Recent items show nurses can succeed through collective action
News reports by Reuters and others described strong public protests during early 2019 by Portuguese nurses seeking better pay and working conditions. One union leader even staged a short hunger strike! And in April 2019 the New York Times reported that three major New York hospital systems had avoided a strike only by agreeing to minimum nurse staffing ratios.
April 10, 2019 – Recent reports have highlighted the efforts of nurses to use collective action to improve working conditions. According to a March 8 Reuters piece, thousands of Portuguese nurses staged a “white march” in Lisbon to honor the profession and highlight demands for better pay and working conditions. (The “white” element evidently refers to the traditional nursing uniform color, not to race–although nursing does need greater diversity, a concern that is at least starting to be addressed.) As the article explained, the nurses had also staged a three-week strike the prior month, causing the postponement of thousands of surgeries. After the government declared that February strike illegal, one union leader went on a hunger strike outside the presidential palace. He called it off only after the government agreed to resume negotiations, as a February 22 item in the Portugal Resident reported. These pieces could have given more detail about what the Portuguese nurses want, but they do show some spirited, creative advocacy. And today, a New York Times article reported that three major New York hospital systems had avoided a strike only by agreeing to minimum staffing ratios, a result one union leader said was likely to influence other hospitals. As the piece said, efforts to set such minimums legislatively have proven difficult. California remains the only U.S. state to do so comprehensively. The Times report could have included information about the extensive research showing how deadly nurse understaffing can be. All of these pieces relied heavily on nursing leaders for comment, and they show what nurses can do when they act together. We thank those responsible.
A beautiful wave of humans dressed in white
A voice in the process
A beautiful wave of humans dressed in white
The March 8, 2019 Reuters article was headlined “Portuguese nurses’ ‘white march’ protest takes over Lisbon streets.” It explains that the “white” element refers to the nurses’ dressing in white and holding white flowers as they marched to honor their profession on International Women’s Day. The nurses acted “to demand better pay and working conditions and protest the Portuguese government’s poor handling of the long-running dispute.” Accordingly, they also carried placards with messages like “No fear!” and “We shall fight!” Organizers estimated that 10,000 marched; the police put the number at 6,000. (The crowd we see in the photo above looks bigger than that to us!)
Organizer Sonia Viegas, of the National Movement of Nurses, said the march was “a beautiful wave of humans dressed in white, which shows the unity in our profession.” The piece describes the three-week February strike, which the government said forced about 5,000 surgeries to be postponed. That strike ended on February 22, when the government agreed to resume negotiations. Those negotiations did restart, although Sindepor, one of the two main unions, was already planning another strike for April in the event that the talks did not go well. Reuters, consistent with its full-credit policy, stated: “Reporting by Catarina Demony and Miguel Pereira; Writing by Andrei Khalip; Editing by Hugh Lawson.”
The February 22 item in the Portugal Resident adds some detail about the government’s decision to resume talks. Natasha Donn’s colorful item says that the “lonely and very uncomfortable hunger strike mounted on Wednesday [February 20] by syndicate leader Carlos Ramalho is to be disbanded thanks to the government’s decision to resume talks with battling nurses.” The report notes that Ramalho, the president of Sindepor, had set up a “flimsy tent” outside Belém Palace and stopped eating in an effort to force the government to resume negotiations. Apparently, the hardest part was the bitter cold at night. But health minister Marta Temida reportedly phoned Ramalho “as he paced the gardens” of the palace to say she would restart talks.
A voice in the process
The April 2019 New York Times piece reported that three of the city’s largest hospital systems averted a strike by more than 10,000 nurses after reaching a deal with the New York State Nurses Association (NYSNA) that will establish minimum ratios of nurses to patients and result in the hiring of 1,450 more nurses. The staffing ratio issue, as Patrick McGeehan’s piece correctly notes, has been a critical one nationwide. Nurses’ unions like NYSNA argue that understaffing is endangering patient safety, while hospitals claim they need staffing “flexibility.”
The report says NYSNA reached a four-year contract with the Mount Sinai, New York-Presbyterian and Montefiore hospital systems that also calls for 3% annual pay raises. But the nurses’ focus was clearly on the minimum ratios, which they have sought for years. The piece notes that California is still the only state with mandatory minimum ratios. NYSNA’s first vice president Anthony Ciampa is quoted as saying the “historic” agreement gives the nurses what they have been unable to get through such state legislation: “We now have a voice in the process and a real say and a real mechanism in which to challenge patterns of staffing shortages and to get those rectified.” That appears to be a reference to the hospitals’ agreement to refer staffing level disputes to an outside mediator, once specific per-unit ratios are agreed upon.
The piece describes the ratios in place in California, then notes that “a nurse in a neonatal intensive care unit at New York-Presbyterian said the acceptable ratio was at least one nurse for every two babies, but the workload there was often double that.” The hospitals’ lead negotiator Marc Kramer is quoted as saying that “this significant investment in our nursing teams will ultimately benefit patients in the long term, while preserving hospitals’ flexibility to deliver the individual, tailored health care that our institutions are known for around the world.” The piece notes that hospitals favor the term “flexibility” over “ratios.” Of course, minimum ratios have never stopped hospitals from increasing staffing, so “flexibility” is often seen as code for the freedom to understaff nurses.
The union leader Ciampa said the deal would probably affect upcoming negotiations with other area hospitals and “will be the trendsetter of the industry.” Sean Clarke, executive vice dean of the N.Y.U. Rory Meyers College of Nursing (who sits on the Truth About Nursing’s advisory panel), was not so sure. The piece quoted him as saying it was too soon to tell, although people “would take notice” of the New York situation, and the deal “would be seen as yet another chapter in that ongoing story” about resolving the differences over staffing levels.
This is a fairly good and balanced piece, describing the nationwide context of the ratio dispute and consulting several nurses with relevant information. Its main flaw may be in failing to mention the research over the last two decades showing how dangerous nurse understaffing is to patients, such as the many studies by Linda Aiken and colleagues at the Center for Health Outcomes at the University of Pennsylvania that have found increasing nurse patient loads increases patient mortality substantially. Still, on balance the piece is a helpful one.
See the articles:
Portuguese nurses’ ‘white march’ protest takes over Lisbon streets, posted on March 8, 2019 by Reuters, with reporting by Catarina Demony and Miguel Pereira, writing by Andrei Khalip, and editing by Hugh Lawson
Hunger strike disbanded as government agrees to resume talks with nurses, by Natasha Donn, posted on February 22, 2019 on the Portugal Resident‘s website.
Facing Nurses Strike, New York Hospitals Reach Landmark Deal on Staffing, by Patrick McGeehan, posted on April 10, 2019 on the New York Times website.
