How NYC nurses won their strike

This article is largely based on a Tempest interview with Judy Sheridan-Gonzalez, immediate past president of the New York State Nurses Association and member of the NYSNA bargaining team at Montefiore Medical Center in the Bronx. A Bronx native herself and resident of the community that Montefiore serves, Judy has worked at Montefiore’s Moses Campus for forty years. I’ve attributed specific statements to her as appropriate. She contributed extensively to the writing of certain sections of the article. I want to express my gratitude to her and also to Sean Petty, a nurse in the New York City Health and Hospitals system. Sean made many helpful suggestions and also contributed most of the ideas in the section on the public hospitals. – Mel Bienenfeld

The three-day strike by nurses at two of New York City’s largest and wealthiest private hospitals, Montefiore and Mt. Sinai, ended in an exciting victory that could set national precedents for solving the severe and long-standing understaffing problems plaguing nurses and their patients. The settlements, ratified by approximately 98 percent of members, extend and clarify nurse/patient ratios, establish enforceable penalties for violations of the ratios, and add to the base salary increases agreed to at other private hospitals whose contracts had also expired and which had reached settlements in the last days leading up to strike.

Staffing ratios were a prime motivation for the nurses and their patient allies in this bargaining round. Severe understaffing was exacerbated by the pandemic and recent “tripledemic,” made worse with burnout and quitting, and, in the case of Montefiore, the closing of some units as the hospital spent on exorbitant management salaries and more lucrative business endeavors, including real estate investments. Patient care suffered and nurses were chronically exhausted. Admitted patients endured conditions such as being treated in hallways.

The previous contract did provide for per-unit staffing ratios (except for the Emergency Department), and a 2021 State law mandated a process for hospitals to establish them, but neither had been enforced effectively. Salary was an issue as well, as living costs rose sharply and higher, competitive salaries for travel nurses were required in order to recruit new staff.

Contracts at 12 private hospitals in the city all expired this past December 31. NYSNA had set that date as a deadline for a settlement to be reached, while being ready to announce a strike if it was not. Members had voted by over 98 percent to authorize a strike in that eventuality, and on December 30 the union provided the mandated announcement of its intention to strike, with walkouts set for January 9.

Bargaining was conducted separately at each of the hospitals. In the last couple of days before the announced strike date, some reached settlements under pressure to avoid a strike or, in the case of smaller underfunded community hospitals, succumbing to somewhat plausible management claims of post-COVID-19 financial distress. The first of these settlements occurred at New York Presbyterian (NYP), a well-endowed teaching hospital like Montefiore and Mt. Sinai which, like those institutions, is the result of mergers, acquisitions, and expansion efforts—business-oriented strategies which bely their non-profit status.

While better staffed than Montefiore, and perhaps with a less developed history of militancy and community relationships, the level of anger at NYP during and after COVID-19, and at all of the other institutions, was similarly high. According to several sources, there was a great deal of pressure to settle without a strike. Significantly, at NYP, the agreement was only ratified (according to CNN) by 57 percent. Since then, the employer has reneged on a retiree health benefit that was negotiated in this round, leading to the militant occupation of the NYP lobby by retired nurses for over two days.

When the midnight deadline hit on the morning of January 9, contracts at Mt. Sinai’s main campus (in Manhattan) and Montefiore’s locations in the Bronx remained unsettled. Militant, angry picket lines and strike rallies took place immediately at both hospitals. What happened at Montefiore, in particular—beginning well before the strike—illustrates how struggles like this can be won and built upon.

Montefiore’s place in the community, and NYSNA’s

Montefiore Medical Center serves a mostly poor community, largely people of color, many of them recent or first generation immigrants. Its patient base is certainly much poorer—and more poorly insured—than Sinai or Presbyterian. Yet it receives funding from wealthy donors and government grants for poor-serving institutions. It is by far the Bronx’s largest employer, controller of much real estate, and it is the Bronx’s major political donor (both former Assemblyman and county Democratic Committee Chair Marcos Crespo and former Borough President Ruben Diaz now hold extremely lucrative administrative positions at Montefiore). Many of its nurses have origins in the same community as their patients, with some being the first in their families to go to college.

Well-motivated to provide good care, these nurses have long been outraged at the stress they have had to endure and the hospital’s lack of concern for its patients. Judy Sheridan-Gonzalez describes “fury” directed at the union over a seriously inadequate contract bargained in 2019, leading her and other NYSNA leaders at Montefiore to begin a process of rebuilding a strong union consciousness. Sources have described unsavory relationships between the union executive staff leadership at the time, the governor, and the League of Voluntary Hospitals as the basis behind the 2019 settlements in Montefiore and other facilities involved in negotiations.

