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Ask the Experts: Nurses strikes


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Labor disputes between nurses and hospitals are nothing new, but over the past few weeks we’ve seen a lot of national news stories about nurses going on strikes. In the last month alone, facilities such as Allina Health in Minnesota, Kaiser Permanente in Los Angeles, and Brigham and Women’s in Boston have all had or nearly had strikes.

Nurse Leader Insider (NLI) asked two experts, Barbara Brunt, RN-BC, MN, MA, former Magnet director at Suma Health System, and Joanne Iritani, RN, BSN, MSN, DNP, a Robert Wood Johnson Foundation Executive Nurse Fellow for their thoughts on this issue. (Note: the following has been lightly edited for clarity)

NLI: Do you think nurses strikes are on the rise? If so, why do you think that is?

Barbara Brunt: I don't know if nurses strikes are on the rise, but I do think there is more publicity when nurses strike. As hospitals are trying to deal with the value-based payment system and because there are shortages of nurses in some areas, I think nurses are concerned about providing quality care for their patients.

Joanne Iritani: I'm not surprised that nurses strikes have increased recently. Conditions seem to be the perfect storm. Organizations are under incredible financial pressure (decreasing reimbursement, increasing expenses due to technology, unfunded mandates, rising acuity, physician costs, etc.). This is occurring in the midst of an increased demand to meet clinical and service quality expectations, a lack of community services to meet patient needs, and the need to support a highly-skilled work force. It’s easily understandable how this becomes the source of tension between the two parties.  

However, I am surprised at the organizations involved. Kaiser, Allina, and Brigham and Women's are large health care systems with nationally recognized progressive and professional nursing cultures, so it was surprising that these organizations are now in the midst of potential strikes. I wonder how are smaller organizations with less progressive nursing departments or organizations in severe financial distress faring?

NLI: Are there conditions in hospitals that could be improved that might decrease nurses strikes?

BB: I think that hospitals that have a strong shared governance system are much less likely to have nurses strike. Nurses want a say in patient care issues.

JI: Nurses are faced with new and increasing professional demands. The RN is directly involved in implementing strategies to meet clinical and service requirements. The increasing complexity of caring for, and documenting care for patients without adequate family and/or community support is an ongoing challenge.

I think there may be lessons we can learn from these organizations, specifically regarding strategies that could have prevented a strike. The technicalities of contract negotiations are detailed and vary by organizational structure, culture, and administrative involvement. The question is, these issues effectively addressed before they reach negotiations? Is there a forum for collaborative engagement?

BB: From a nurse manager’s perspective, you need to be aware of the federal/state regulations regarding what they can and cannot do during labor negotiations or a potential strike. It is important for you to listen staff's concerns.