Hospitals, MedCity Influencers

Nursing Strikes Reveal Systemic Issues Healthcare Must Address

The deficiency of nurse-specific billing data makes nurses literally and figuratively invisible in terms of political and financial decision-making capacity within the U.S. healthcare sector.

Although the three-day nursing strike in New York City this past January was undoubtedly the most publicized, it was just one of many planned in the U.S. during the same time frame. Nurses were also mobilizing to strike at hospital systems in Minnesota, Massachusetts, and Los Angeles, all coordinated through the same labor union, National Nurses United. And U.S. nurses weren’t alone in their grievances, with British nurses also making their voices heard this past December in the largest nursing strike in the history of Britain’s National Health Service.

Many nations in the world experiencing the same discord among their nursing populations at essentially the same time for similar reasons is certainly cause for reflection. While pay tops the list, domestic or abroad, the heart of the issue nurses are standing up for is their patients. They are pushing back on dangerous patient-to-nurse ratios, which one called “unsafe, too big to manage” and “an accident waiting to happen.”

For those of us who have had a long career in nursing, the unrest we are seeing has been a long time coming. While Covid-19 threw gas on today’s over-stressed nursing work conditions, the warning signs have been there for decades. In the 1960’s we saw the Nurse Training Act as an early attempt to address the nursing shortage, authorizing $283 million to build new nursing schools, expand training and provide loans for nursing students. This and other measures over the years have brought brief periods of relief. However, the industry has a long way to go. A shortage of registered nurses is projected to persist worldwide, with as many as 13 million more needed by 2030.

Inadequate staffing

While inadequate staffing is the root cause of “dangerous patient-to-nurse ratios,” this is exacerbated, particularly during a surge, by 1) hospital staffing models and 2) a shortage of qualified nurses. It is common knowledge that U.S. hospitals do not staff for 100% occupancy – in reality, staffing for much less. When a surge occurs, they are often caught short and scrambling to fill in, often with temporary resources or asking their nurses to work extra shifts. Further complicating this situation is the skill level of the nursing staff itself. With older nurses retiring or shifting to non-bedside positions, we now see a higher ratio of novice nurses to experienced nurses, resulting in skill gaps that can and often do impact patient safety.

Novice nurses must receive the support they need if we ever hope to have enough nurses to care for patients. Alarmingly, nurses in the 25-to-35-year age range are now leaving the bedside at higher numbers than nurses in other age groups, reportedly due to frustration and fears over current working conditions.

To respond to these challenges, healthcare organizations must initiate new care models to ensure safe and competent staffing levels. Many are shifting to a team-based approach where more experienced nurses oversee novice nurses and support personnel, who take on more of the actual patient care. Nurses should not be forced to “strike” or leave their positions for these changes to be implemented. However, if their concerns about quality patient care and safe staffing aren’t met, they understandably must protect their patients and their licenses.


Along with better working conditions, today’s nurses also want the value of their contributions to be recognized with higher compensation. Based on the reported negotiations, striking nurses in New York will see as much as a 19.1 percent increase in their wages. While this is certainly a short-term victory, it doesn’t address systemic challenges based on how nursing services are accounted for long-term on U.S. balance sheets.

Despite being the most intensely used hospital service by acute care inpatients, America’s nurses are economically measured poorly. Today, nursing costs are rolled into the patient room charge at the same fixed cost for every patient receiving the same level of care within the institution. This often does not account for the patient’s total nursing care during their stay. Unlike physicians, nurse practitioners, and some allied health professionals not employed by the hospital, who bill for their services and are recognized on the revenue side of the hospital ledger, there is no clear way to recognize a nurse’s value at the bedside.

The deficiency of nurse-specific billing data makes nurses literally and figuratively invisible in terms of political and financial decision-making capacity within the U.S. healthcare sector. Identifying the actual economic value of nursing services and changing policy to directly reimburse hospitals for nursing services is another way to positively impact patient outcomes, improve nursing professionalism, and create a more accurate measure for hospital reimbursement.

Applauding courage

The nurses who went on strike demonstrated courage to stand up for their patients by advocating for adequate numbers of competent nurses to care for patients. If healthcare organizations don’t address the staffing and competency issues that affect patient care outcomes, nurses will stand up and speak with one voice to make change happen. Every person deserves safe, quality care. Nurses deserve to provide that care in a setting where an adequate number of competent nurses are available and are compensated fairly and accurately.

Photo: FilippoBacci, Getty Images

Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, is a practicing nurse practitioner in critical care for Penn Medicine, Chester County Hospital and adjunct faculty for Drexel University in Philadelphia, PA and Neumann University in Aston, PA. Anne has over 39 years of experience in nursing and 25 years of experience as a nurse practitioner. She currently serves as Chief Nurse of Health Learning, Research & Practice, Wolters Kluwer.

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