How Union Workers Are Fighting to Save America’s Beleaguered Health Care System

Yves here. This post confirms something Lambert has highlighted in the context of elections: that nurses are one of the most effective union groups. Here they are combatting abusively low hospital staffing levels. Not only will this campaign help slow the decline of the quality of care, it should help slow the exodus of nurses, who otherwise suffer from overwork and moral injury.

By Tom Conway, the international president of the United Steelworkers Union (USW). Produced by the Independent Media Institute

Among the handful of neurologically impaired patients in Judy Danella’s care one day in March 2023 were three so ill that they struggled just to swallow.

She fed each of them in turn, delivering spoonful after spoonful of pureed food, patiently nourishing them toward better health even as she herself was stretched thinner by the minute in a facility that’s chronically shorthanded.

Danella and her union coworkers at Robert Wood Johnson University Hospital in New Brunswick, New Jersey, wrestle every day with the understaffing crisis straining America’s health care system to the breaking point.

Health care employers across the country long refused to hire adequate numbers of nurses, certified nursing assistants, dietary workers, and other essential staff, preferring to push skeleton crews to the bone and put profits over patients.

But now, the same health care workers who battled COVID-19 are fighting for the safe staffing levels needed to protect their communities on a daily basis and prevent the already-fragile care system from collapsing in the next pandemic.

U.S. Senator Sherrod Brown of Ohio and Representative Jan Schakowsky of Illinois introduced legislation in Congress on March 30 to establish mandatory minimum staffing levels for nurses at hospitals nationwide. But in the meantime, citing the ever-greater urgency, union workers continue advocating for similar measures on a state-by-state basis.

Danella and fellow members of the United Steelworkers (USW), for example, will rally with workers from other unions at the New Jersey statehouse May 11 to demand passage of bills establishing minimum staffing levels for registered nurses in hospitals, ambulatory surgery centers, and state psychiatric facilities.

“You want to give the patient the best care you can,” explained Danella, a registered nurse and president of USW Local 4-200, which represents about 1,650 registered nurses at the Robert Wood Johnson facility, a Level 1 trauma center.

The legislation, already introduced in the state Senate and General Assembly, would require one registered nurse for every four patients in an emergency department, one for every two patients in intensive care, and one for every five patients in a medical/surgical unit, among other provisions.

The bills also would give the nurses a voice in designing and implementing staffing systems that model future needs, deploy “floaters” to cover gaps, and provide further adjustments to better serve patients needing extra attention. That’s the kind of flexibility and forward thinking essential to providing proper care for all patients, especially on days when Danella needs up to 90 minutes just to feed three people.

“You prioritize your work,” said Danella, explaining how she handles the constant stream of text messages alerting her to more tasks assigned to her throughout her shift. “You just somehow get through the day, and you manage.”

Although Danella relies on her experience to handle whatever the hospital throws at her, industry-wide understaffing puts patients around the country at risk.

In Washington, for example, another state where union members are fighting for safe staffing levels, 48 percent of health care workers in a recent survey cited incidents of patient harm or deaths due to understaffing.

And in Michigan, where union workers have spent years fighting for minimum staffing ratios, 42 percent of nurses recently reported knowing of patients who died because of short-staffing. In 2020, nurses at a Detroit hospital filed a lawsuit claiming they were illegally fired for pointing out that short-staffing contributed to dozens of unnecessary deaths in the emergency department.

The Safe Patient Care Act, legislation that would have required hospitals to meet minimum staffing levels for registered nurses, died in Michigan’s Republican-controlled legislature during the 2022 session. Now, Jackie Anklam, president of USW Local 9899, hopes the Democratic majorities that took control of both chambers in January will enact minimum ratios for nurses and other groups of health care workers as well.

“It should be for all,” stressed Anklam, whose local represents hundreds of workers at Ascension St. Mary’s Hospital in Saginaw, noting union members in every department contribute to a collective lifesaving mission.

Anklam said current shortages force pharmacy technicians into brutally long days. Short-staffing also traps certified nursing assistants with high caseloads. And instead of hiring more environmental services workers, she said, the hospital increases workloads.

The staffing crisis affects not only hospitals but facilities across the continuum of care.

The USW and other unions want the Centers for Medicare and Medicaid Services (CMS) to establish minimum staffing levels at nursing homes and other long-term care facilities, funded largely with federal dollars, that serve growing numbers of aging Americans.

The ratios would not only save lives but also decrease the amount of time residents wait for therapy as well as help dressing, bathing, and using the restroom.

In addition, Chris Sova, a registered nurse and president of USW Local 15301, said minimum staffing would help to address the stress that workers experience as they race to answer one call bell after another.

“In the background, it’s a constant dinging,” said Sova, whose members at Bay County Medical Care Facility in Essexville, Michigan, take pride—despite their own staffing challenges—in answering call bells at high speed.

