Unsafe Staffing Levels

Saint Vincent nurses walked out on March 8, 2021, after trying for eighteen months to force their employer to fix serious safety problems at the hospital. Chief among their concerns was a pattern of chronic understaffing that the nurses say endangered patients.

One of the nation’s largest health care systems, Tenet Healthcare has raked in record profits during the pandemic while implementing bare-bones staffing and other cost-cutting measures at its facilities, with results Tenet workers say have been appalling.

The relationship between nurse staffing levels and patient care outcomes is well documented, with research suggesting that the chances of in-patient death jump 7 percent with each additional patient a nurse is assigned to care for.

Back in 2018, the MNA fought for Massachusetts to follow the example set by California, the only state with legally defined nurse-to-patient ratios. California’s nurse staffing law has improved care outcomes, particularly for poor patients. In Massachusetts, the hospital lobby managed to reverse initial public support for the 2018 ballot measure by launching an aggressive campaign to confuse voters that eventually defeated the measure.

After trying and failing to create change through the ballot box and various shop-floor strategies, the MNA nurses hit the picket lines to protest understaffing at Saint Vincent Hospital.

An Arduous Battle

Perhaps unsurprisingly, the hospital and its parent company tried to crush the strike. They unsuccessfully sought to malign the nurses in the eyes of the Worcester public, taking out full-page anti-strike ads in the local paper. They paid Worcester police hefty sums to function as Saint Vincent’s security apparatus. They reduced the hospital’s operations amid a COVID-19 surge, evidently in order to convince the Massachusetts Department of Unemployment Assistance that the striking nurses no longer deserved benefits. And for months, they insisted that scabs would replace strikers in high-stakes roles attained through long years of specialized experience.

Steve Striffler, an anthropologist who directs the Labor Resource Center at the University of Massachusetts Boston, told Jacobin that Tenet’s behavior appears designed to convey

that nurses everywhere should think long and hard about striking because companies are going to spend tens of millions of dollars and fight to the end . . . to resist improved wages/conditions, resist improved hospital safety, and to bust unions. [Tenet] didn’t succeed, but they came close and sent a clear message to unions that they are willing to fight hard.

The MNA nurses viewed themselves as the last line of defense for patients against the company’s campaign to erode care. In the end, their collective action forced Tenet to boost staffing and abandon its insistence on displacing strikers from their previously held positions and shifts.

Better Staffing

The nurses’ new contract, ironed out at an in-person mediation session with US secretary of labor Marty Walsh, guarantees specific staffing improvements. These include reduced patient assignments on the cardiac postsurgical unit, the two cardiac telemetry floors, and the behavioral health unit. The contract also limits the hospital’s ability to “flex” nurses, or send them home mid-shift when management deems them superfluous.

While these new policies fall short of the MNA’s original demands, the contract stipulates that all nurses will be recalled to their previous positions and shifts within thirty days. This back-to-work guarantee — standard fare for strike resolutions — resolves the final sticking point in the nurses’ negotiations with Tenet (which has a history of retaliating against employees who call out unsafe care conditions)

Johnnie Kallas, who researches health care labor organizing and directs the Labor Action Tracker at Cornell’s Industrial and Labor Relations School, told Jacobin:

The nurses’ victory is a huge win for the labor movement because they achieved considerable improvement in their working conditions while facing enormous obstacles. . . . Despite the threat of permanent replacements, MNA nurses won a strong contract that improved staffing in the middle of a global pandemic while maintaining their previous jobs.

A New Attack on Union Power

The MNA nurses voted 487 to 9 in favor of ratification. But without universal, nonprofit health care, for-profit providers will continue to “maximize their cash positions” by trampling over the needs of patients and workers.

Tenet remained indifferent to the pleas and indictments from high-profile elected officials, suggesting that legislators are constrained in their ability to manage health care corporations’ greed. To push back on abusive employers and transform the industry, health sector employees will need to continue gumming up the works of for-profit care by organizing. Wherever they do, they should be ready for pushback.

Just three days after the Saint Vincent nurses reached the tentative agreement with their employer, one of the permanently hired scab nurses filed a petition with the National Labor Relations Board in an attempt to decertify the MNA as the union for nurses at the hospital. As local investigative journalist Bill Shaner has reported, the nurse purportedly spearheading the decertification petition is represented pro bono by lawyers from the anti-union National Right to Work Legal Defense Foundation.

Still, when asked for her thoughts on the campaign to remove the MNA, Saint Vincent nurse and bargaining unit co-chair Marlena Pellegrino brushed the decertification effort off. “We are solely focused on our path ahead. We have been battle tested.”