More and more nurses are joining unions | STATUS

There’s a lot of bad news about health care these days — insurance companies refusing to pay for needed care, astronomical drug prices and shortages of hospital staff — but there are still some reasons for hope. I first wrote about nursing staffing problems in The New York Times in 2010. Then new research revealed a frightening fact: When nurses are overworked, more patients die.

But recently in Pittsburgh, where I live, 860 registered nurses and advanced practice nurses at UPMC Magee-Women’s Hospital decided they had had enough and voted to unionize and join the Service Employees International Union (SEIU). As a nurse who has also worked too many shifts with too few staff, I can say that healthcare unions are a reason for optimism.

The number one complaint from Magee nurses echoed the objections of nurses across the country: They couldn’t care for patients the way they needed to, and the hospital administration wasn’t listening. Magee-Women’s Hospital is best known locally for its labor and delivery unit, and many Pittsburghers were either born in Magee themselves or have children or grandchildren who were. It is a historic hospital and also the first hospital in the UPMC system to vote to form a union.

In deciding to unionize, Magee nurses are following a national trend. From 2000 to 2024, union membership declined across the country, except in the education and health sectors, where it increased by 0.2%. And it’s not just nurses unionizing: About 400 doctors at the Allina Health System voted to form a union in 2023. A division of SEIU that represents interns and residents now represents 81 percent of doctors-in-training in the Philadelphia area and has local chapters across the country. And in January 2024, a group of health care workers at Nevada’s Sunrise Hospital — including pharmacists, speech pathologists and social workers — voted to unionize. National Nurses United, with more than 225,000 members nationwide, is the nation’s largest registered nurses union.

Unions improve working conditions, which leads to better patient care. Research shows that nurses at unionized hospitals earn higher salaries than non-union nurses, tend to stay on the job longer and have safer staffing ratios. Patient outcomes also tend to be better at unionized hospitals.

I spoke with some of the nurses who led the organizing effort at Magee and learned that their frustration had increased since the pandemic. Jean Stone, a member of the obstetrics resource team, said nurses were overworked before Covid-19, but during the pandemic their workload became impossible.

“Before Covid, we were constantly criticized,” she said. “In Covid, it was apocalyptic. »

Many U.S. healthcare professionals were hoping for a post-pandemic reset, a recalibration to make the system more responsive to patients and staff. Instead, many hospitals have doubled down on increasing their profits and ignoring the needs of their employees. “Things changed after Covid. They saw what they could do [in terms of overwork]” Stone said.

For example, Magee had incentivized nurses to work extra shifts, but even as the pandemic continued to rage, the hospital ended the extra pay, leaving nurses overworked and underpaid. Lucy Rose Ruccio, a neonatal nurse practitioner at Magee, said understaffing meant neonatal ICU staff were busy “putting out fires” instead of dealing with more routine matters.

She described a frightening scenario in which a baby in the NICU needed phenobarbital to control recurring seizures. However, because the hospital’s electronic medical records system did not automatically continue to list patients’ prescribed medications, phenobarbital disappeared from the baby’s list. The error was not detected for several days, when the drug was restored. The baby was fine, fortunately. But it’s easy to imagine an oversight like this ending tragically for another struggling newborn or fragile patient.

Like many national health care companies, UPMC is highly profitable and generous in compensating executives, but not front-line staff. In the fiscal year ending 2024, 25 UPMC executives earned more than $1 million annually. Retired UPMC CEO Jeffrey Romoff received $29.9 million in fiscal years 2023 and 2024, even though he had already left the company. (UPMC did not respond to requests for comment.)

Hospital leaders across the country operate in an environment of abundance, while front-line staff sweat in an environment of scarcity. This imbalance is typical of the corporatization of health care in the United States. Because nurses are hospitals’ primary workforce, reducing the number of nurses is an easy way to increase revenue, and hospitals are making these reductions even as they seek to rank nationally. Magee ranks 32nd nationally in the U.S. News and World Report rankings for obstetrics and gynecology, but the hospital’s staff is rated “poor,” the lowest rating possible. Magee emergency room nurse Alix Levy captured the national sense of unease among nurses. “The American health care system is in a race to the bottom,” she said. “That’s what it usually feels like.”

The union vote gives nurses hope, however, Levy said. “We did this good thing, and it can’t be taken away.” Nationally, the importance of nurses to quality care is recognized: This fall, for the first time, the Joint Commission added nurses to its national performance goals for hospital accreditation. Magee nurses are eager to work out their union contract because, as Ruccio said, “it became increasingly clear that we could no longer make meaningful changes on our own.”

If corporate greed is the evil plaguing our health care system, unions might be what the nurse ordered to cure it. That, to me, is incredibly hopeful.

Theresa Brown is a nurse, author of “The Shift” and “Healing,” and a frequent contributor to The New York Times.