In July, a last minute contract reached by 1199 SEIU United Healthcare Workers East leadership and hospital executives in New York City averted a one-day strike that was to impact 70,000 health-care workers in over 100 hospitals and nursing homes. During the previous week, union members voted 95% in favor of the strike and 1,500 low-wage healthcare workers in Staten Island picketed for better benefits and working conditions.
The contract promises an annual raise of 3% in year 1 and 2, followed by 3.5% in year 3 and 4 of the deal. In addition, workers will receive full health insurance coverage but will reduce pension payments by employers. Several questions remain unanswered such as new hiring practices, the unclear future of outpatient clinics—especially in the newly merged health Contiuum Health Systems, overwork and short-staffing, the closure of units in various hospitals, and the overcrowding due to closed units and hospitals elsewhere; not to mention the ongoing working conditions in most city hospitals, which include concerns over safety and wellness related to shortstaffing, the inability to take breaks, and the division between workers in different paygrades. In short, the union is fighting a purely defensive battle, but still aren’t able to maintain the standards of workers, only to stave off a percentage of the attacks.
In addition, while there is a pay increase, it is not retroactive to pay for neglected cost of living increases in previous years. Furthermore, whole those who voted were overwhelmingly in agreement, many workers felt that yes, a strike was necessary, but not on the terms set by the union. Of our colleagues with whom we spoke, and other healthcare workers we surveyed who are 1199 members, many expressed extreme dissatisfaction. If the one-day strike had happened, no strike pay would have been offered. Furthermore, workers felt that they were being told to go on strike, not that they were deciding to strike. Finally, many workers were dismayed with the demands of the strike; while the potential rise in cost of health insurance matters, it is a relatively minor aspect of de-facto decreasing wages, overwork, and the potential at any time for a worker to lose her job. It is important to understand worker critiques of the strike not as a critique of taking action, but of the content of the demands, and the complete lack of democratic control. Workers feel like they get told when to come to work and when not to, and the master seems the same whether management or union leadership.
Another healthcare is possible
The overwhelming vote in favor of the strike is not surprising. Healthcare workers are upset and seeking new alternatives. Unlike the rest of the non-unionized private sector, healthcare unions are recruiting record numbers of workers. Since 2010, healthcare strikes have risen by 73% and numbers of days on strike have risen by 27%. Despite ambiguous claims by ‘expert’ academic and policy analysts claiming rising mortality following hospital strikes, such analysis ignores the motivating factors behind worker initiated strikes – such as unsafe working conditions, administrators’ use of inexperienced temporary workers, mandatory overtime and weekend shifts, lack of ancillary staff which delays vital diagnostic and treatment procedures, and higher volumes of patients in the face of staff shortages that have all been blamed for rising deaths and costs. Studies also neglect the critical role of strikes in protecting healthcare facilities in underserved communities that would otherwise be left with no access to immediate care.
Despite the increased mobilization of healthcare workers in unions, why is New York left with fewer hospitals? Why are our workplaces getting busier and more stressful? Why do we work so closely with another (the janitors, nurses, techs, doctors, social workers, aides) and yet are carved out into different unions that rarely talk or show solidarity for one another? And why is our relationship with the union more like a “grievance mill” filing for individual complaints rather than forums for collective reflection and larger-scale organizing?
More often, those we trust to be our representatives (such as hospital and union hierarchies, politicians, ‘expert’ academics) are unaware of immediate conditions in the units and clinics. We (healthcare workers) should open new forms of collectively practicing our visions for a better form of practicing care. We hope these suggestions may be of use:
- Find times and spaces inside and outside the hospital that can launch conversations that bring together all of our co-workers (i.e. nurses, aides, techs, janitors, doctors) to vent but also think of solutions that can make our workplaces safer and less stressful. For example, one lunch per week on the unit could be a relaxed space to hear one another’s concerns and consider immediate solutions. And for solutions that might benefit other units or require more resources and support, we can start having a monthly lunch with other units to explore larger-scale alternatives.
- We must identify ways to sustain our group meetings, be it in the form of regular lunches, committees, or gatherings outside work that link with other unit staff and present larger-scale concerns to hospital administration for immediate attention. And if ignored, mobilizing co-workers to find new strategies to press for a response.
- We must challenge our unions and locals to begin working in solidarity with other unions that represent other skilled professionals in our hospitals. Our work relies entirely on a team-based approach, so we must help one another, including our ‘temporary’ co-workers secure full-time jobs.
- We must not only avoid working over-time, but have protected time of at least several hours per week, in which we are free of clinical responsibilities to participate in quality improvement projects. These projects involve receiving training in health services research and finding solutions to improve the quality of care in our specific units and clinics. The work is rewarding and helps nurture real leadership and team-work skills.
- The protected time from clinical duties can also help us initiate projects that build stronger links with community groups to address locally pressing health issues, such as diabetes, asthma, alcoholism, or obesity. Many of our hospitals have lots of meeting space for support groups, educational and prevention projects, workshops, health fairs, and other forms of community support. Often sharing resources and skills with the community empowers residents to improve their health in a respectful and perhaps more effective form than if it were to be addressed in an ER or clinic. It also allows residents to see us, healthcare workers, as people that genuinely care for their well-being beyond acute or emergency care, and may support us if we were facing our own crisis, such as a closures or lay-offs.