In the years since enduring the front lines of the Covid pandemic, nurses have been increasingly vocal about the challenges they face in securing adequate working conditions—and the direct correlation between working conditions and patient safety. As unions have worked to improve these conditions, they’ve won significant gains. But understaffing remains an ongoing issue, and now at least one New York hospital system is fighting back.
Important progress
In 2023, nurses voted to strike across New York, and after failing to approve a contract, 7,000 nurses at Montefiore Medical Center and Mount Sinai Hospital walked out. Many of these nurses have been vocal about the fact that staffing shortages or low staffing ratios directly lead to patient harm. Some agreements have been reached in the recent past, which will hopefully lead to better working conditions and staffing ratios. In addition, some agreements have created financial penalties and an expedited arbitration system, leading to over $4 million in fines by May 2024.
During the same period, other hospitals across New York agreed to new contracts with the nurses to avoid a strike, all of which promised to improve pay and staffing requirements to some degree.
A worldwide issue
Staffing challenges in the nursing profession aren’t limited to New York. It’s a global challenge, with a significant potential impact on patient safety. A March 2023 report by the International Council of Nurses (ICN) emphasized that burnout, driven by excessive workloads and inadequate support, leads many nurses to leave the profession. This creates a vicious cycle: understaffing leads to overwork; overwork leads to burnout; this forces nurses out of the system, contributing to understaffing. All of these factors can directly lead to patient harm.
To break this cycle, the ICN called for substantial investments in expanding the nursing workforce and improving working conditions.
Hospitals fight back
But instead of working toward a healthier, more resilient healthcare system, some hospitals are fighting to mitigate the progress nurses have made. New York-Presbyterian Hospital, for example, the largest system in New York City, was one of the hospitals that avoided a nurses’ strike by agreeing to a contract in 2023. Now, it’s petitioned a federal court to overturn a $270,000 penalty imposed for chronic understaffing, arguing that it had made "good-faith efforts" to address the issue.
It's also appealed to the U.S. Supreme Court to uphold the dismissal of nurse and union organizer Rosamaria Tyo, even though her firing was found to be retaliatory by an administrative judge, the National Labor Relations Board, and a federal appeals court.
Working toward better patient outcomes
Proper staffing, adequate rest, and sufficient pay are necessary to ensure that nurses are able to perform their jobs effectively. Hospitals should be working to get ahead of a labor shortage that’s only projected to get worse, rather than pushing back on staffing targets that protect patient safety, or penalizing nurses for seeking better conditions.
