After months of stalled negotiations, over 7,000 nurses in New York began a three-day strike on January 9 in a powerful show of force that nearly shuttered two major hospitals. The Mount Sinai and Montefiore nurses, represented by the NYSNA, struck for safer staffing and improved working conditions, and their action enjoyed overwhelming support from patients, fellow hospital workers, and the broader working class.

In the lead up to the strike, New York governor Kathy Hochul tried to act on behalf of the hospital corporations and offered to broker a deal, calling for binding arbitration. The nurses knew better and rejected the offer. Hospitals tried to weaponize the nurses’ decision to follow through with the strike,  arguing that other private hospitals correctly accepted similar deals. Despite the hospital bosses’ hypocritical claim that Mount Sinai and Montefiore nurses were choosing to abandon patients, nurses did not fall for the corporate gaslighting. By early morning the next day, the strike was on.

At Mt. Sinai Hospital, on the Upper East Side, dense picket lines on both sides of Madison Avenue drew continual honks of support from bus and truck drivers, cabbies, UPS workers, and others. Nurses themselves circled the hospital many times in personal cars, often with their heads stretched out the windows and a union sign proudly on display. Chanting, chatting, marching, and speeches could be heard and seen in front of Mt. Sinai and Montefiore hospitals from 6 a.m. until late evening.

At Montefiore’s 210th Street location in the Bronx, upwards of 1,000 nurses picketed together in four-hour shifts, concentrated in two large clusters but sometimes walking the circumference of the hospital. Present, too, were doctors, healthcare workers represented by SEIU 1199, and other hospital workers, as well as SUNY nursing students, hotel workers, and many other supporters. At one point, the electrified crowds took over the streets and began a march. By day 3, a 30-person-strong contingent of Verizon workers, represented by multiple CWA locals, showed up to support the strikers. Donald Dunn, former president of local CWA local 1108 and current vice president of Local 1109’s Suffolk Division, said,

Obviously, safe staffing issues is something we all have to fight for, for the patients and nurses, and in the past, we’ve been on picket lines with them [nurses], and they’ve come out and supported us. … When you stand up and fight, you win. We’ve got to stick together.

Over the three days the nurses were on strike, the energy on the picket lines was high. Participants condemned the hospitals’ corporate leadership, calling out CEOs making millions while healthcare workers struggle to care for patients. Many of those on the picket line noted that during various peaks of the pandemic, the hospital CEOs fled to their condos while healthcare workers put their lives on the line. The support received by NYSNA nurses during their strike points to the potential for much greater and more militant forms of working-class solidarity, which will be necessary in the battles to come.

While the full language of the tentative agreements (TAs) have yet to be seen, nurses generally seem to be claiming at least a partial win, particularly at the hospitals that struck. The agreements include increases in staffing and mechanisms for enforcement, which place a cost penalty on the hospitals for breaking their agreements. The TAs also include pay increases of around 19 percent over three years, protected healthcare benefits, and improved pandemic measures. Ultimately, though, many of the new measures, such as improved staffing ratios, will depend on rank-and-file nurses, who must hold hospitals accountable for violating agreements. Already at Presbyterian hospital, management has apparently reneged on its commitment to not raise retiree healthcare costs, provoking nurses to occupy the lobby in protest.

A Citywide Strike Could Have Won More

Originally, a strike was authorized at six hospitals in New York: Mount Sinai, Mount Sinai Morningside and West, NewYork-Presbyterian, Montefiore, BronxCare, and Richmond University medical center. After working through the hellish conditions of the pandemic, which greatly exacerbated problems of understaffing and nurse burnout, it was clear that a majority wanted a strike. Indeed, a potential citywide nurses’ strike was authorized by an amazing 98.8 margin. Were a citywide strike called, it would have doubled the number of strikers and brought the nurses’ righteous indignation and demands to national attention. With overwhelming public support for nurses and a relatively active union, a citywide NYSNA strike could have won greater concessions for more workers, helping revitalize the labor movement and win over union-skeptical nurses. A citywide strike would have also greatly improved the bargaining position of public sector nurses, for instance, who are also represented by NYSNA and whose contract expires in March. Many of the nurses’ elected leaders, however, came up short.

The NYSNA leadership’s weak strategy can be seen in the contract ratification process at Presbyterian Hospital, where 43 percent of nurses voted no to the TA and many expressed anger at the union’s handling of negotiations. Indeed, the NYSNA leadership’s decision to push a TA at Presbyterian, without going on strike and without informing membership of the details, was likely meant to weaken the pro-strike movement among nurses at other hospitals. Even as we go to press, three weeks after the strike concluded, the “fine print” of the respective hospital contracts has not been made public, nor have the results of many of the ratification votes (Maimonides and Wyckoff hospital nurses respectively voted 93 percent in favor, while Mt. Sinai and Montefiore nurses apparently ratified by even higher margins).

