Health workers in the US are struggling, whether against the violence of the fascist anti-migration cops in Minnesota or on the picket lines in New York. We spoke to a fellow worker in New York about their current strike. The way that management uses agency nurses to undermine the dispute seems particularly noteworthy. It is always easy to comment from the sidelines, from across the pond, but if pickets and the wider organisation of the strikers cannot respond to the organised scabbing, then the visits of ‘socialist’ mayors at the picket line will only have sedating effects on the strikers. Like in the UK or in Germany, one of the main issues is that the strike is limited to nurses and a small group of registered staff, rather than uniting the entirety of the hospital workforce.
Intro
My name is Keith. I’ve been a registered nurse for about eight years now. I’ve been working at Mount Sinai Hospital, the main campus, since June 2024. I work in a stepdown unit. We are currently on strike.
There were originally going to be strikes at 16 facilities by over 20,000 nurses, but four NYC facilities and 3 Long Island facilities that are safety net hospitals reached agreements prior to the start of the strike. Safety net hospitals are hospitals that take patients who have public health insurance and are in areas where there’s a lot of people on public health insurance. That left 15,000 nurses employed by three companies – Mount Sinai, Montefiore, and New York-Presbyterian – striking across nine of their campuses. Mount Sinai has been acquiring hospitals like crazy this century and is in an always-ongoing process of centralization.
The hospitals on strike are all private institutions. I don’t know about NYP or Montefiore, but we definitely have a luxury med surgical unit for private payers at my hospital. Mount Sinai also comprises private research university departments and has a large medical school attached to it. These are all facilities with, from our perspective, quite a lot of money sloshing in and out of them. They could meet our demands, but they’ve been rather intransigent instead.
The union
It would not surprise me if it was an intentional plan on the part of NYSNA (New York State Nurses Association), the union under which all of these facilities are organized, to have so many contracts expiring all at the same time. They also picked these hospitals because they’re private facilities with less patients on public insurance. So there’s more of a sense that they can weather the disruption better than a lot of the smaller hospitals and minimize the impact on the patient population here in New York City. Because they’re private facilities, they also set some of the salary standards for nursing across the rest of the city. There was a big contract renegotiation on the part of the public hospitals a couple of years ago. They agreed that their salary would come into parity with our salary over the course of 4 or 5 years. So our contracts tend to be at the vanguard of working conditions for nurses in the city and in the surrounding metropolitan area.
Initially, 15,000 nurses were on strike. This is the biggest strike in New York City in over two decades. NYSNA organises only registered staff, apart from general nurses also advanced practice nurses, nurse anesthetists and nurse practitioners. Perhaps some of the educators at the hospital are also part of NYSNA. The health care assistants and the auxiliary staff are in different unions. Nurses in some of the hospitals in New York are not organised by NYSA. The main NYU campus, I believe, is under SEIU 1199, but the majority of nurses in New York are with NYSNA.
The prelude to the strike
The prehistory actually starts in 2023, which is when the last big strike happened at Mount Sinai. I did not work there at the time, but a number of my colleagues did. And the understanding that I have gathered is that in the wake of the Covid 19 pandemic, which hit New York City the hardest, there was a loss of a lot of experienced nurses who decided to retire. The staffing conditions had gotten very bad and because the union had not been very strong in 2016 and 2019, there had not really been a significant, upward wage increase for a pretty long time. On our unit (step-down) we zealously defended a 1:3 to 1:4 staffing ratio. The patients need a lot of care and with three patients you just about manage. So when my colleagues tell me that they were getting 5 or 6 patients prior to 2023, then the quality of care just cannot have been up to par.
