Are Nursing Strikes Ethical? New Research Raises the Stakes

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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Editor-in-chief, AJN


  1. C DiRie May 17, 2010 at 12:28 pm

    It is sad but true that nurses are sometimes pushed in to positions where they must come together and protect themselves and their patients from those things that can potentially harm them. What must a nurse do to have a powerful voice at the table where decisions are made about their work and their patients? I have not always been blessed to work in hospitals where these decisions are inclusive. I and my patients have been affected by decisions that come from the top without the bedside nurses voice of reason. Nurses must have an impact on the work environment and sometimes management will not listen until nurses join forces and unionize. They should strike and have a right to strike if management is threatening the care that they provide.

  2. kit May 6, 2010 at 9:56 am


    The NNU must work collaboratively. Why is that necessary? It is necessary because this group must deal with many stakeholders in a complex system.

    For instance, stakeholders like Temple University work in their own best interests. In fact, all AHA associated facilities are doing this as well.

    Moreover, hospital leaders are working against RN union building. Please see the recent anti-union event sponsored by the AHA if you question my statements. (* Link above)

    Meanwhile, many of our team members write about being a professional. Would greater participation in a union reduce this potential? I’m not convinced.

    For example, we need to consider how many professionals are in unions. These unions include members like professors & physicians. Perhaps we need to consider why that is the case. Typically, it is because these professionals recognize a critical mass truly matters.

    RNs will not gather strength simply by collecting college degrees or working on “Magnet hospital projects”. By contrast, they might gain strength if they follow the lead of realists like professors. That is RNs must follow facts, monitor trends & work collectively.

    In addition, RNs need a larger body to negotiate for us. My thinking is that the NNU is the most progressive group that is willing to offer those negotiations.

    In turn I offer my best to an anyone who is navigating these uncharted waters. From my perspective, we either swim together or we risk not floating at all.


  3. William Nobles April 29, 2010 at 1:46 am

    As a RN with over 18 years of experience, I am amazed that nurses join a union. I think there are places where a union would possibly be needed, just not nursing. I understand that some of the reasons they strike for have merit, but some are just petty. I really dont understand why they want to insult the nurse who comes in to take care of the patients until their strike is resolved. I guess they wish the hospital would just close down during that time. Nurses are not the only people working in a hospital. So the hospital closing would effect so many jobs in a town, and even put hospitals certifications on the line by closing. I would pray these nurses are not that shallow. I doubt those same nurses would stop reporting to work and possibly lose everything they own, and possibly their jobs to show support for a fellow union worker who delivers office supplies to your hospital.

    If a person was terminated or just simply resigned from a facility for what ever reason, would you insult and picket the nurse who takes that position? If you take a staff position at a hospital, then you are taking a job somone else had. That person could have been terminated for standing up for what they believed. Are you going to turn the position down to show suport to them?

  4. Eileen McDonnell April 18, 2010 at 6:57 pm

    I am sure that it breaks the hearts of the nurses who find themselves in a position of having to strike in order to maintain a sound professional boundary,the responsibilty to advocate for safe ratio’s and safe patient care. If this dialogue is not permitted moral distress occurs and both the practioner and experience unwaranted suffering.
    A Strike hurts the nurses financially. It also exposes them to the unjust political assault of demonization by an unethical administration whose real goal is to keep secret unsafe staffing practices in the day to day hospital operation.

    Any hospital administrator who boldly request a gag order to prevent an employee from speaking out against unsafe practice, as the administration at Temple University Hospital has done, has in fact validated and reinforced a managment style that propagates such substaandard conditions.
    It is a leadership failure.
    In hospitsls of excellence, such reporting is encouraged and dialogue, no matter how difficult, is pursued. Safe patient care is the goal. Mutual respect between management and those on the front lines is the means.

  5. Laura T. April 17, 2010 at 2:22 pm

    Nurses striking remind of the air traffic controllers strike of the 1990’s when Reagan was president. The strike would have disrupted the entire air travel network & would have created a major economic disruption to people & businesses. Reagan solved the problem by firing the air traffic controllers & using military controllers. Today, those fired controllers still do not have their jobs back. Thing about nurses striking today is that since there has been an on going nursing shortage, the nurses usually won & got what they wanted. However, because of the current “bad” economy people by the thousands are going into nursing & schools are beginning to graduate enough students to where the nursing shortage is a shinking gap. Eventually, there will no shortage & if nurses do decide to strike, they will be like the air traffic controllers–fired by the hospital–because there will other nurses more than glad to fill the positions. Maybe nurses could consider collective bargining with a no strike clause, like the post office utilizes. That way, nurses would get what they wanted & not have to strike, thus they continue to provide quality nursing care. Additionally, I am so grateful I did have to go on strike when I worked for the USPS & am not about to start.

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