“Patients should not be treated like commodities”: Baltimore Nurses Are Fighting for a Transformative First Contract

This transcript has been edited for length and clarity.

Crowd chants: What do we want? 

Safe staffing!

When do we want it?

Now!

What do we want? 

Safe staffing!

When do we want it?

Now!

What do we want? 

Safe staffing!

When do we want it?

Now!

Nicki Horvat: Alright, so you know we’re all out here because they essentially gave us a very underwhelming wage proposal and we’re just out here to show them that we know our work, that we are worth more than they’re trying to make us settle for, that our patients and our lives and safety are worth fighting for. Our community. Our community, exactly. So let’s show them that we have solidarity among us, that we have community support and that we’re not going to back down until we win.

Maximillian Alvarez: Join thousands of others who rely on our journalism to navigate complex issues, uncover hidden truths, and challenge the status quo with our free newsletter, delivered straight to your inbox three times a week.

Alright, welcome everyone to another episode of Working People, a podcast about the lives, jobs, dreams, and struggles of the working class today… brought to you in partnership with In These Times magazine and The Real News Network, produced by Jules Taylor, and made possible by the support of listeners like you. Working People is a proud member of the Labor Radio Podcast Network… if you’re hungry for more worker and labor-focused shows like ours, follow the link in the show notes and go check out the other great shows in our network. And please support the work we’re doing here at Working People because we can’t keep going without you. Share our episodes with your coworkers, friends, and family members, leave positive reviews of the show on Spotify and Apple podcasts, and reach out to us if you have recommendations for working folks you’d like us to talk to. And please support the work we do at The Real News by going to the​re​al​news​.com/​d​onate, especially if you want to see more reporting from the frontlines of struggle around the US and across the world. 

My name is Maximillian Alvarez and we’ve got another special on-the-ground episode of the show for y’all today. On Thursday, June 20, at 8 in the morning, unionized nurses at Ascension Saint Agnes Hospital in Baltimore held a rally outside the hospital to raise awareness of their efforts to secure a first contract and to show management that they’re not backing down from their core demands for safe staffing and an operational model that puts patients and patient care first. Saint Agnes Hospital is part of the Ascension health network… Ascension is one of the largest private healthcare systems in the United States, and it is now the largest nonprofit and Catholic health system in the country. 

In their press release about the action, the union, which represents over 500 registered nurses at Ascension St. Agnes, stated: 

“Registered nurses at Ascension Saint Agnes Hospital in Baltimore, Md. will rally on Thursday, June 20, in support of ​‘Patients First’ and staffing protections, which they have proposed to hospital management during contract negotiations. The nurses, who are members of National Nurses Organizing Committee/​National Nurses United (NNOC/NNU), have been in negotiations since Jan. 18, 2024… ​‘Nurses are fighting for ​‘Patients First’ protections in our contract because they are essential safeguards for our patients and the community we serve,’ said Nicki Horvat, RN in the Neonatal Intensive Care unit and member of the bargaining team… Saint Agnes nurses are calling on Ascension to accept their proposals to improve safe staffing and, subsequently, nurse retention. Nearly 20 percent of nurses at St. Agnes began employment at the hospital after January 1 of this year. Meanwhile, just over a third of nurses have more than four years of experience at the hospital… Saint Agnes nurses’ ​‘Patients First’ proposal includes Ascension’s commitment to maintain all facilities and services within the community for the duration of the contract and that any replacement be ​‘equally accessible.’ It also includes patient protections against lawsuits for the resolution of billing disputes and against surprise billing or excess charges… A January 2024 report from National Nurses United found that Ascension cut a quarter of its labor and delivery units in the past decade amidst a nationwide rise in pregnancy- and childbirth-related mortality. These cuts drastically impacted metropolitan areas and areas with higher rates of low-income, Black, and Latine patients… In November 2023, Saint Agnes nurses voted to join NNOC/NNU, making Saint Agnes the first private-sector hospital in the city to unionize and the fourth Ascension hospital to unionize in 13 months. The Catholic hospital system is one of the largest in the country with 140 hospitals in 19 states and also one of the wealthiest, with cash reserves, an investment company, and a private equity operation worth billions of dollars — and, because of its nonprofit status, is exempt from paying federal taxes. Tax records indicate Ascension’s CEO took home more than $13 million in compensation in 2021.” 