So in 2023, when conditions were very poor, in terms of management’s perception the strike came very suddenly. This contributed to the fact that they won a lot of concessions after only three days of striking, in terms of staffing and a decent wage increase. There is the sense that management weren’t expecting the last strike and they felt they gave way too much away and they were definitely going to go harder in the run up to the next contract. In the build up to our strike, it’s been surprising how brazen management has been. It’s been retaliation. For example, nurses from the Emergency Department (ED) went to the collective bargaining session between the labor bargaining unit and management on their break as a show of support and solidarity and strength. After that they had grabbed some of the extra food that was left over and brought it over to the emergency department to put it in the break room and to give everybody updates about what had happened at the negotiations. This behaviour of bringing food and giving updates was not at all unusual. But several of these nurses were given disciplinaries for “disrupting the unit”, including one person who was given the most severe final warning. Obviously, NYSNA was not happy about that. And they immediately added the expungement of these disciplinary actions from the nurse’s records into their demands that they were making for the hospital.
The reaction of management
After the strike notice was given we started to see travelling agency nurses coming to the unit. I read somewhere that they hired 8,000 scab nurses for the three facilities. Management offers anywhere from 8 to $9000 a week to these nurses. There is an entire ecosystem of people that do travel contracts and take these horrible strike contracts a couple of times a year and they walk away with a pretty good income.
Before the strike, management was trying to get some of them oriented within the workplace. You don’t actually have to teach or support agency nurses that are sent to replace you during industrial action. It’s your choice. On some units nurses were refusing to do that, as was their right. But the hospital started putting out these notices saying, “We’re hearing about all this bullying that’s happening toward our agency nurses and we are not a bullying facility. We will take action against anyone…” and so on. Some of these agency nurses actually acted as management snitches. Then one of the agency nurses, or ‘strike nurses’, as they are called here, took a picture of some nurses putting supplies, such as catheters or pads, into a bucket. According to the union and according to the nurses who have all spoken to the media, they collected these supplies for a coming patient cases. This was on the labor and delivery unit, and apparently the strike nurse took a picture of this, sent it to management and said, “Look, these nurses are hoarding supplies. They are planning on hiding them so that we won’t be able to use them. When they went on strike”. Management tried to reach out to the accused nurse via phone call, but just before strike they might not have picked up a management call. They were then fired by voicemail. This is literally 12 hours before the strike is going to start. So there were a lot of intimidation tactics on the part of Mount Sinai management.
The demands
No backsliding on staffing ratios is our first and most important demand. The issue we’ve been having regarding pay is that instead of treating healthcare and wages as separately negotiable issues, management has insisted on “bucket bargaining” where they offer these lump sums – first $4000, then $4500, now $5000 – that are supposed to cover healthcare, wage increases, professional development, and anything else the union wants. This is functional backsliding in terms of our compensation because projected increases in healthcare premiums and cost of living even under favorable circumstances (and given the current political regime, who’s to say what will happen to cost of living) will outpace that. To put this into context, in private hospitals in New York, the average starting salary is definitely over $100,000. Even for a new grad nurse, it can be anywhere from 110 to $120,000. The average rent in Brooklyn is around $4,000, in Manhattan it is up to $6000 a month and rents are going up.
The other thing I want to highlight is retention. Up to 30% of nurses leave the profession within the first 3 years, and also, because of the high cost of living in NYC, we have to fight hard to make working conditions at our hospitals attractive enough that people who would otherwise live and work in upstate New York, Long Island, or New Jersey – where typical features of American middle class life, like a single-family house and less congested roadways, are more in reach – choose the city, instead. The more management erodes the relative benefit of working at our facilities, the more our facilities will tend to be staffed by a higher proportion of younger, less-experienced nurses, which has negative consequences for the communities we serve and for us.
Also in terms of staffing levels they tried to go for a handshake agreement, “This is the ratio that we’re shooting for, but if we can’t make it on a given day, then that’s no big deal.” They won pretty significant arbitration rights around staffing enforcement after the 2023 strike. Nurses in under-staffed won pay-outs because of these arbitration rights and management wanted to reverse that. In case of understaffing we would fill out this form that is called a protest of assignment (POA), which basically highlights unsafe conditions. Everybody who was in the union who was working that day would sign and we faxed it to the union. The union bureaucracy would keep track of which units are being staffed appropriately and which ones are not.
