SAN JOSE, Calif. — Stanford nurse Mark O’Neill could have quit his job caring for desperately ill COVID and cardiac patients, joining the exodus of other health care workers seeking a reprieve from the stress of the past two years.
Instead, on Monday he’ll walk a picket line.
“I’m exhausted, but we need to push really hard to get help for the issues we’re facing,” said O’Neill, one of 5,000 nurses slated to strike next week at prestigious Stanford Hospital and Lucile Packard Children’s Hospital after the collapse of three months of labor negotiations, with no future bargaining sessions scheduled. “We’re asking Stanford for a change.”
The Stanford nurses join a growing number of other U.S. health care workers with shared grievances about staffing, pay, benefits and quality of life that have mounted during the COVID-19 pandemic. Last Monday, 8,000 nurses across Northern California staged a one-day strike at 18 Sutter Health facilities. Recent health care strikes also occurred in Oregon, Massachusetts, New York, Montana and Alabama. A massive strike of 50,000 Kaiser health care workers was narrowly averted last November.
With nurses in short supply, unions have new leverage — and have emerged as increasingly powerful voices in a tight job market. Fatigued by the pandemic, many nurses are rethinking their careers. A new McKinsey report found that the share of nurses who said they were likely to leave their positions in the coming year rose to 32%, up from 22% last February.
In preparation for Monday’s walkout, “strike nurses” from around the nation are being flown into the Bay Area and delivered by bus to Stanford’s top-ranked hospitals. Strike nurses are typically the highest compensated nurses in the industry, with agencies like HSG and U.S. Nursing paying $12,000 to $13,000 a week to the Stanford replacements.
“If you put your badge down, I’m going to pick it up,” said Aleehya Carr of San Antonio, Texas, who hopes to work the Stanford strike. “People walk out on patients that still need help…Imagine if it was your mother or your father.”
But the regular nurses have their own set of frustrations toward the highly-paid temps. That tension played out at Sutter Health this past week, when nurses staged a one-day walkout but were replaced for the whole week by contract nurses.
“They’re getting housed, they’re getting transported to the hospital, they’re getting fed, they have extra lab people and clerks — all the things that we want,” said Carol Hawthorne-Johnson, a registered nurse who has worked in Eden’s intensive care unit in Castro Valley for 30 years. “They’re also getting different salaries and that’s what’s encouraging nurses to come out here.”
During the pandemic nursing shortage, hospitals have increasingly turned to high-paid travel nurses to fill the gaps, fostering resentment year-round.
To reduce its workload next week and ensure it can provide critical and emergency care, Stanford may reschedule some elective procedures, said spokesperson Julie Greicius. But the larger issue looms.
There are several reasons why nurses have chosen this moment to push for change, said Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies at UC San Francisco.
For one, contracts have expired, so it’s time to re-negotiate. Nurses have seen profits rise at Stanford and other large health systems, even as COVID cases soared. According to the university’s 2021 annual report, revenues at the two hospitals exceeded expenses by $845 million, compared to $107 million in 2020 — although some of that was due to one-time federal relief grants.
Nurses also know they are harder to replace – and want their contributions acknowledged in the form of improved working conditions, protected vacation time, higher wages and better benefits.
“Nurses have given so much during this pandemic,” Spetz said.
On a relative basis, nursing is a lucrative profession, and not just for the strike replacements. But throughout the country, nurses say they’re depleted by long hours and short staffing, and traumatized by the magnitude of death. Through surge after surge, they risked infection. They responded to repeated appeals to work overtime shifts. They missed family dinners and canceled vacations. They helped dying patients say goodbye to their families on video calls. They cried in their cars and fought deep fatigue on their long drives home.
“Nurses are fed up,” said Diana Mason, professor with the Center for Health Policy and Media Engagement at George Washington University School of Nursing.
“When you are working short staffed, there’s moral distress,” she said. “You know that patients are getting complications that they should not have gotten, because you couldn’t be there for them.”
To be sure, hospitals must meet legal nurse-to-patient ratios. But that just sets the bare minimum, said Mason and Spetz. Few hospitals have solid strategies to adjust these staffing ratios in response to very sick patients.
Stanford nurses are asking for annual wage increases of 7% for each of the next two years and 6% in the final year of their contract, with $3,000 bonuses and ongoing mental health counseling.
This will boost staffing levels, they say, because it will be easier to recruit and retain workers.
Stanford is offering wage increases — 5%, 4% and 3%, plus ratification and retention bonuses. In the first year, annual base salaries for entry level nurses would start at $143,000 and climb to $211,500 for nurses at the top of the pay scale.
With so many nurses out on quarantine during the pandemic, Stanford boosted ranks by bringing on traveling nurses who work on a contract basis. Stanford would not provide a count of these traveling nurses, but the union says it can approach 25% in some sites, such as the Intensive Care Unit.
But veteran nurses say it’s challenging to work with a rotating cast of newcomers, who earn much more than they do. Because these traveling nurses aren’t allowed to work on the very sickest patients, they say, the toughest work gets shifted to the lower-paid veterans.
Despite the influx of traveling nurses, there still isn’t enough staff, they say.
When working overtime shifts in the ICU and later the post-anesthesia care unit, Kathy Stormberg recalled times at home when “there weren’t enough hours in a row to get a load of laundry washed, dried and folded….I cancelled going places, and seeing friends. I cancelled eating dinner with my family.”
For O’Neill, who lived in hotels during the first three months of the pandemic, “the hardest part was the time that has been spent away from my family,” missing his young daughter’s new vocabulary and sense of humor. “FaceTime calls aren’t the same as a hug or kiss.”
And the pleas for overtime shifts are constant, he said. “You’ll be working a 12-hour shift, and be asked to stay over for another four hours. On a daily basis, we’ll get at least one text message saying the unit is short-staffed, asking ‘can I come in to work overtime?’ ”
“Nurses can’t even relax on their day off, because they keep getting these texts,” said Stormberg.
Stanford warns that the strike will be unsettling for patients and highly divisive to its care teams. “The impact can be deep and long lasting and should not be taken lightly,” it cautioned.
But it could fundamentally change the standing of many veteran workers, said Spetz.
“This is really an opportunity to draw attention to the fact that nursing is a highly respected profession that requires a lot of skill and knowledge to do it well,” she said. “And often it is overlooked.”
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