The 4 biggest 'pain points' driving strikes in health care (and how to address them)

By Carol Boston-Fleischhauer, CNO and Managing Director

Every strike is different. Each is driven by its own unique blend of local conditions, employee concerns, and relationships between employers and unions.

In February 2021, I led a team of researchers to study the collective bargaining landscape and identify the challenges in the work environment motivating nurses to strike. While many of today’s pain points still share common ground with challenges faced eight months ago, they’re evolving as providers move beyond acute Covid-19 surges. But if we step back, we can see clear patterns emerging. Nurses and health care workers nationwide are facing specific frustrations that increasingly motivate them to join picket lines.

So what are these pain points? And how can organizations address them? I’ve revisited each of these pain points—with updated insight on how workforce leaders should be responding to them today.

1. Workplace safety concerns

   At the beginning of the pandemic, the health care industry faced severe shortages of PPE. Many workers also experienced ineffective and constantly changing infection control policies as well as delayed notifications of potential exposures. Providers worked hard to address these obvious safety concerns with myriad tactics.

   However, many workers still don't feel safe at work. On top of the continued risk of Covid-19 infection, health care workers are now battling violence both inside and outside the workplace. To address this concern, unions are demanding greater transparency about employee safety concerns, along with assurance of effective infection control practices. Leaders need to prioritize a holistic approach to staff safety, including renewed attention to workplace violence, to assuage staff concerns.

2. Understaffing

   During the initial surges, many staff were redeployed with different staffing models to support Covid-19 readiness as core services were suspended. More recently, amid labor shortages in the health care workforce, the continued uptick in Covid-19 hospitalizations required some hospitals to increase the number of patients assigned to each nurse. Staffing ratios in ICUs have proven to be especially challenging.

   Today, increased RN turnover has created intense competition for labor resulting in a severe shortage of bedside nurses. This comes at a time when nurses report their intent to leave their current positions due to staffing and workload concerns. Unions are now seeking guaranteed minimum staffing ratios—especially in higher-acuity settings, such as the ED and ICU—and aggressive plans to mitigate existing shortages. Beyond an all hands on deck focus to retaining staff and restructuring care models with a team approach to staffing, leaders are urged to be transparent with staff regarding the organization’s approach to stabilizing the nursing workforce; including opportunities for staff to provide input into retention plans.

3. Inflexible or overdemanding work schedules

   Throughout the pandemic, many nurses have faced changing, unpredictable, and extremely demanding work schedules. Scheduling stress and the increasingly heavy workload have contributed to widespread fatigue. Today, nurses who are burned out by the pandemic and struggling with continued uncertainty around childcare and family obligations are seeking more flexible schedules and roles. Organizations should proactively create alternative work schedules and roles to meet these emerging needs, both to re-engage staff and retain nurses.

4. Compensation concerns

5. During the surges, many providers employed various approaches to compensation including hazard pay, bonuses, and enhanced overtime rates. However, in most cases, a permanent revamp of compensation did not occur. Compensation has evolved as a flashpoint, as inflation has risen nationwide and pay has surged for travel nurses and new hires. Many long-tenured workers now feel underpaid.

   Collective bargaining action is being used to level this playing field. Executives are challenged to re-evaluate total compensation, including core philosophy, baseline and merit rates, differentials, and creative compensation-based rewards. Consider lucrative retention bonuses instead of sign-on bonuses. While agency rates cannot be matched dollar for dollar, staff are demanding more competitive compensation and looking to unions to achieve that objective. 

Parting thoughts

Labor organizing activity isn't spontaneous and isn't (usually) about a single issue. Rather, it's a cumulative reaction by employees who feel their needs aren't heard, acknowledged, and addressed by leadership. Covid-19 has created a fertile ground for collective bargaining that must be prioritized and addressed.

In this climate, it's more important than ever for employer leadership to create forums for employees to be heard and involve employees in relevant decision making, including options for staff development, engagement, and retention. The modern currency of leadership is being visible. Now, more than ever before, that mantra must be maximized.