The rank-and-file
Prior to the contract negotiations I did not hear very much from the union. They put out a newsletter that they mail to you. They will have staff that come to the hospital a couple times a month and stand in the lobby and say, “Hey, if you have any questions about the pension, your benefits or anything like that, you can come talk to us.” But I would say it has not been very active in terms of the rank and file. We have WhatsApp chats with union representatives, but the union reps in our chat are not from our units. I haven’t necessarily seen a lot of encouragement or that the union try to reach out and get somebody to take on a rep role. So it is pretty professionalised.
The pickets and the scab nurses
The pickets have been pretty well attended, at the weekend less so. It’s been a challenge specifically because it’s all happening in January and it’s been an unusually cold January in New York City so far. The union was also prepared for this. They have tens of thousands of those little hand warmers, things that you can put in your gloves. They have catering that comes to the line every day. So if people are having a hard time, they can feed themselves and still feel free to come out instead of crossing the picket line. I always see people, you know, hugging each other and saying things like, “Hey, thanks for coming out.” There’s even little competition between different units trying to see what percentage of their people they can get to come out. The organisers, they’ve been trying to have little events, for example yesterday was International Heritage Day. Nursing in America is very immigrant driven. There’s people from all over the world working in nursing over here. And so people were wearing traditional garbs playing their music and things like that. Today, they’re doing International Food Day, and they’re having a little pet fashion show where people can bring their pets decked out in union regalia.
In terms of participation, there are people on my unit that have very young kids or who have per diem jobs at other facilities that they are prioritizing right now, due to the income disruption from the strike. But I would say almost everybody is at least making an effort to come out to the picket every few days. We also have people that commute in from Long Island and from New Jersey, or from all the way down in Staten Island. It can be quite a long commute trying to get there. During the peak hours of the day, I would say there’s always at least a few hundred people on the line.
The scabbing strike nurses are pretty used to the pickets. The pickets got a couple of them to lose their contracts. There was one of the strike nurses that came out at 7 p.m. and there were still some people on the picket line and they were going, “Shame, shame, shame”. He made a vulgar gesture at them and they recorded it and posted it to social media. That person lost their contract. In general, it’s been harder to get people out there first thing in the morning to actually try and stop the scabs from going in. One of the benefits of being on strike is that you don’t have to wake up at five in the morning to get to work on time like you usually do. So getting people right there at 7:00 has not always been easy. The union has worked with partners in the neighborhood that are allowing picketers to use the bathrooms. They’ve agreed to start the picket at 9:00 instead of at 7:00, so that it’s not noise first thing in the morning for all of these people that are graciously agreeing to help us.
So there’s not always a lot of people there at the time that the strike nurses are coming and going. I would say this is something people are doing at home, to follow a lot of these strike nurses on their various social media accounts. When people say on social media, “Oh my God, the conditions here are horrible. You know, it’s so hard. I hate this contract.” People will screenshot that and they’ll post it everywhere and say, “Hey, if you’re thinking of taking a contract at Mount Sinai, this is what you’re walking into”. There was one strike nurse that made a video where there was a HIPAA (right to privacy / data protection) violation in the video. The patient privacy laws that govern America are very strict, they carry extremely severe penalties for any facility where that’s found to happen. That nurse lost their contract, instantly. They’re definitely making it known to any would be replacement scabs, “Hey, you’re under a microscope. Anything that you say about us, we’re going to catch you.”
I don’t know if the picket line has done much in terms of the scabs, but the person that it has affected is the CEO of the hospital, doctor Brendan Carr. He actually had to hire people to act as decoys, leaving the parking garage in the same model of car that he also drives, so that people would follow the wrong car with tinted windows and that he could sneak out without having to confront anybody.
