Nurses on Strike: An Ethical and Financial Conundrum

Over the past few years, nursing staff in hospitals, clinics, and care centers around the world have been the subject of labor disputes, protests, and strikes with increasing frequency, and with justifiable reason. As efforts are being made by hospitals towards implementing a value-based payment system with which all relevant medical personnel is fairly compensated, nurses still strive to provide quality care, regardless of their wages remaining arguably lower than other caregivers. Moreover, as the shortage of nurses rises in some areas, the remaining personnel has to work harder to cover the responsibilities which would otherwise be handled by multiple nurses. These factors, coupled with the financial discrimination perceived by many nurses set the field for the longest nursing strike of the past years.

However, there are two sides to the nursing strike coin; as strikes within the medical personnel in this branch begin to arise, there is a growing fear that these actions — especially those outside of the law by not providing a 10-day strike notice  — would negatively affect the health of the patients by contributing to the negligence and otherwise lack of care for them. This fear is further compounded when we take into consideration that the population of unionized nurses has increased more than 50% in the 1990-2008 range, for a total of just under a million unionized professional nurses. Co-authors Jonathan Gruber and Samuel Kleiner have performed of fantastic work of analyzing the effects of nursing strikes on the care of patients in hospitals, clinics, and other health centers.

Do Strikes Kill?

In their study, which is posted in the National Bureau for Economic Health, Gruber and Kleiner analyze data of nurses’ strikes in New York from 1984 to 2004, and contrast them with hospital discharges, observing categories such as treatment intensity, patient mortality, and hospital readmission. The conclusions painted a negative picture for nursing strikes, as they showed that, during said protests, in-hospital mortality increased by at least 19.4 percent. In the sample of 38,228 patients studied, it was determined that at least there were 138 additional deaths that could have been avoided were the appropriate medical personnel have remained available. Moreover, there was a 6.5 percent increase in hospital readmissions, which translates to around 344 additional patients readmitted to hospitals during nurses’ strikes.

The silver lining to this otherwise negative news is that, when it comes to treatment intensity — that is, the number of procedures performed during the patient’s stay —, the number remains the same, which suggests that patients are still receiving all the necessary treatments for their conditions during their stay, despite the nurses’ strike. The problem, it seems, affects exclusively the productivity of hospitals with unionized nursing staff.

Further analysis suggests that strikes reduce the productivity of affected healthcare centers — be they private, or otherwise — by about 28%, a figure which is not present either before, or after the strike, which suggests that said reduction is attributed solely to the strikes. The law-mandated 10-day strike notice does nothing to preserve the health of the patients, as the reduction in productivity is still present even after hiring replacement workers, especially for patients who require intensive care.

Regardless, the American Nurses Association stands firmly behind nurses’ rights, and supports their decision to strike, as long as they remain within the law and fulfill every requirement to do so.

An Ethical and Financial Issue

It goes without saying that everyone — including nurses — should be reimbursed properly for the value each and every professional adds to the workplace. The ethical and philosophical discussion behind this principle is a topic for another article but, assuming this statement is a fact: are the potential benefits of nurses’ strikes worth the risks the patients are exposed to every day these protests are in place?

It is more than clear that, hospitals and medical personnel aside, the ones suffering the most are the patients whose lives are caught in the middle of the dispute and which are sometimes forfeit to the decreased productivity they convey. In the same manner, the value provided by nursing personnel leaves little doubt that these caregivers can and should be reimbursed in a manner which allows them to develop in both professional and personal levels.

Current Situation

With all the factors mentioned above, coupled with increasing expenses on new technology, unfunded government mandates, rising acuity, and increasing physician costs, hospitals and healthcare centers budgets are stretched as thin as ever. Additionally, such hardships present themselves in a time where demands and expectations for quality are at an all-time high. Said elements are ingredients for strikes in even the companies which are internationally recognized for having progressive and professional nursing cultures such as Kaiser, Allina, and Brigham and Women’s.

Overseas health centers are also the subject of disputes, as the nurses belonging to the Royal College of Nursing in the UK are on the verge of their first strike in the union’s 100-year history. The causes of these disputes are very much the same as their American counterparts, as the nursing personnel has experienced a 14 percent pay cut since 2010 due to a government cap on public-sector pay. The message from the affected party is quite clear as they are constantly tasked with the responsibility for patients’ lives, and demand to be compensated as such, for both their well-being and that of their patients.

In both cases, it is evident that the healthcare centers are not to blame for these precarious conditions, as there are government mandates in place which, to the detriment of the nurses, put a hard limit on the wages they receive. In this manner, it is at government level that the renegotiation of wages must be held. However, until that happens, there are also few measures which could be adopted to reduce the possibility of future strikes from occurring, such as addressing the technicalities of contracts before the negotiations take place. Furthermore, it helps if the nurse manager is fully aware of the state and federal regulations regarding what they can and cannot do during labor negotiations or a potential strike.

With these factors in mind, reducing the chances of a strike and keeping nursing personnel satisfied — at least until wage and benefit negotiations for the public sector take place — becomes a very real possibility.