“It’s like the water dripping in the middle of the night,” Sova said. “It’s just one of the many things wearing on you.”

While workers receive extra pay because of short staffing, he added, “they just want more help.”

Danella knows that the hospital industry will continue to oppose staffing minimums and cut corners to fatten their bottom lines. But she said union workers refuse to back down because continuing shortages will only exacerbate staff turnover and put even more lives at risk.

“It’s just a domino effect,” she said.

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  1. Jason S

    The nursing unions did not fight the vaccine mandates — which was a big cause for the massive loss in healthcare provider (including nursing) staffing shortages around the country. They don’t really care about nurses.

    1. Arizona Slim

      Exactly. And, speaking as someone who has a vaxx-injured friend who was forced to get the, ahem, stuff in order to keep her job, I find the silence of the unions infuriating.

      BTW, my friend doesn’t work in health care, but her company does a lot of business with hospitals and clinics. Hence, my friend and her fellow employees were mandated. That mandate literally ruined her life.

    2. Yves Smith Post author

      This is an unreasonable criticism.

      The vaccines did keep the hospital system from collapsing during wild type, which is what they were designed to combat (preventing severe cases). When people got severe Covid, they tied up hospital beds for 2-3 weeks, usually dying after their lung turned to bloody mush. That level of hospital capacity loss meant people with routine emergencies like heart attacks and strokes often waited 30+ hours to be treated as in many died unnecessarily.

      Nurses being on the front line of patients dying such ghastly deaths and then preventing other more treatable emergencies from being attended to would be inclined to support the vaccines for keeping many Covid cases out of hospitals.

      The flip side is I am told many nurses did quit hospital systems over the menstrual side effects. They were concerned that that meant they were having a reproductive impact too.

  2. Jason Boxman

    U.S. Senator Sherrod Brown of Ohio and Representative Jan Schakowsky of Illinois introduced legislation in Congress on March 30 to establish mandatory minimum staffing levels for nurses at hospitals nationwide. But in the meantime, citing the ever-greater urgency, union workers continue advocating for similar measures on a state-by-state basis.

    Well, that’s convenient, given staffing levels aren’t new, and liberal Democrats can’t actually pass this now. I guess this is governing through wishful thinking.

  3. RJM

    Dating back to the 1960’s it was the widespread understanding in the state of Indiana that it was the duty of the state to make sure that there was an adequate number of doctors, lawyers, nurses, ministers being educated by the state to secure those needs by the citizens of Indiana. That responsibility of the state has been ignored for many decades and most noticeably in the areas of primary care medicine and nursing. In my view the nurses union has been fighting the good fight for staffing issues, salaries and patient care issues. The last paragraph
    starting with “Danella knows……..” accurately describes the situation. The only hospital administration in over fifty years I thought honest, trustworthy and did an excellent job was the executive officer of the 12th Evac Hospital in Vietnam in 1970. The nurses union is leading the way trying to force needed changes in medicine.

  4. JonnyJames

    Something has to be done about the “health care” system in the USA. In fact we don’t have a health care system at all. It is a neo-fuedal fiefdom of private interests that amounts to Health Extortion. It is well documented that the US has the most expensive “health care” in the world, with the worst health outcomes. Now that’s what I call an extortion racket. (The USA also has the lowest average life expectancy in the entire OECD, and continues to fall.)

    At least the Mafia is honest, they want the money, they say “nothing personal, strictly business” while the health extortion industry pretends to care about patient welfare. Let’s just be honest about this,.

    Nurses unions (like my wife’s union the CNA) have been warning about shortages for years. The demographic curve is a big factor, ever-increasing tuition for nursing school programs, and super high-stress job conditions are making the situation worse and worse in a downward spiral.

    We need to have a comprehensive health policy, a genuine health care system, and to reign in BigPharma, the AMA and other powerful interests that block any progress and maintain the Extortion Racket. That will require political will and with our “elected” officials being so institutionally corrupt, that’s a tall order, Unfortunately, things will have to get ugly before any positive developments arise.,

  5. RoadDoggie

    There was a good episode of “It Could Happen Here” where they interview some nurses who ran for positions at their Union after being lied to continuously. Lemme find you a linkie.
    Part 1:
    Part 2:

    The interviewer is not great, but the subjects all are excellent at telling their stories. I imagine they have had some practice.

  6. Roxan

    An old friend of mine, started the first nurses union in Philadelphia, back in the 1970s, at Temple Hospital. It was a real battle, including firebombing his car. As far as I know, Temple and Medical College of Pennslvania (closed) were the only union ‘shops’ in the city and good places to work–good pay and good management. Most places seem to only have unions for the aides and cleaning staff, who can be very rigid about what work is ‘theirs’ vs the nurses (everything!) I worked at both, and they really tried to help the seriously bad neighborhoods surrounding them. Many hospitals seem almost antagonistic to their neighborhoods and patients.

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