The impact of the strike
There are people that have text chats with PCAs, physical therapists, doctors. Our sense talking to those people is that the hospital is definitely operating below capacity. There are procedures that they just can’t do or they can’t do at the scale needed to make it actually profitable and worth their time. Strike nurses, even if they say that they have a certain specialty, they’re not known as being reliably able to execute that specialty in a safe way. We know of at least three preventable patient deaths that happened in our facility since the strike has started. There was a critical care patient whose sedation was improperly managed. He decannulated himself and he passed away from that. And then there were a couple of other cases. The discontent amongst the physicians is increasing, they are not at all satisfied with the quality of care that their patients are receiving, and they’re starting to get vocal about it. There is a possibility that the physicians union at one of the facilities might issue a strike notice because of the substandard patient care that they’re witnessing.
The other hospital workers
We have a lot of support amongst the, the PCAs and the physicians. The hospital has actually had to implement a ‘no politics rule’, where people can get in trouble for talking politics, which is to say, saying that they support the strike. There are some people that have tried to just wear red or wear a button with a little NYSNA union logo on it, and they’ve gotten reprimanded for it. At least amongst the specialties that we work with most closely, there is support for the strike. I know that the IBEW, the electrical workers have come out a couple of times to the picket line for solidarity purposes. I haven’t seen a lot of dietary or transport staff or radiology staff or any other general support staff coming out, though. The physical therapists have come out to see us. The unit clerks have come out to see us.
Negotiations
The thing that has struck us is that the entire first week of the strike, there was no contact between the union negotiators and management, not even through the third party mediator. So five days into the strike and the only things that were discussed were non economic issues. Another big point that the union has been standing up for is safety, because there is an increasing problem across the United States and in New York in particular, with patients feeling that they can be verbally and physically abusive to nursing staff. It is a result of this customer service driven and lawsuit-fearful nature of US health care. So they try to wrangle a lot of stronger concessions around nurse safety. There was almost a shooting that happened at the hospital a few weeks ago and there wasn’t very clear communication from management about what had actually happened. So they were trying to get the hospital to take that more seriously.
This past week, there was also no movement at all in terms of negotiations until yesterday, when the bargaining committees, the negotiators from all of the facilities that are on strike, got together in one place and said, “We’re not going to play this intimidation game anymore. These are our demands. You’re not going to talk us down from this, so come and talk to us or we’re going to continue to reach out to local politicians and the media, to ratchet up the pressure on you guys.” Zohran Mamdani, mayor in New York City came out to New York Presbyterian the first day of the strike to call for the bargaining to restart. Bernie Sanders was there as well.
Future pressure points
But I would say that the possible start of a strike at Kaiser in California, with over 30,000 nurses, is our biggest point of leverage right now. If they go on strike, a lot of the strike nurses might shift over there. It’s really very difficult to safely staff a hospital, and safely deliver health care, under these conditions, because the longer it goes on, the more the lawsuits start to stack up. The new frontier of litigation against hospitals in the last ten years has been pressure injuries. Courts are issuing awards to families because hospitals and nursing homes allowed pressure injuries to happen to patients that have been astronomical. If a pressure injury happens on your watch, you are paying for it.
ICE, Minnesota and the current moment
I would say protection for migrant workers and patients is not at the front of our media communication, but is it a part of our list of demands, as well as protection of trans healthcare workers and trans patients. Minnesota and the struggle against ICE has definitely been motivating for me. It felt very bad to be an American for the last several weeks. It’s felt like there’s a lot of forces that you have no real control over. But with the strike there is something that we can stand up for. Here is something that we can do something about by banding together and acting collectively. At least some of us are talking about the wider political situation. That’s maybe a subculture within the strike itself. This is a point of resistance against what is developing in America, and I might actually be able to participate in it. And I feel motivated to try and grow that in whatever way that I can.