In response, as Angela Roberts reported at The Baltimore Sun, ​“Justin Blome, director of marketing at Ascension Saint Agnes, said in an email that patient and associate safety remains the hospital’s top priority. Thursday’s rally wasn’t a strike or work stoppage and did not affect patient care, he said. During contract negotiations, Blome said, the hospital has been focused on ​‘setting a tone and tenor of collaboration and respect’ as leaders bargain in good faith with National Nurses United. ​‘We believe differences are best resolved at the bargaining table, rather than through public demonstrations, and look forward to continuing the work of reaching a tentative agreement on a mutually-beneficial contract that supports all,’ he said.”

I was there on the ground at the rally for The Real News, and after the chants died down and the crowd disbursed, I got to sit in the shade and speak with registered nurse and bargaining team member Nicki Horvat about what she and her healthcare coworkers are fighting for. 

Crowd chants: Who got the power? 

We got power. 

What kind of power? 

Nurses power!

Who got the power? 

We got power. 

What kind of power? 

Nurses power!

Nicki Horvat: Hi, I’m Nicki. I am a NICU nurse at Ascension Saint Agnes here in Baltimore.

Maximillian Alvarez: Well, Nicki, thank you so much for sitting down and chatting with me. I know you’ve had a long morning. We are here right out in front of Ascension Saint Agnes Hospital here in Baltimore where y’all just held a rally and I wanted to ask if you could just tell folks listening a little more about who you are, who these folks are here and what brought y’all out to this street corner this morning? 

Nicki Horvat: So I am on, well first of all, we unionized. We formed the first nurses’ union in Baltimore back in November. We had our election and we won and we formed a bargaining team of which I’m a part, I lead the maternal child health division or I represent them. And so we rallied today to bring attention to mainly two things, which is safe staffing and our Patients First language in the contract that we’re trying to bargain. And I’ll explain what that is after I say this next. So right now we’re in the process of bargaining our contract, which means that the five of us nurses who have been elected to represent our fellow nurses in the hospital, we sit at the bargaining table with Ascension’s lawyers and their labor relations people with our lead negotiators and we negotiate the contract. So our goal is to get a strong first contract that has ​“Patients First” language in it, which means that patients are the number one priority regardless of who they are, where they come from, what their situation is, and that they are not treated like commodities like patients very frequently are in this country. And that one of the main reasons we unionized was because we have been bringing up issues year after year collectively and they’ve kind of fallen on deaf ears.

Maximillian Alvarez: Well, let me ask a little more about that real quick because I’ve been telling folks for the past four years, every interview I’ve done on this show is technically a Covid interview and people are always asking me like, oh, what are you hearing from workers? What happened? How are folks faring after Covid? And I was like, there are a lot of answers to that question, but I feel like one of the answers I always come back to is this country is not prepared for the crisis in healthcare and education that we are going through. That was greatly exacerbated by Covid.

Nicki Horvat: Absolutely.

Maximillian Alvarez: I wanted to ask if you could speak a little more to the issues that y’all were raising over and over again that you weren’t getting responses from management that ultimately led y’all to wage and win this unionization campaign last year.

Nicki Horvat: So safe staffing is number one pretty much across the country. They maximize their profits by not staffing safely, basically it’s like the basic concept. And so that is always our number one priority is making sure that nurses, you’ll hear the nurse to patient ratio, which is how many patients are assigned to one nurse. And we have so much research data that shows that high nurse to patient ratios lead to worse patient outcomes, poorer patient satisfaction, higher nurse burnout, increased risk for medical errors. And so you look at that data and you’re like, yeah, obviously nurses should have lower nurse to patient ratios. And logically yeah, you’re like, duh. But common practice is no, let’s give the nurses as many as we possibly can to maximize their profits.