Despite attempts by NYSNA’s top leadership to avoid a strike, the bargaining committees of Mount Sinai and Montefiore held firm, choosing to turn down TAs and continue to fight for their key demands, which included safe staffing ratios and, crucially, enforceable penalties for violating the ratios. Nurses found this important, since they saw that hospitals can agree to safe staffing ratios but then continue to violate them. Speaking at a January 21 public panel, former NYSNA president and current per diem nurse at Montefiore, Judy Gonzalez, explained that hospital management began to offer many concessions in the days, and especially the hours, leading up to the strike, but the bargaining committee said no—they promised: absent a TA, the strike would happen. The nurses wanted to go out, calling for an end to years of abuse by the hospital. Gonzalez further indicated that many nurses wanted to continue the strike, feeling this newfound surge of power.

Montefiore nurses seem to have a greater degree of rank-and-file member involvement and control than at some of the other hospitals. According to one nurse we spoke with, Montefiore nurses organized nightly meetings immediately before the strike with up to 1,500 participants, as well as Zoom calls and multiple in-person meetings after the strike was concluded and the TA was accepted. The full agreement between the bargaining committee and hospital management was also distributed to Montefiore nurses. The structures of membership involvement and leadership accountability were without a doubt a crucial aspect in winning. Nurses everywhere should take inspiration from the strike and build up structures of rank-and-file control.

Going Forward in NYC and Beyond

Leading up to this year’s fight, the NYSNA chose to employ a different strategy from the one it used during the last contract fight four years ago. In 2019, NYSNA attempted citywide bargaining with the three largest private hospital systems, Montefiore, Mt. Sinai and New York Presbyterian, and it developed several universal demands. While the attempt at citywide bargaining and universal demands points to the potential for greater solidarity between nurses of different hospitals, many nurses felt sold out by the subpar contract agreed to in 2019. Some nurses whom Left Voice spoke with argued that different hospitals have different working conditions, and some hospital executive committees are closer to hospital management than others, and as a result, this sector of nurses chose to negotiate separately this year, hospital by hospital. While the shift to local bargaining may have made the strike easier to realize, and may have been tactically advisable, strategically, hospital-by-hospital bargaining ultimately undermines nurses’ potential for larger, coordinated labor action. High among nurses’ demands should be parity in pay and working conditions between all private sector hospitals, providing a step toward industry-wide parity between the private and public sectors.

In the public sector, it remains to be seen how things will move forward when contacts expire in March, affecting 9,000 additional nurses. Nurses in the public sector are taking notes from what they saw their colleagues at Mount Sinai and Montefiore achieve with their strike. Organizing has already started, and nurses with NYSNA held a speakout and march on the boss on January 18 in honor of Martin Luther King Jr.’s legacy. Public sector nurses are technically blocked from striking by the Taylor law, but healthcare workers have been discussing how this law curtails their militant potential. We can only hope that the examples set by private sector nurses can motivate public sector nurses to challenge and overcome their no-strike clauses if necessary.

The New York nurses’ fight stands as part of an ongoing fight against a capitalist healthcare system always looking to compromise patient care in pursuit of profits. This has led nurses to lead a quarter of the top 20 major work stoppages tracked by the Bureau of Labor Statistics in 2022. Nurses — and healthcare workers more generally — are showing their willingness to fight.

Now, nearly four years from the 2019 strike vote, it seems clear the experience that healthcare workers had through both the Black Lives Matter movement and working through the Covid-19 pandemic has demonstrated how little healthcare bosses care about patients. This has emboldened nurses to fight for better patient care.

Class Collaboration or Class Struggle?

The nurses’ strike and contract struggle included both rank-and-file leadership and the NYSNA’s bureaucracy — the full-time functionaries. In the union and among the nurses, there is a wide spectrum of political thinking. The essence of the debates can be simplified to one question: Do we engage in class struggle against the hospital bosses and their political apologists, or class collaboration with those same forces?

From the strong pro-strike sentiment among nurses, there was clearly a desire for the union to take up a militant fight. This desire for militancy, for class struggle, ran up against the class-collaborationist pressures of many in union leadership, and it explains why a potential 2019 nurses’ strike was called off and the 2023 strike was confined to two hospitals.

The class-collaborationist outlook of union leadership was shown by remarks made by Nancy Hagans, president of NYSNA, about the Maimonides contract:

My members at Maimonides are so excited to sign off on the best contract that we have ever had. This contract helps demonstrate our hospital’s respect for nurses and our patients. We are excited that Maimonides came to the table in good faith and showed its respect for our hardworking members who have put their lives on the line throughout the Covid-19 pandemic…

Such statements reinforce the idea that hospital management and unions can work together as partners, if only the boss stops being so greedy. In contrast, many nurses know instinctively that the hospital bosses don’t give a damn about workers or patients, and are instead motivated by profit incentives and personal career aspirations.

The powerful nurses’ strike at Mt. Sinai and Montefiore hospitals point the way forward for the labor movement and can provide inspiration for healthcare workers everywhere. The struggle of nurses at Mt. Sinai and Montefiore clearly demonstrate how the absence of thousands of healthcare workers in two hospital systems pressured the hospitals, despite hospital executives’ attempts to hire scab labor to weaken the strike. The experience points to how workers are essential: when they use their power to fight, they can win.

If we want to build a healthcare system that truly puts people over profit, then hospitals, clinics, and all aspects of healthcare must be run by the workers and community who truly care about patient well being — not by executives looking to exploit illness and suffering for financial gain. We need a healthcare system in which hospitals are nationalized and run by the workers, patients, and community. The bosses need us. We don’t need them!