Nurse Unions: Florence Nightingale Doesn't Work Here Anymore

National Nurses United marked National Nurses Week this year with strike threats at six hospitals in five states, winning increased staffing levels in some locations and beating back health care cost hikes in others.

Timed to coincide with Florence Nightingale’s birthday, Nurses Week is pushed by the American Nurses Association to honor its members. But while the ANA, forever dominated by nurse managers, marks the occasion with fact sheets and webinars proclaiming its commitment to “flexible staffing plans,” the nurse unions that broke away from ANA are finding that a stiffer spine wins the day.

The strike threats brought chronic hospital understaffing into the limelight, causing administrators to announce they would rather spend tens of millions of dollars on replacement nurses during strikes than commit to regularly assigning enough nurses to care for patients adequately.

The threat of a job action was enough to back down four of the hospitals within days: St. Vincent’s in Worcester, Massachusetts, granted a contract that guarantees each nurse cares for only four to five patients per shift—a landmark in the Massachusetts Nurses Association’s fight to establish enforceable nurse-to-patient ratios in the state.

Nurses in Bangor, Maine, ratified a contract that improved their staffing levels for the first time ever. They won a provision that frees up the lead or “charge” nurse to help fill in when other nurses are overburdened.

Hospital managers decried the nurse union’s “national agenda,” claiming that local nurses were being led astray by a pied piper in the form of the California Nurses, which won the nation’s only state law mandating nurse-to-patient ratios last decade. CNA is the NNU’s largest affiliate.

“What’s wrong with patient safety?” asked Mary Havlicek Cornacchia, a nurse at Boston’s Tufts Medical Center and union vice chair there. “We’re proud of that agenda.”


RNs in Minnesota’s far northern Iron Range put their strike plans on hold after marathon bargaining sessions resulted in progress, though details are yet to emerge.

Nurses at Washington Hospital Center in the nation’s capital cancelled picketing today, too, in the wake of a settlement that followed a one-day strike in March.

And the PASNAP union shelved its second strike in Wilkes-Barre, Pennsylvania, when Community Health Services—a corporate health care behemoth despite its congenial name—backed down from demands to gut the nurses’ own health care plan.

After the flurry of settlements, the only strike under way is at Children’s Hospital in Oakland, where management is also attempting to dramatically escalate nurses’ health care costs.

“They’ve never not cried poverty,” said Martha Kuhl, an Oakland nurse and CNA’s treasurer. “But when asked point-blank, they say they can afford to pay. They just want to get their operating margin better so they can get better bond ratings to compete in the health care marketplace.”

The Oakland nurses are taking their second strike in eight months.

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In a twist, the staff of the New York State Nurses Association—an ANA diehard—announced they too would strike at midnight tonight if NYSNA does not rescind its takeaways and settle a new contract.


The biggest fight came at Boston’s Tufts Medical Center, where the CEO formerly headed the Massachusetts Hospital Association. The deep-pocketed lobby has fought off the union’s attempts to establish nurse-to-patient ratios through state legislation since the 1990s.

Since lawmakers wouldn’t budge, the MNA turned to winning ratios in the hospitals. They knew they had a hard sell: Tufts CEO Ellen Zane had staked her reputation on killing ratios.

Tufts instituted a new staffing policy in 2009 that aimed to save money by pushing patients through the hospital faster, shorting the number of higher-paid nurses, and boosting the work of lower-paid techs.

Management produced a grid assigning a certain number of nurses per shift, adjusting for the sickness of the patients that day.

Tufts’ 1,500 nurses carefully tracked the staffing system’s shortfalls, documenting 626 instances where nurses said patients were endangered by management’s unsafe staffing decisions. The reports produce a grim, everyday portrait of patients falling, waiting hours for pain medication, and sitting in filth, as overwhelmed nurses were unable to manage their patient load.

One nurse reported an angry patient, unable to get a nurse’s attention, just left the hospital. Another told of parents who ran around a floor crying for help because no one was responding to a child’s seizure.

“What do you get when you get a very sick patient?” asked Barbara Tiller, a Tufts clinical resource nurse and president of the hospital union. “You have a disaster on your hands.”

In a rebuke to the ANA’s advocacy of hospital-controlled, voluntary staffing systems, Tufts nurses found that 81 percent of complaints occurred when the hospital was ignoring its own staffing policy.

Nurses brought their concerns to the public, participating in a Workers Rights Board convened by the local Jobs with Justice chapter.

Managers dismissed the reports as hyperbolic and anecdotal, and promised nurses that they just needed more time to find and train enough techs.

“They’ve never been able to hire enough techs, because once they realize they’re on Friday night and every other weekend, they’re out,” Tiller said. “They quickly learn they work way too hard for the money they get.”

The nurses were due to walk out today, but reached a settlement at 2 a.m. It limits the number of patients to six on nights and five on days, and restricts the “floating” re-assignments and mandatory overtime that management abuses to cover staffing holes.

“We got language we can sink our teeth into,” Cornacchia said, weary but triumphant.