Daily Briefing

Why health care workers are going on strike

Labor strikes are on the rise across the health care industry as workers feel overwhelmed by the demands of the Covid-19 era and increasingly concerned about pay and staffing shortages.

Employer strategy is poised to change in 2022. Here’s what that means for you.

Dozens of strikes across the country

According to a tracker by Cornell University's School of Industrial and Labor Relations (ILR), there have been at least 30 strikes involving health care workers so far this year.

It's part of a broader wave of labor activity across industries: The Cornell tracker shows strikes against a total of 178 employers this year, including 12 strikes involving at least 1,000 workers. According to the Washington Post, workers and labor leaders say strikes are motivated by a lack of high-quality jobs and concern that wage growth is not keeping pace with inflation.

In the health care industry, unions representing 31,000 Kaiser Permanente employees have authorized walkouts, with unions seeking 4% annual pay raises without a two-tier wage system.

Kaiser has proposed 1% annual pay raises over the next three years alongside its two-tier system. Arlene Peasnall, Kaiser's SVP of human resources, said the company's proposed pay scale reflects a response to "unsustainable" labor costs.

"Affordability is a real issue in health care, which was highlighted once again during the pandemic," she said. "We are trying to be available to more people, and we cannot do that if we are too expensive."

Elsewhere in the industry, more than 700 nurses at Saint Vincent Hospital in Massachusetts have been on strike for seven months, and around 2,000 people working at Mercy Hospital in New York have been on strike since the beginning of October.

Why health care workers are striking

Many health care workers have said they were working in emergency mode during the height of the pandemic last year, but the pandemic has continued to drag on, and many workers said they can't handle it anymore.

"It got to the point where seeing signs outside the hospitals—'Heroes Work Here'—appeared a little hollow," said Denise Duncan, president of United Nurses of California/Union of Health Care Professionals. "It's almost like it's been forgotten."

According to Kate Bronfenbrenner, director of labor education at Cornelll's ILR, the pandemic "was a wake-up call, because it wasn't just you could get injured on the job, but going to work could kill you. Workers are feeling like they're working harder than ever and they put themselves out there during Covid and risked their lives for what?"

These conditions, combined with concerns over pay and staffing shortages, have led health care workers to strike more than ever before, Politico reports.

"From our members, I’ve never heard the word 'strike' uttered so many times, whether they're covered by a contract or not. Whether they're in negotiations or not," said Jamie Lucas, executive director of the Wisconsin Federation of Nurses and Health Professionals. "They're fed up. The reasons have always been there, but there's a new realization that they have the upper hand." (Bogage, Washington Post, 10/17; Tahir et al., Politico, 10/20; García-Hodges, NBC News, 10/14; Herman, Axios, 10/12)

Advisory Board's take

The 4 biggest 'pain points' driving strikes in health care (and how to address them)

Carol Boston-FleischauerBy Carol Boston-Fleischhauer, CNO and Managing Director


Every strike is different. Each is driven by its own unique blend of local conditions, employee concerns, and relationships between employers and unions.

In February 2021, I led a team of researchers to study the collective bargaining landscape and identify the challenges in the work environment motivating nurses to strike. While many of today’s pain points still share common ground with challenges faced eight months ago, they’re evolving as providers move beyond acute Covid-19 surges. But if we step back, we can see clear patterns emerging. Nurses and health care workers nationwide are facing specific frustrations that increasingly motivate them to join picket lines.

So what are these pain points? And how can organizations address them? I’ve revisited each of these pain points—with updated insight on how workforce leaders should be responding to them today.

  1. Workplace safety concerns

    At the beginning of the pandemic, the health care industry faced severe shortages of PPE. Many workers also experienced ineffective and constantly changing infection control policies as well as delayed notifications of potential exposures. Providers worked hard to address these obvious safety concerns with myriad tactics.

    However, many workers still don't feel safe at work. On top of the continued risk of Covid-19 infection, health care workers are now battling violence both inside and outside the workplace. To address this concern, unions are demanding greater transparency about employee safety concerns, along with assurance of effective infection control practices. Leaders need to prioritize a holistic approach to staff safety, including renewed attention to workplace violence, to assuage staff concerns.

  2. Understaffing

    During the initial surges, many staff were redeployed with different staffing models to support Covid-19 readiness as core services were suspended. More recently, amid labor shortages in the health care workforce, the continued uptick in Covid-19 hospitalizations required some hospitals to increase the number of patients assigned to each nurse. Staffing ratios in ICUs have proven to be especially challenging.

    Today, increased RN turnover has created intense competition for labor resulting in a severe shortage of bedside nurses. This comes at a time when nurses report their intent to leave their current positions due to staffing and workload concerns. Unions are now seeking guaranteed minimum staffing ratios—especially in higher-acuity settings, such as the ED and ICU—and aggressive plans to mitigate existing shortages. Beyond an all hands on deck focus to retaining staff and restructuring care models with a team approach to staffing, leaders are urged to be transparent with staff regarding the organization’s approach to stabilizing the nursing workforce; including opportunities for staff to provide input into retention plans.

  3. Inflexible or overdemanding work schedules

    Throughout the pandemic, many nurses have faced changing, unpredictable, and extremely demanding work schedules. Scheduling stress and the increasingly heavy workload have contributed to widespread fatigue. Today, nurses who are burned out by the pandemic and struggling with continued uncertainty around childcare and family obligations are seeking more flexible schedules and roles. Organizations should proactively create alternative work schedules and roles to meet these emerging needs, both to re-engage staff and retain nurses.

  4. Compensation concerns
  5. During the surges, many providers employed various approaches to compensation including hazard pay, bonuses, and enhanced overtime rates. However, in most cases, a permanent revamp of compensation did not occur. Compensation has evolved as a flashpoint, as inflation has risen nationwide and pay has surged for travel nurses and new hires. Many long-tenured workers now feel underpaid.

    Collective bargaining action is being used to level this playing field. Executives are challenged to re-evaluate total compensation, including core philosophy, baseline and merit rates, differentials, and creative compensation-based rewards. Consider lucrative retention bonuses instead of sign-on bonuses. While agency rates cannot be matched dollar for dollar, staff are demanding more competitive compensation and looking to unions to achieve that objective. 

Parting thoughts

Labor organizing activity isn't spontaneous and isn't (usually) about a single issue. Rather, it's a cumulative reaction by employees who feel their needs aren't heard, acknowledged, and addressed by leadership. Covid-19 has created a fertile ground for collective bargaining that must be prioritized and addressed.

In this climate, it's more important than ever for employer leadership to create forums for employees to be heard and involve employees in relevant decision making, including options for staff development, engagement, and retention. The modern currency of leadership is being visible. Now, more than ever before, that mantra must be maximized.







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