing instructors. In 2019 it was estimated by ECRI that over 80,000 qualified applicants were turned away from nursing schools due to insufficient staff to teach them.

“A lot of nurses join because they’re motivated to help patients,” said Schabacker. “When there is a shortage, they’re prone to step in and do an extra shift, come in on weekends. If someone is tired, overworked, sleep deprived, they’re going to make more mistakes.”

A nurse’s strike won’t help patients in the short term, he said. “It’s a sign of true, understandable desperation.”

— CNN’s Tami Luhby contributed to this report

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