Maximillian Alvarez: This is the business school brain genius idea that every corporate boardroom has in every industry is let’s squeeze more work out of fewer workers… 

Nicki Horvat: Exactly.

Maximillian Alvarez: I mean, I hear this from workers on the railroads. I hear this from retail workers at Macy’s or dollar stores who are systematically understaffed and there’s got to be a reason why this keeps cropping up in industries around the country. And I just wanted to ask if you could say a little more about what that translates to for you and your coworkers on a shift on a day-to-day basis. What does this corporate drive to pile more patients onto fewer nurses mean for you on a daily level?

Nicki Horvat: Yeah. It means that we can’t spend the time or attention with every single patient that every single patient deserves. I mean, these are human lives that we’re talking about. And I mean, I said it before that patients should not be treated like commodities. And one of the main issues in this country is that healthcare is treated like a business. And so if you view people like commodities and put a price tag on them, you’re obviously not going to be prioritizing their health and their wellbeing. That’s one of the things that Ascension very clearly shows is that they have the resources to and the power to change the conditions that we work in. They have the money, they have a lot of cash reserves, they have a $41 billion investment arm, which ironically is invested in a lot of companies that exacerbate people’s health issues. But if we prioritize patient care then we would have lower ratios, but having those higher ratios means that people aren’t getting individualized care. Every nurse is pulled in five, six, seven different directions. If you’re in the ICUs and you’re tripled, you have three patients that are high acuity. That should be two to one, is the ideal maximum ratio in ICUs. And most of them are honestly one-to-one with the care that they require. So frequent tripling, which has been happening a decent amount here, should not be happening.

Maximillian Alvarez: A term was introduced to me a couple years back when I interviewed striking physicians out in the Pacific Northwest where they told me about the ​“retail health” model and how the more that our healthcare system has been taken over and dominated by corporate entities, Wall Street entities, the more that again, it follows the corporate playbook: pile more work onto fewer workers, decrease the quality of care to the bare minimum that you can get away with. And I bring that up because I know in the past, whenever nurses or other healthcare workers go on strike or try to unionize or try to raise issues at their job, like educators, they are pitted against their patients. Educators are pitted against their students and saying, oh, you guys are selfish. You don’t care about your patients. So if you did, you wouldn’t be out here on this street corner. You’d be in there taking care of ​’em. So what’s your message to folks out there about how and why this is for patients? Because I feel like that may be a, I suspect that’s an easier case to make these days because more and more of us as patients have been feeling the decrease in the quality of care we’ve been getting ourselves. 

Nicki Horvat: Yeah. And I mean I think the answer is twofold to that because yes, there’s a component of we don’t want to be burned out. So there is the personal tie that we want better working conditions for ourselves, but no nurse gets into this field for money. No nurse gets into this field because they don’t like people. We all get into this field because we love people and we want to take care of them, and we want to be able to pour ourselves into helping people in their healing journeys and the amount of moral distress that we feel when we literally don’t have the resources or the bandwidth or the time to do that. And we’re worried that we’re going to make a mistake or that not having the proper time leads to a poor outcome for the patient. That’s a heavy weight to carry. And so prioritizing patients, this is how we do it, this is how we use our voices to advocate. Nurses are the number one advocate for patients in the hospital. So just as we advocate for patients at the bedside, so we’re advocating for them out in the street and showing management that the conditions that they have created within the hospital are unacceptable and that the patients deserve better care.

Maximillian Alvarez: And this is almost word for word what your colleagues in Massachusetts at Saint Vincent Hospital were saying two years ago when they waged the longest nurses’ strike in state history over very similar concerns. I mean like Saint Vincent Hospital is owned by Tenet Healthcare, which is a healthcare giant housed out of Texas. And so they were talking about what it means to have, again, a corporate minded entity like take over their hospital, squeeze their workers, decrease the quality of pay, and they waged a monthslong strike over it and ended up winning. Now Ascension is also a private hospital. Can you say a little more about those conditions behind the scenes that folks, average folks, don’t see and how this is translating to what y’all are fighting for at the bargaining table?

