The Nurses Who Wouldn’t Come in From the Cold

Working in these conditions quickly became impossible, workers testify. ​“There were a few times right before we went on strike,” Andrews recalls, ​“when I sat in my car, needing to go into work to punch in … and I just sat there. I didn’t want to get out of the car. I am not alone in that feeling.”

Nationally, nurses are changing employers— and even quitting healthcare altogether — in record numbers, supposedly due to ​“burnout.” But reporters who talk to nurses identify a deeper malaise. ​“Healthcare workers aren’t quitting because they can’t handle their jobs,” writes Ed Yong in The Atlantic. ​“They’re quitting because they can’t handle being unable to do their jobs.” Andrews, who has contemplated leaving nursing for exactly this reason, agrees. ​“When you feel like you’re not doing enough to take care of your patients, it is such a moral injury,” she says, using the term ​“moral injury” to refer to the distress caused by being forced to break one’s moral code — such as the dread nurses face when not allowed to take proper care of their patients.

Andrews was far from alone in experiencing moral injury at an understaffed hospital. But not all St. Vincent nurses experienced staff shortages the same way. Pellegrino, who has been at the hospital for 35 years, explains the nurse-to-patient ratio was a critical problem on many, but not all, floors. ​“As an operating room nurse, you can only operate on one patient at a time,” she says, while nurses in the float pool and telemetry units might be caring for five patients at once.

But even nurses with lower patient assignments joined the picket line in solidarity with their colleagues and in service to their patients. ​“In my specific unit, it wasn’t as bad as some of the other units,” says progressive care nurse Aimee Albani, who has been at St. Vincent for 18 years. When asked why she still went on strike, Albani says she did it as part of a union and as part of the hospital. ​“If you have other people in the hospital who aren’t able to care safely for their patients,” she explains, ​“it’s the same as if you aren’t able to care for patients.”

Labor and delivery nurse Deirdre Simpkins echoes Albani’s reasoning, saying she went on strike after six years of working at St. Vincent ​“not so much [because of] what I saw in my particular unit, but what was going on throughout the hospital.”

As St. Vincent nurses risked their jobs for the common good, hospital management was interested in a different set of priorities. St. Vincent is owned by the massive Tenet Healthcare Corporation, which approaches its staffing decisions with the goal of ​“limit[ing] year-over-year growth in the company’s salaries, wages and benefits spending,” as noted in the publication Healthcare Innovation.

With Tenet at its helm, St. Vincent did not respond to the nurses’ strike in the most obvious ways, such as by hiring more nurses; instead, St. Vincent spent money to bring in contract ​“travel nurses” to try to break the strike.

For their willingness to cross the picket line, these travel nurses were paid at least double what in-house nurses were paid, workers say. Despite the higher rates, Tenet finds these travel nurses to be a worthwhile long-term investment, with Tenet Chief Operating Officer Saum Sutaria reportedly wanting to increase the use of travel nurses across the company’s hospitals. Tenet’s goal is to avoid so-called wage inflation (i.e., increasing baseline wages for permanent staff).

With travel nurses dampening the strike’s impact on St. Vincent’s bottom line, the hospital tried to wait the nurses out. But after six months, nurses say, management was feeling the pressure — the cost of the strike in travel nurse contracts and security expenses was adding up, as were local politicians’ calls to reach a deal. By this point, more than 100 hospital beds had been closed and nurses say that patients freshly discharged from the emergency room were joining the picket line to tell the striking nurses what a mess the hospital was without them. Strikers were also hearing reports of ambulances being redirected away from St. Vincent to other hospitals, which were also reaching capacity.

On August 27, 2021 — 172 days into the strike and after two years of demanding safe staffing — the nurses finally received the concession they had been waiting for. Management agreed to limit nurses’ patient assignments in the cardiac post-surgical unit, on medical surgical and telemetry floors, in the behavioral health unit and beyond.

“We got [what we wanted],” Ritacco told local news the day of the agreement. ​“Conditions will be exponentially safer in that building now.” It seemed like the nurses had finally won.

In email correspondence, hospital spokesperson Matthew Clyburn referred to the late August deal as an ​“agreement on nearly every component” of the contract.

“[The hospital] only had the last meeting to do the back-to-work agreement,” recalls Albani. ​“And that’s when they lowered the bar.”

As negotiations were wrapping up, management told their 700 striking nurses that more than 100 of them would not be getting their old positions back. Instead, they would be permanently replaced by their picket line-crossing peers.

The positions that were going to be replaced, according to nurses, were some of the best paid and most prestigious at the hospital, which often required decades of experience — such as positions in same-day surgery, the gastrointestinal lab, the recovery room, the catheterization lab and maternity. ​“Those would be positions you’d be waiting for, sometimes for years,” says nurse Carla LeBlanc, ​“to gain enough seniority and experience before you could have them.” LeBlanc has been at the hospital for five years in a float pool position; she doesn’t have the seniority for a specialty position.

