The Struggle Over Safe Staffing for Nurses

On May 9, 2023, nurses staged a sit-in at the Minnesota capitol to defend the “Keeping Nurses at the Bedside Act.” This bill stipulated that staffing committees be set up to determine safe nurse-to-patient ratios and transparency from hospitals to patients about the staffing levels and wait times. The bill had support from both the Minnesota House and Senate, and earlier that week it was in the “final stages” of negotiations before being passed into law. However, at the last moment, on May 3, Mayo Clinic threatened capital flight in order to try to keep the bill from passing:

In an email to DFL legislative leaders [“Democratic-Farmer-Labor Party” is the name for the Democrats in Minnesota] and [Governor] Walz’s office, a Mayo Clinic executive said the nonprofit would reconsider its plans for new facilities and infrastructure that are “four times the size of the investment in US Bank Stadium”—a $1.1 billion project.”

In the US, healthcare is a commodity and Mayo Clinic is a giant healthcare corporation in this market, despite its “nonprofit” label. It employs more than 60,000 people and owns over $20 billion in assets. In 2021, it brought in over  $15 billion in revenues. Being a nonprofit is simply a tax designation, and it means that there are no stockholders receiving dividends. Other than that, a nonprofit corporation functions like all other corporations.

The “Keeping Nurses at the Bedside” bill came after a historic statewide, three-day strike involving 15,000 nurses last September. A key demand of that strike was for nurses to have a “seat at the table” in staffing decisions to address the short-staffing crisis affecting hospitals across the state.

After Mayo Clinic’s email, DFL representatives quickly made adjustments and offered a “compromise” excluding the healthcare behemoth from the purview of the bill, which finally passed two weeks later. For the prestigious nonprofit hospital, even giving nurses “a seat at the table” to set staffing levels was unacceptable.

Mayo Clinic also demanded legislators cut a healthcare affordability bill, which was similarly modified to exclude them. It would have created a board that could review the budgets of hospitals and insurers and fine them for unreasonable increases in healthcare costs. The US healthcare industry is notorious for being expensive, with nearly twice as much spent on health per person as similarly developed countries, and all for a lower quality of life and longevity. We’ve recently reported on the grotesque effects of the profit motive on American healthcare and the socialist solution.

Burnout is from speedup!

These massive healthcare industry profits are not directed towards hiring or training more nurses, even after the COVID-19 pandemic exposed the chronically understaffed healthcare system. Since the pandemic, the rate of nurses reporting burnout has remained steady. In a survey conducted by the American Nurses Foundation last November, 64% of nurses reported feeling stressed in the last two weeks, 60% felt frustrated, and 57% reported exhaustion. Only 20% of nurses report feeling valued, and 14% say they felt fulfilled. The survey also asked, “What contributes most to your workplace burnout?” The top answer: “Not enough staff to allow me to adequately do my job.”

Burnout among healthcare staff has already had consequences—over 333,000 healthcare workers left their jobs in 2021, including 117,000 physicians and 53,000 nurse practitioners. Another survey reports 67% of nurses are planning to leave their jobs within the next few years. Medical errors, which endanger patients, increase with understaffing. A study from Johns Hopkins Medicine reports medical errors are now the third leading cause of death in the US, with more than 250,000 deaths annually. Hospitals have protested safe staffing mandates with the argument that there aren’t enough nurses to fill open positions—but this is the effect, not the cause, of the staffing shortages.

In a factory, the bosses seek to increase their profits by getting workers to work faster, which results in the production of more commodities in a given hour. The healthcare bosses use the same principle: get fewer healthcare workers to handle more patients in a given hour to increase the revenue per employee.

Nurses stay and fight!

Around the country, there has been a growing determination by organized nurses to fight back. In January, more than 7,000 nurses in Manhattan and the Bronx went on strike for safe staffing levels. This was immediately after New York’s “safe staffing law” took effect on January 1. The law, initially mandating specific nurse-to-patient ratios, was watered down to be similar to the one proposed in Minnesota; whereby a committee made up of 50% nurses and 50% administrators would negotiate staffing levels. But between July 2022 and January 2023, negotiations went nowhere. Hospital management shut down any attempts at discussion and went ahead with their proposed skeleton-crew staffing levels.

Matt Allen, a nurse at Mount Sinai Hospital in Manhattan, revealed the impotence of the law: “At the end of the day, the big flaw in this law was that it allowed the hospitals to have a unilateral say in whatever they were going to be submitting to the Department of Health.” The Democrats love to pass laws that sound good on paper, but leave the real power in the hands of the employers.