Nicki Horvat: Yeah, I think just overall we’ve seen the quality of supplies go down. There’s been shortcuts in supply manufacturers to ostensibly lower their costs, but then that obviously impacts patient care because cheaper quality supplies mean that IV catheters don’t last as long, so you have to be stuck more or we don’t have the supplies that we need to perform certain tasks. We just went through a four-week-long cyber attack, in which case we had to deal with paper charting and the chaos of that with very little training, things like that. The things that we’re asking for are not unreasonable things. They’re kind of basic things that are needed to ensure high quality care. And it’s honestly, this whole process, it’s been kind of mind-blowing to me that we even have to fight so hard for things that should be a basic necessity.

I think something else too that happens frequently is not having the other staff that we need to make our jobs easier. So if housekeeping doesn’t come around, us nurses act as a housekeeper. If we don’t have a secretary, we have to act as the secretary. If floors don’t have a tech or don’t have enough techs, then nurses act as the tech as well. So not only are we doing the nurse’s primary job for a large number of patients, but we’re often doing three or four other roles that should not fall on us, but end up, pretty frequently, end up falling on us. 

Maximillian Alvarez: Well, and again, speaking to all of that, I know you are exhausted and you were leading this rally this morning, so I got to let you go in a second. I just wanted to ask, yeah, if you could give listeners an update on where things currently stand with bargaining and what folks around the city can do to stand in solidarity with y’all?

Nicki Horvat: Yeah, absolutely. So right now we’re about six months into our bargaining. We have come to agreements in principle on a lot of the important but smaller issues. And we’re really at a place where we’re tackling our top priorities. So safe staffing, safe floating, which means nurses going from their home units to other units to help with the staffing, our wage proposal, some of the bigger, more substantial items that we’ve gotten pushback on. So today we held the rally to really show the solidarity we have and show the community support we have and to show them just that we’re not afraid, that we’re not going to be intimidated, and that we’re not going to back down until we win a good contract for our patients and for ourselves. And yeah, I guess what the community can do is to just come out and join us, wear red, talk to your hospital administrators, talk to, we’ve been trying to meet with specifically the Archbishop of Baltimore because we have a lot of Catholic backing. Part of Catholic social doctrine is very pro-union and pro-worker. And one of the things that really guts a lot of us nurses is that Ascension claims to be a Catholic nonprofit and really showcases its mission as a healing ministry of Jesus. And yet the hypocrisy that they show in not following that mission and prioritizing profit over patients is just really messed up and it really, really hurts a lot of us. And so us unionizing and winning a good first contract is a way to hold them accountable to the very mission statement that they say they live up to and to prioritize what should actually be a priority. So yeah, community involvement is always welcome. We always love seeing people in support as people drive by and honk. It’s super empowering and just really, really helps the efforts.

Crowd chants: We will be back! We will be back! We will be back! We will be back! 

Maximillian Alvarez: Alright gang, that’s going to wrap things up for us this week. I want to thank our guest Nicki Horvat for taking the time to talk with me, especially on such a busy and intense morning. And as always, I want to thank you all for listening and I want to thank you for caring. We’ll see you all back here next week for another episode of Working People. And if you can’t wait that long, then go subscribe to our Patreon and check out all the great bonus episodes that we’ve published for our patrons over the years and go explore all the great work that we are doing at The Real News Network where we do grassroots journalism that lifts up the voices and stories from the front lines of struggle around the world. Sign up for the Real News newsletter so you never miss a story. And help us do more work like this by going to the​re​al​news​.com/​d​onate and becoming a supporter today. It really makes a difference. I’m Maximillian Alvarez. Take care of yourselves. Take care of each other, solidarity forever.