At Montefiore, a critically important aspect of the growth of union and social consciousness was strengthening pre-existing connections of the union to local community groups. Organizations like the Northwest Bronx Community and Clergy Coalition had been involved in the struggle for quality healthcare, and NYSNA activists developed consistent relationships with these groups, accompanying them at health fairs, meetings with progressive politicians, and other activities. A high level of community concern over declining conditions at Montefiore led the union—in consultation with its community partners—to include several “community demands” in its contract proposals, including increased funding to facilitate: the reopening and expansion of closed inpatient units to prevent “hallway patient” admissions; reorganization of the Emergency Department to prevent patients from being treated in overcrowded and unsanitary conditions; and—addressing a particularly sore spot in the community—restarting the popular and recently terminated Maternal-Child Home Care Health Program.

Montefiore NYSNA leaders, along with their community and union allies (the Committee of Interns and Residents) established a public presence by attending events like an American Museum of Natural History Gala, demanding that the hospital spend its revenues on healthcare instead of buying up properties and maintaining exorbitant salaries for managers. On December 20, they held a symbolic “people’s tribunal” at a public school, attended by over eighty community residents and several organizations and political leaders, at which judges found Montefiore guilty of egregious behavior. The union was thus in a good position to alert the community that a strike was very likely, given Montefiore’s intransigence in meeting the needs of both patients and caregivers. Alerting Bronx residents to prepare themselves to visit nearby hospitals for care should a strike occur was yet another element in labor-community relations, an essential piece of building this type of solidarity.

Preparing members for struggle

Internally, union leaders made sure members were aware of developments. For years before the contract expiration date, they urged nurses to save money in preparation for a possible strike (though they realized that this would be difficult for most) and linked them to agencies where they might find temporary work in case of an extended strike. If the outcome this time was to be much better than in 2019, they would have to prepare themselves to fight for it. As early as the Spring of 2022, leaders engaged members in the process of crafting contract demands around what nurses actually asked for, explaining consistently about the interconnections between nurses’ direct needs and the needs of the community, creating, expanding, developing and educating members of Contract Action Teams. (Sheridan-Gonzalez says that she and others joked about these CATs welcoming “kittens” and developing “tigers” from among their ranks.)

Members were asked not just to authorize a strike when the time came, but whether they were willing to go on an open-ended strike. The answer was overwhelmingly yes. Open-ended strikes are rare for nurses in the current U.S. labor movement and are considered very difficult to organize but, if possible, much more effective. And members had been following closely during the previous year, as nurses elsewhere staged successful strikes or won contract demands with a credible strike threat. When the vote was taken at Montefiore, of the over eighty percent who participated, 99 percent said yes to a strike.

In mid-December, the CATs increased their activity, forming WhatsApp and Facebook groups of hundreds and even thousands (NYSNA has about 2,700 members at Montefiore). The union was thus able to communicate with its members in multiple ways, giving updates after each negotiating session.

The sessions themselves were open (as they were at Mt. Sinai). The union had demanded and won face-to-face bargaining—the first hospital to win this demand—and members could, and did, attend in person, cheer, applaud, and even speak. Members could also attend virtually, with online attendance varying between 40 and 200. Despite this, management barely budged in the direction of the union’s demands until right before the strike date.

The strike begins

As January 9 approached, Montefiore and Mt. Sinai were the only two hospital systems remaining without settlements. Management suddenly began making concessionary offers of a settlement, to which it demanded rapid agreement. While significant, the concessions included no comprehensive solutions to the abuse that nurses and patients experienced.

Meanwhile, the potential lost revenue to private and public coffers and the inability of major medical institutions to properly care for its patients presented a possible public crisis. The hospitals appealed to Governor Kathy Hochul to step in, which she did, urging both sides to submit to binding arbitration. The hospitals agreed to do so within seconds of her announcement (obviously, since they had asked for her to do this), but the NYSNA bargaining committees at both hospitals refused to give in to what would certainly be yet another “employer’s deal.”

Throughout negotiations, but especially after the strike notice was announced, union teams at both hospitals were in close touch, comparing strike plans and management offers and behaviors, as well as actual proposals, though there was no formal declaration that each would only settle with the agreement of the other.

Management was not prepared for a strike. They apparently believed that the union’s team at Montefiore would be pressured to accept similar settlements to those at some of the smaller hospitals, and that nurses would not actually walk out. There did not seem to be a plan to outlast the strikers.

But on the union side, nurses were well aware that the hospital had the financial resources to meet their demands, so they had no fear that the hospital would “close” should there be a prolonged strike. They also knew that the hospital could not run without them. When traveling nurses were brought in (and paid quite a bit more than staff nurses), they of course were not familiar with the units they worked on and were even less able to handle the chaotic conditions created by the understaffing. Some quit in frustration during the first two days. In addition, a scant few of the 2,700 nurses crossed the picket line, shattering the hospital’s hopes to outlast the nurses.