Also in January, thousands of nurses in California mobilized as part of a National Day of Action, defending nurse-to-patient legislation. This legislation, won through mobilizing thousands of nurses over 20 years ago, is the first in the country to include specific numerical staffing ratios. Even with this law in place, hospitals are allowed to apply for “program flexibility waivers” to circumvent the staffing ratio standards. Since the pandemic, state regulators have been encouraging hospitals to apply for these waivers.

In 2022, nurses in Worcester, Massachusetts went on strike for 177 days over safe staffing, the longest nurses strike in 15 years. The nurses went back to work only after 140 new permanent nurses were hired to address the staffing shortage. Massachusetts is the only other state in the country besides California that has a law dictating numeric nurse-to-patient ratios, though it only covers ICU staffing.

In Austin, Texas, nurses at Ascension Seton announced a one-day strike for June 27, as they fight to alleviate critical staff shortages. Seton Hospital management announced that the nurses would be locked out for another three days after the strike.

Unity of all healthcare workers and a militant strategy is needed!

Public funding for hospitals has slowly been drying up since the 1960s, forcing hospitals to depend more on their own profit margins in order to get new technology, provide training, and increase staffing. Hospital executives have interests opposed to healthcare workers—i.e., to increase profitability at the expense of healthcare workers and patients.

Despite burnout rates, many nurses are choosing to stay and fight for safer conditions for both themselves and the patients. Strikes are among the most effective tactics workers have against the bosses because it directly hits them at the source of profits—labor. But they can only really succeed if they are well-prepared, build broad class solidarity, and shutdown production entirely.

This struggle has progressed from an economic one at individual hospitals to a political one, fighting for legislation at the state level. Hospital administrations have proven that they are going to resist cuts into their bottom line using all manner of bribery, threats, and trickery. Unfortunately, instead of militant struggle, union leaders have appealed for compromise, which only weakens the struggle. Just like haggling, when negotiating demands, you must start high and expect that the opposing side will try to undercut you.

Starting with the demand for numeric nurse-to-patient ratios, Democrats in New York whittled away at the law until it was a powerless staffing committee composed of two irreconcilable groups—administrators and nurses. Starting with attempts to establish a staffing committee in Minnesota, the DFL further chipped away at the bill to carve out an exception for the largest healthcare employer in the state.

These “compromises” expose the real face of the Democrats: it’s not workers, but capital that determines their platform. The Democratic Party’s idea of a “compromise” is always one that will short-change the workers. They are a capitalist party, which means they represent the bosses whenever the negotiating table spills into the halls of the Capitol. We saw them break the railroad workers’ strike and increase police department budgets after the George Floyd protests, and their real class interests are exposed here in the nurses’ struggle for safe staffing as well.

A militant strategy is needed to take on the bosses and their parties, on both the political and economic fronts. The working class’s core strength lies in its numbers and ability to withhold its labor. The 15,000 nurses on strike in Minnesota can make the administrators flinch; uniting the 370,000 people working in healthcare across the state would have a proportionally bigger effect! All healthcare unions could coordinate a unified offensive, demanding staffing and budgetary committees controlled by the unions to make all hiring and firing decisions. A break from the Democrats and establishing a workers’ party would be a critical step forward in countering the “compromises” offered by the Democrats and Republicans. The union leaders could take a step forward in this respect by ending their support and funding of Democrats and Republicans and running independent labor candidates.

Most legislation around hospital staffing does not go further than creating “reports,” “investigations,” and “committees”—on which the administration is always well represented—instead of mandating concrete nurse-to-patient ratios. Any reform under capitalism is subject to be whittled down and rolled back and must be defended by militant strike action. Even where legislation exists, hospitals find loopholes and exceptions in the law.

Legislation on paper is not enough to secure safe staffing levels. The driving factor for understaffing hospitals is the profit motive. In order to prioritize patients and nurses over profit, we must target private property. We must take profit out of healthcare by nationalizing the major hospital networks like Mayo Clinic, along with the health insurance, medical equipment, and pharmaceutical industries. These should be integrated into a unified, democratically administered public health provider. Under workers’ democratic control, training and education programs could be fully funded to ensure the population has sufficient healthcare staff and is prepared for emergencies like the pandemic.

By expropriating the massively profitable healthcare industries and putting them under democratic workers’ control, a socialized health care system could be free at the point of service. The fight to take profit out of hospitals is the fight against capitalism!