Is Nurse Burnout More Damaging than Nurse Strikes?

In recent weeks, nurses in various health systems in NYC have gone on strike to put pressure on their employers to listen to their concerns and offer solutions. Understandably, public concern is directed at patient outcomes: Who is taking care of the patients? Do patients receive substandard care during a strike? Why would nurses put their patients at risk like this? Those of us who do not know what it is like to work as a nurse can learn a lot by paying attention to not only what the nurses are saying, but also the statistics that back them up. The data tells us that when hospitals nurses are understaffed and underpaid, patients suffer. As a result, in some health systems, not making changes to nurse work environment (either through strike action or without) has worse patient outcomes.

About a decade ago, a study about patient outcomes during nurse strikes was published that continues to be cited today. Its main conclusion was that during nurse strikes, mortality and readmissions increased due to inconsistent care. Further studies seemed to show negligible impact. However, a large-scale study published in 2022 indicates that the issue is more complex and nuanced, revealing societal opinions about nurses and the healthcare profession. Overall, the general public feels that nurses have an obligation to their patients to remain at their posts, not use strike action to achieve their goals, while experts argue that "any risks associated with a strike need to be balanced against failing to act." As for patient outcomes, the impact of strikes has much to do with how the strike is handled by the administrators, how effective they are in hiring temporary nurses, how long the negotiations last, as well as the overall quality of healthcare before the strike.

In the case of the nurses striking in NYC, the main argument is that they cannot provide adequate patient care under current working conditions. First, their workloads far exceed safe nurse-to-patient ratios due to understaffing. When nurses are responsible for too many patients, those patients' health outcomes suffer. Their second grievance regards the health of the nurses themselves. Chronically understaffed departments demand that nurses work without breaks for rest or meals, resulting in unsafe conditions that can put patients at risk. Both these issues - overworked and exhausted nurses - result in more medical errors, including lapses in infection control. As stated by NYSNA President Nancy Hagans, "“As nurses, our top concern is patient safety. Yet nurses … have been forced to work without enough staff, stretched to our breaking point, sometimes with one nurse in the Emergency Department responsible for 20 patients. That’s not safe for nurses or our patients." 

In a post-pandemic environment, recruiting and retaining qualified nurses has proven difficult, resulting in more strikes, from 270 in 2021 to 385 in 2022, a 42% increase. In most of the strikes, the nurse unions were protesting not salaries, but rather, working conditions and ability to provide quality of care to their patients. In the largest nurses strike of 2022, including about 15,000 nurses in Minnesota, grievances were "short-staffing, retention, and better patient care."  In what may become a trend in nurse contracts, those nurses not only received a pay increase (which also assists with recruitment), they will also now have a say in staffing levels, gain protections when raising concerns about safety, and be able to trigger a staffing review based on patient outcomes and nurse well-being. The pressures to hire and retain staff look to be here to stay, with the need for significant improvement nationwide.

The issues surrounding any strike, especially when involving a critical profession such as nursing, are contentious and emotional as well as costly and systemic. In these days of employment and financial pressures, innovations that don't require additional staff or long-term expenditures are even more important. We propose the investment in preventive biocidal EOScu, the copper-infused hard surface that kills 99.9% of bacteria all day long, significantly reducing the risk of infection. Turbulent times can be better weathered with tools that help maintain continuous, consistent efficacy, through pandemics, staffing shortages, and even strikes.