I had tears in my eyes when I visited our strike line for the first time last month. Hundreds of nurses were bundled against the January chill in red New York State Nurses Association (NYSNA) scarves, chanting in sync, showing our unity and resilience, and our commitment to our patients. The energy was electric. I felt chills down my spine and it brought me back to 1998 when I was a young nurse in my twenties; at the time, we went on strike at Maimonides, where I still work, and won the first nurse-to-patient staffing ratios in New York City.
Now, 25 years later, nurses are still fighting to make sure there are always enough nurses at the bedside to provide safe patient care. This January, 7,000 members of the NYSNA from Montefiore and Mount Sinai Hospital went on strike for 3 days and won what we were told was impossible: enforceable nurse-to-patient staffing ratios at two of New York City's largest hospital networks.
I've never been prouder to be the president of my union, or more proud of the 42,000 nurses across New York State that make up our membership. Our groundbreaking victory sparked a national movement, and healthcare workers across the country are now working to win enforceable staffing ratios in their own union contracts.
During our strike, many nurses brought their kids, and we were joined by patients and fellow union members. One of my colleagues showed me photos from when his mother brought him to our strike back in 1998 when he was only 7 years old; now he's a nurse and a union activist, following in her footsteps.
Nurses like us go into this profession because we want to give support at the bedside, to provide quality clinical care, and also to support patients and their loved ones at the most difficult times. And sometimes to hold hands, pray, and give comfort to a patient as they die -- as we did all too often during this pandemic.
When there aren't enough nurses at the bedside, we can't practice our profession at the level we trained for, and our patients suffer. Patients may not get their medications on time, or get thorough evaluations, or the care they need. Nurses, in turn, burn out and leave the profession.
The COVID-19 pandemic worsened the understaffing crisis, as nurses were pushed to our breaking point, working around the clock, often without the protective equipment we needed to keep ourselves safe, or enough staff to provide the care our patients deserved. Many of us fell ill, some of our colleagues died. All of us faced unimaginable trauma and heartbreak, seeing more death in one day than many senior nurses like myself had seen in an entire career at the bedside.
When nurses at private sector hospitals throughout New York City began negotiating our union contracts that were set to expire for 17,000 NYSNA members on Dec. 31, 2022, we told our bosses that our top priority was solving the crisis of chronic understaffing. Some hospitals were willing to negotiate and settle contracts, including the Brooklyn safety-net hospital Maimonides where I work.
But two of New York City's largest hospitals told nurses that NYSNA's demands were unreasonable and impossible to win. Just days before our strike, Mount Sinai management doubled down and told nurses they would never agree to staffing ratios, and, while Montefiore had ratios in their union contract for inpatient units, those ratios existed only on paper, without an enforcement mechanism. That wasn't good enough. Nurses held the line for enforceable staffing ratios that would help deliver quality care to our real-world patients, not just on paper.
Our strike showed hospital management -- and the public -- that nurses are united and ready to fight for our patients and our profession. After 3 days holding our strike line in the cold, with nurses sacrificing time and pay to make our voices heard, we won.
In their historic and precedent-setting contracts, Mount Sinai nurses won wall-to-wall nurse-to-patient staffing ratios in all inpatient units, and Montefiore nurses won ratios for the first time in the Emergency Department. Both contracts have concrete enforcement mechanisms with expedited arbitration and possible financial penalties for the hospitals that will lessen the financial incentive for management to understaff.
Safe nurse-to-patient ratios work. California nurses won them in statewide legislation in 1999 and the data does not lie: patient outcomes are better and nurses stay on the job when ratios are enforced. In New York City, our union also won improved nurse-to-patient ratios and enforcement at Maimonides, Wyckoff, Flushing, RUMC, and BronxCare, in addition to Montefiore and Mount Sinai -- in some areas exceeding California nurse-to-patient ratios.
The Montefiore and Mount Sinai contracts have precedent-setting staffing enforcement mechanisms, including expedited arbitration of staffing disputes and a new approach of including potential financial penalties payable to nurses when employers fail to uphold contractual safe staffing standards. At both hospitals, 98% of NYSNA members voted to ratify their contracts.
We don't have a magic wand that will fix the crisis of understaffing overnight. It's going to take time to see changes on the hospital floor, and our contract victories are the first step. The new staffing ratios we won will now go to the New York State Department of Health and will become the new staffing standards to be enforced by state law, as well as through our contracts.
Now, our work begins to enforce our contracts and to help win similar victories for nurses and patients throughout New York State and across the country, so that every patient in every hospital will always have enough nurses to receive the care they need and deserve. My greatest hope is that the kids who joined our strike line, and who were inspired to become nurses themselves, will look back in another 25 years and remember how this victory changed our profession for the better.
Nancy Hagans, RN, CCRN, is president of the New York State Nurses Association (NYSNA).