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Key points
- Before striking, nurses must confront the conflict with their professional identity of serving the sick.
- A major reason they strike is understaffing, which they maintain is dangerous to patients and themselves.
- Another reason they strike is lack of respect and professional autonomy.
- Nursing strikes are becoming frequent as their concerns conflict with hospitals' needs to balance budgets.
As a psychiatrist specializing in consultations for patients in the medical hospital, I've had an up-front view of the crucial role nurses have in patient care. Despite this, I did not have the slightest idea that they were having increasing distress about their working conditions. It took a nursing strike at our University of Michigan Medical Center for me to learn about that. It took deep conversations with the nurses for me to understand both their uneasiness about abandoning patients by striking and their certainty that only a strike could improve the safety of their patients.
Strikes by nurses are becoming more and more frequent. The reasons for them remain basically the same.
The psychological dilemma
Nursing is a profession with high ethical and moral standards. The responsibility and obligation of each nurse are to serve the sick. A strike will inevitably disrupt patient care. A nurse who votes for and then participates in a strike has to accept responsibility for this disruption.
The strike at our hospital bore out this nurses' dilemma. During the week preceding the strike, they saw vehicles regularly come and go, transporting sick patients able to be moved to other hospitals. Daily, they observed the impact of their work stoppage on patients.
The strike brought psychological dilemmas for the rest of us hospital staff as well. Cleaning and cafeteria workers, for example, had to choose whether to come to work or stay away in order to support the nurses. I, too, was faced with a psychological dilemma. All my life, I had never crossed a picket line. Now, in order to fulfill my own professional responsibilities, I would have to do so. The nursing council authorized those nurses who worked in units such as intensive care and the emergency room to continue coming to work. This made it easier for me, too, to enter the hospital despite the picketers.
The reasons why nurses strike
Staffing levels
This is always a key issue because it concerns patient safety. During the inevitable and unpredictable surges in patient admissions, there are suddenly more patients than a unit's nurses can safely care for. More and more patients are assigned to each nurse. Because of this, nurses cannot learn and know enough about each patient. They cannot keep good track of their status and visit their room as frequently as necessary.
Even during non-surge times, patients—especially of the baby boomer generation—are older and sicker, requiring more care. The nurses note that the patient-to-staff ratios considered adequate in the past no longer work well, even during non-peak times.
This understaffing leads to hospitals' expectations that nurses will do double shifts when needed, adding exhaustion to the physical and mental challenges of the job.
Professional autonomy
Nurses do not feel respected as professionals. They say they cannot fully practice their profession as they understand it. For example, nurses consider counseling patients and families as a key component of their professional role. Because of decisions by others above them in the hospital hierarchy, they are told to limit this and spend their time on other activities.
Salaries and benefits
Like workers everywhere, nurses are concerned about their benefits and their salaries, especially during inflationary times. Nurses note their increasing responsibilities for accurately operating complex technologies related to medical care. They point to the shortage of nurses due to the physical and emotional challenges of the job.
The hospital administration's point of view
Hospital administrators generally respect and value the essential contributions of their nurses. They want and need to retain them. The problem for them is that nurses' salaries take up a major percentage of the hospital's operating costs: at least 25 percent. So increases in the number of nurses and/or increases in their salaries and benefits have a major impact on a hospital's expenses. They must keep the budget balanced by controlling expenses. This is even more important now when government and private insurers keep decreasing their reimbursements to hospitals for the costs of patient care.
Some compromises
Compromises are difficult but possible. At our hospital, they included the following. Nursing autonomy was improved. When unit staffing was deemed insufficient, the head nurse would report to the director of nursing instead of a hospital administrator. The director of nursing would then become part of the decision-making process about whether to close beds in that unit if necessary. In addition, a salary increase was put in place without cutting the funding of benefits.
Nursing strikes and us
The complexity of all these issues had a major impact on me. They resonated long after the strike was over. Though my novel The End of Miracles is primarily a psychological suspense, I wrote a significant subplot fictionalizing the nursing strike. It portrays the point of view of the nurses, as well as how it was resolved.
Currently, in the United States and around the world, many hospital nurses are mounting strikes or considering doing so. It's a good time to consider and understand why they feel compelled to take action by striking.
References
Starkman, M (2016), The End of Miracles: A Novel, She Writes Press
