After the Pandemic, Nurses and Other Healthcare Workers Are Demanding More … And Getting It
Posted in Blog What's New
- Carol B. Davis, Associate Director, HCFI
- November 2024
From 2022 to late 2024, thousands of healthcare workers in nearly twenty states have walked off the job, demanding better compensation, higher staffing levels, and more responsive management.
In many ways, this post-pandemic epidemic should have been predicted. Workers deemed “essential” by federal and state leaders during the COVID-19 pandemic now find they are saddled with hangovers from the global crisis: staffing shortages that have led to higher workloads, increased professional liability as overworked employees with heavier workloads pose greater risks to patient safety, and record rates of staff burnout, turnover, frustration, safety fears, and weakened patient care for colleagues who remain.
The vicious cycle started before March 2020, but now that most pandemic special accommodations such as workplace flexibility have expired, the high-pressure work environment and increasingly tense relations between management and healthcare staff have reached a tipping point nationwide.
We’re seeing the effects in the barrage of news about fed-up nurses and other hospital and patient care workers who—activated through collective bargaining units—have started walking out. Bureau of Labor Statistics data show that 13% of healthcare professionals are union members, most notably 20% of nurses.
In aggregate, hundreds of thousands of healthcare workers are represented by unions1,2 in these strikes3, signaling the wide reach of labor activism and demands for a new way forward.4
In 2023 and 2024, U.S. healthcare workers staged dozens of strikes, advocating better contract terms for working conditions, improved staffing ratios, higher pay, and better benefits—ironically, often including affordable healthcare coverage. The anger has spread. Overall, the count for U.S. nurse strikes has more than tripled from 2020 to 2023, according to NurseTogether.com, and 2024 looks to exceed 2023 numbers.
Nurses—the most prevalent profession in health systems and 20% of America’s healthcare workforce–have led the wave, although work stoppage actions also included a range of clinical, support, and administrative professionals.
Interestingly, strikes occurred in both for-profit and nonprofit hospitals, with some of the largest for-profit health systems such as HCA Healthcare and Ascension being frequent targets. Not-for-profit giants such as Kaiser Permanente and Providence Health also were focuses of the outrage. The 2023 work stoppage at Kaiser Permanente alone involved more than 75,000 workers.
In addition, public university-affiliated hospitals such as St. Louis University Hospital in Missouri and Robert Wood Johnson University Hospital in New Jersey faced worker unrest.
Also, such disputes are no longer private—they’re being contested in meeting rooms, on the street, and in the press with large numbers of workers showing up and speaking out. In October 2023, for example, 75,000 workers at Kaiser Permanente staged a three-day strike—the largest strike ever in the U.S. healthcare industry.
And as recently as late October 2024, mental health workers added themselves to the roster of professionals walking out during contract negotiations with Kaiser Permanente. While the rising tide of work stoppages is remarkable, leaders should not be surprised that essential workers remember the widespread acknowledgement5,6,7,8 that they rightly deserve to earn wages commensurate to their vital services or at minimum should have compensation packages that allow them to live and care for their own families in the places they care for patients.
Our team at the Georgetown University Health Finance Initiative anticipated this ascent of the “essential worker” in Looking Back to Look Forward .9 Since then, less has been written or said about what tradeoffs are ahead to put things right between health systems and health workers. Could the upheaval usher in a win-win for healthcare consumers and workers alike?
Possible positive outcomes include improved retention of essential caregivers, realignment of staffing and boundaries of professional healthcare to better meet worker needs, and wider adoption of and openness to policies and investments that foster improved systemwide accountability for patient outcomes. Negotiations have resulted in dozens of new contracts–some with modest wage gains under 5% over a number of years, but many with wage gains in excess of 20% , 30% or more over the upcoming three- or four- year contract term10.
We will continue watching with interest and monitor any shifts in state-by-state union participation as this reordering of the healthcare workforce proceeds. At the moment, though, the only key agreement among patients, providers, and payers alike is that much is at stake.
With labor costs topping the expense line in every hospital budget, it remains to be seen which healthcare providers will reach sustainable terms that resolve these labor-contracting dilemmas to the satisfaction of all involved.
References
1Bureau of Labor Statistics, US. Dept of Labor. Union Membership- 2023, Table 3, Table 5. https://www.bls.gov/news.release/pdf/union2.pdf
2Bureau of Labor Statistics, US. Dept of Labor. Work Stoppages in Healthcare and Social Assistance, https://www.bls.gov/wsp/factsheets/summary-of-work-stoppages-in-healthcare-and-social-assistance-industry.htm
3“Nursetogether.com. October 12, 2023. Complete List of Nurse Strikes, 2020-2024. https://www.nursetogether.com/nurse-strikes/
4Roy, M. From Detroit Three to Healthcare, US Labor Unions Flex Muscle.” Reuters. Oct. 12, 2023. https://www.reuters.com/markets/us/detroit-three-healthcare-us-labor-unions-flex-muscle-2023-10-12
5Kinder, M. https://www.brookings.edu/articles/essential-but-undervalued-millions-of-health-care-workers-arent-getting-the-pay-or-respect-they-deserve-in-the-covid-19-pandemic/ May 2020
6Kane, J. W., & Tomer, A. (2021). Valuing Human Infrastructure: Protecting and Investing in Essential Workers during the COVID-19 Era. Public Works Management & Policy, 26(1), 34-46 https://doi.org/10.1177/1087724X20969181
7Gaines, K. “What’s Really Behind The Nursing Shortage. 1,500 Nurses Share Their Story” https://www.msbn.ms.gov/onw/2020-03/whats-really-behind-nursing-shortage-1500-nurses-share-their-stories
8Duffy, M. Why Improving Low Wage Health Care Jobs is Critical for Health Equity. AMA J Ethics. 2022;24(9):E871-875. doi: 10.1001/amajethics.2022.871.
9The Impact of COVID-19 on Patients, Providers, and Policy, 2021-2022 Collection, “Looking Back to Look Forward,” Section IV: Ascent of the Essential Worker, Georgetown University Health Finance Initiative, McCourt School of Public Policy. https://bit.ly/HCFI_Collection202208
10Gooch, Kelly “45 hospitals, health systems raising workers’ pay”, Beckers Hospital Review, October 24, 2024. https://www.beckershospitalreview.com/compensation-issues/4-hospitals-health-systems-raising-workers-pay