The hospital was threatening to take these specialty positions from nurses who might have up to 40 years of experience, replacing them with recent graduates or inexperienced nurses from other departments — and then giving them sign-on bonuses. The nurses interpreted the hospital’s move as a way to punish strikers and discourage future strikes. ​“Who is expendable? That’s what they were deciding,” LeBlanc says.

Removing 100 nurses may have seemed safe to management, given that the change was announced after the core strike issue had been resolved and, according to Albani, most nurses were already preparing to come off strike.

“People were hurting,” Albani says. ​“It had already been six months that people had been in a position that was really difficult for them and had been putting their kids and families in that same position. We thought this is going to be it, [that] people are going to say, ​‘We’re crossing [the picket line] because only 100 of you are not going to get your jobs back.’ ”

But something else happened. At a meeting she ​“will never forget,” Albani instead witnessed nurses unequivocally agreeing that there was no way they would leave 100 of their coworkers behind. Many of these nurses had developed strong relationships with one another over decades; striking together for their patients had only strengthened those ties. Many said they would sooner quit their jobs or even nursing itself than cross the picket line and leave their friends and colleagues behind.

Out of 800 total nurses at the hospital, nearly all 700 who originally went on strike remained on strike.

“We said, ​‘We’re not voting on an agreement until everyone goes back,’” says surgery nurse Kathy Duszak, who has been at the hospital for 24 years. ​“We walked out together, and we will go back together.”

In a dozen interviews, nurse after nurse echoed this sentiment when asked why they kept striking after winning their key demands. The fact was that their key demand — and the goal of the strike itself — had since changed. ​“At the beginning,” LeBlanc says, ​“we were fighting for all nurses for the benefit of our patients. But once they said we wouldn’t all get our jobs back, then we were fighting for our jobs, for these nurses that I have grown to love and respect.”

Nurses were especially cognizant that the 100 jobs the hospital had threatened with permanent replacement belonged to specialty nurses who ​“didn’t really stand to gain much from our contract, because they don’t have [nurse-to-patient] ratios like we do on the floors,” according to Duszak. Still, these specialty nurses had decided to risk their jobs in solidarity with their floor nurse colleagues and for the good of their patients. ​“They went out because they are part of the union,” Duszak says, ​“and we just couldn’t go back without them having their jobs.”

Nurses also said the strike became bigger than just one hospital or one union — they felt a duty not only to their patients, but to each other, and workers everywhere. ​“We had to stay out for the labor movement that was watching us,” says Ritacco.

“We felt responsible for all the other strikes in the country,” says Andrews, referring to the fact that the St. Vincent nurses’ strike anticipated 2021’s larger strike wave, which included weeks and sometimes months-long strikes at John Deere, Nabisco, Kellogg’s, Columbia University and beyond. ​“If we gave up even for a minute,” says Andrews, ​“it was going to be like dominos.”

Negotiating committee co-chair Dominique Muldoon, who has been at St. Vincent for 25 years, says that nurses were especially unwilling to set a precedent of striking workers being replaced permanently. Similar threats have increasingly been used as strike-breaking tactics elsewhere, and in the absence of the Protecting the Right to Organize Act (which would outlaw the practice), it is up to workers to make sure that permanent replacement does not become common practice. The nurses at St. Vincent took this responsibility very seriously.

Had the nurses let themselves be replaced, says Albani, ​“It would’ve been a total failure. Who would’ve ever gone on strike knowing you might not have a job in the end?” St. Vincent nurses ultimately remained on strike for an additional four months until every striker was offered their original position back. They showed that, together, workers can fight threats of permanent replacement just as effectively as they fight for contract demands. Nurses voted 487 to 9 to ratify the contract (In These Times spoke with the sources for this piece prior to ratification).

Every strike is for the ​“common good” insofar as strikes strengthen worker power and improve standards across industries. But the movement for the common good stems from the understanding that, when necessities such as healthcare and education are commodified and beyond public control, then union issues go beyond people’s rights as workers. Unions must now fight for people’s rights as patients, parents, students, tenants and debtors.

For the nurses at St. Vincent, defending the common good meant fighting for a hospital where they could do what they were meant to do: care. ​“We are not making a pair of shoes or a pillow,” says Patty Warman, a float pool nurse who has worked at St. Vincent for 34 years, 28 of those as a nurse.“We are caring for people.”

As St. Vincent turned into a for-profit hospital,this higher purpose seemed to have been forgotten. ​“Hospitals were never meant to be moneymaking industries,” says Andrews. ​“They were supposed to break even and really focus on giving awesome care.” And if reminding a hospital why it exists requires her fellow nurses at other hospitals to strike, Andrews adds: ​“I got your back.”