By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

Tough Decision/by love4loaded, via Flickr

Nurses at Temple University Hospital in Philadelphia have been on strike since March 31st over a number of issues including wages, health benefits, and a “gag order” that could prohibit nurses from speaking out against the hospital. Nurses walking picket lines is not a new phenomenon. What is new is research showing that patients suffer harm when nurses strike.

In March, a paper (subscription only) published by the National Bureau of Economic Research provided some evidence that nurses’ strikes have harmful effects on patients. The authors analyzed strikes (in all, 50 strikes in 43 hospitals) in New York State over a 20-year period and looked at what happens to inpatient mortality rates and 30-day readmission rates for patients admitted during a strike. They found that inpatient hospital mortality increased by 19.4% and that readmission within 30 days increased by 6.5%. The researchers asked, “Is this because [patients] receive less care, or because they receive worse care?” And, in an analysis to see if the results were different in strikes where management hired replacement workers, it showed they were not—outcomes were still worse.

These findings really shouldn’t come as a surprise. How can care be safe when there are fewer nurses than the normal levels (which often are already less than adequate for providing optimum care)? How can care be safe when replacement nurses—whether newly hired or shifted from other positions—are plopped onto units with little time to get to know the patient or families? (This is the “nurse-is-a-nurse-is-a-nurse” concept—also known as the “just send me a warm body” approach.)

So now I wonder: will employers at hospitals where nurses strike try to make nurses the “bad guys,” claiming striking nurses have no regard for patients or are failing to follow the professional code? This has been the argument that has stopped nurses from striking for years and is still the reason many nurses will cross a picket line or not join a union.

But the alternative question is this: is it better to take a stand now to change the status quo so that, ultimately, patient care and working conditions and staffing improve—and thus, in the long run, more patients get better care? It’s a question I’ve always struggled with. I have been fortunate in that I’ve not worked in a facility during a labor dispute—but that’s perhaps because the state nurses’ association that negotiated our contracts did a good job and I was a recipient of others’ hard work and hard choices.

What about you? Would you strike now for better conditions in the future, or would you cross the line to provide care for the patients already there?

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