Montefiore’s nurses were aware of their power. They were also aware of public support. New Yorkers, like people elsewhere, had lauded healthcare workers as heroes early in the pandemic and knew how hard they worked. Many were also aware of NYSNA’s public safe staffing campaign. It was, therefore, not just NYSNA’s immediate community allies, but the public at large who were on the nurses’ side in this strike, as the honking horns and raised fists of motorists passing the picket lines attested, as well as donations of coffee, donuts, pizza, the presence of many community allies on the picket lines, along with assorted union locals (the Union Rat appeared ceremoniously) and progressive organizations. Ultimately, elected leaders and the AFL-CIO offered words of support at a press conference held on day three of the strike.

What was clear was that the hospital simply could not function during the strike.

The settlement

After three days, the strike remained strong and morale was high. Rather than undergo further dysfunction and financial loss, management decided to settle and gave in to NYSNA’s demands. They agreed to most of the “community demands,” sweetened their salary proposal with an addition to the experience step in the contract (as proposed by the union), established staffing ratios in the Emergency Department for the first time, and—importantly—agreed to a carefully crafted enforcement mechanism for staffing ratios in all units, again as proposed by NYSNA. Better means of recruiting and retaining nurses were also part of the agreement.

NYSNA’s team had thought through what an effective enforcement mechanism of staffing ratios would entail, and proposed details of what would constitute sufficient evidence of violations, how those would be adjudicated, and a dramatically expedited arbitration procedure if management disputed the claim. Each step would have time limits to streamline the process, and if the claim were upheld, possible penalties included sharing among the nurses on the affected unit the amount of the salaries that would have been paid in order to meet the required ratios, or a 15 percent discount to be paid to all patients on the unit during the period of the violation.

Coordination between the two bargaining teams proved particularly effective in securing these unprecedented settlements. Voting members of these teams consisted solely of elected groups of working nurses who were fully able to make their own decisions in the face of external pressures. That fact—combined with the openness of the process and efforts made for extensive communication among and between members—enabled them to be fully aware of the feelings of the membership and put the teams in the best position to judge whether to begin a strike and, later, when to end it.

After the strike

Sheridan-Gonzalez says that everybody has been watching this strike to learn what can be accomplished. By “everybody,” she primarily means healthcare workers and unions—in New York, but also nationally and even internationally. Locally, it includes the Bronx community who rely on Montefiore for care: “Thank you for fighting for us” has been the response of NYSNA’s community allies. Patients, doctors, and other hospital personnel echo these sentiments. Interestingly, the Physician Assistants at Montefiore simultaneously voted to be represented by a union for the first time in Montefiore’s history. An election for union representation by the residents is occurring this month.

Sheridan-Gonzalez’s team intentionally tried to model certain aspects of contract bargaining: fully involving members in forming proposals, conducting open negotiations, providing members with explicit details of a tentative agreement (not just “highlights”), and adequate time for discussion and voting. The outcome, she believes, proved that if conditions require it, and if workers are organized to participate in a strike, it can be successful and members can gain a sense of their power.

Beyond generating a superior contractual agreement, members describe never-before-felt pride, solidarity, love, and comradeship in the process of the strike activities themselves: the picketing, the rallies, the reports, the presence of media and others. The winning over of the hearts and minds of the public was so palpable, it brought many to tears. The nurses’ voices were finally heard.

At the next contract round, in a few years, workers at other private hospitals in the city may well attempt to achieve the same gains—of necessity, by the same means—as nurses at Montefiore and Mt. Sinai. As for the enforcement provision of staffing ratios, Sheridan-Gonzalez knows of no equivalent model anywhere in the United States, and expects that nurse unions elsewhere will take a careful look at what happens at those New York hospitals.

The public hospitals

A much more immediate contract fight is taking shape in the New York Health and Hospitals Corporation (H + H), where NYSNA also represents nurses. Those contracts are among the many contracts expiring (or already expired) in the city’s current bargaining round, which currently seems to be dragging out indefinitely, as Mayor Eric Adams demands prior healthcare givebacks from the unions. In the case of the public hospitals, the staffing and patient-care crisis, bad enough in the more wealthy private sector, has been a disaster. Nurses in H + H work for $15,000 to $20,000 less and, not surprisingly, turnover has been profound. The COVID-19 crisis has produced a breaking point, and nurses hope that they will be able to confront Mayor Adams from a position of strength to put forth their central demands of pay parity with the private sector and the enforcement of clear staffing guarantees.

The public sector nurses have certainly been inspired by the strike of their private sector colleagues and its impressive outcome regarding staffing. But in the public sector—where New York State law makes striking illegal—nurses will need to organize in unprecedented ways and consider new, creative tactics. The January 16 attempted takeover of the lobby of H + H headquarters is an indication of their willingness to fight in these ways. Actions throughout the system are likely on March 2, when the contract expires, and NYSNA will be calling for public support. It remains to be seen, though, whether residual demoralization and cynicism can be countered with a developing sense of power.

Featured Image: mosaic of video stills captured by the author Mel Bienenfeld.