Around the US, nurses are sounding alarms over widespread understaffing amid ongoing surges in COVID-19 hospitalizations. As hospital administrators and corporate spokespeople continue to claim that a nationwide shortage of nurses is to blame, unions are pushing back and pointing to the fact that employers have been the main driver of these shortages by maintaining poor working conditions and overworking (and often underpaying) existing staff. 

Through union organizing, nurses are pressuring employers to improve staffing and respect their voices in the workplace as burnout and turnover rates in nursing have soared throughout the pandemic. But the conditions for this current crisis didn’t pop out of nowhere once COVID-19 began to overwhelm our healthcare institutions—they are also the result of years’ worth of top-down administrative adjustments and policy decisions that healthcare professionals were decrying before anyone knew about COVID. 

“Little by little, they started chipping away at a lot of our benefits. They’ve taken sick pay away, they’ve decreased our vacation time, and they’ve increased patient loads for nurses.”

Mary Jorgensen, UW Health system nurse

In 2011, for instance, when he was governor of Wisconsin, Republican Scott Walker signed Act 10 into law, a controversial bill that incited mass protests as it eliminated collective bargaining rights for a wide range of workers in the public sector

After the bill was signed into law, the University of Wisconsin Health system cited Act 10 as justification for refusing to renew the union contract that expired in 2014, leaving around 2,000 nurses represented by the Service Employees International Union Healthcare Wisconsin without a union going forward. Soon after that, nurses say, once the previous union contract expired, cuts and unilateral changes that employees had no opportunity to bargain over were implemented and have continued over the past several years and through the COVID-19 pandemic. 

“The administration said we were just gonna keep going on and nothing would change, we’d work like the union was still in place, we’d still be able to negotiate. But little by little, they started chipping away at a lot of our benefits. They’ve taken sick pay away, they’ve decreased our vacation time and they’ve increased patient loads for nurses,” said Mary Jorgensen, a nurse who’s worked in the UW Health system for 17 years. “It’s really taken a toll on us.” 

Starting in 2019, nurses began a union authorization card drive to push the UW Health system to voluntarily recognize their union. The COVID-19 pandemic delayed the organizing drive initially, but has since picked back up in recent months.

On Jan. 13, 2021, nurses presented over 1,500 union authorization cards to UW Health CEO Dr. Alan Kaplan, demanding the health system voluntarily recognize the union, which would represent 2,600 nurses in the UW Health system. These efforts comprise one of the largest union organizing campaigns of nurses currently underway in the US. 

Nurses have also reported facing retaliation and intimidation from management for participating in the union campaign, and UW Health has retained “union avoidance consultants” during the campaign. 

“We have over 60% of nurses who have signed cards that want a union and the reason why we need it is because patient safety is really suffering,” added Jorgensen. “We’re at a crisis level now.”

Andrea Romer, a nurse at UW Health for 17 years, works in a unit with critically ill patients. Nurses in her unit are often forced to take on more than one patient at a time due to staffing shortages, even as other units regularly sacrifice nurses to help cover the critically ill unit, and nurses report routinely having to skip lunch breaks and work double shifts to cover said staffing shortages

 “We’re really balancing critically ill patients in an unprecedented pandemic situation,” said Romer. “There isn’t really a contingency plan for being short staffed, it’s just hoping that people will pick up shifts to work more or we’ll pull from other units.”

“There isn’t really a contingency plan for being short staffed, it’s just hoping that people will pick up shifts to work more or we’ll pull from other units.”

Andrea Romer, University of Wisconsin Health System Nurse

Romer added that the union organizing campaign itself has done a lot to put nurses in productive conversation with one another across various departments, rather than keeping the departments divided and pitted against one another as a result of conflicts over nurses being floated to cover critically ill patients, leaving their own departments short staffed. 

Shari Signer, a nurse in the UW Health system for 15 years, said over 40 changes have been made from their previous union contract since 2014, including cuts to staffing, decreased vacation time, cuts to shift differential pay (additional pay rates for work outside of regular work hours, 8AM to 5PM), increases in nurse-to-patient ratios, and being forced to use personal sick time if nurses are infected or exposed to COVID-19. These cuts have continued even as UW Health reported profits of over $538 million in their latest fiscal year. 

“Because of these changes, and without our union being present, without us having a voice to say this is not appropriate, the hospital is able to do whatever they want, and it’s very much impacting our ability to care for patients,” said Signer. “There’s nothing stopping them from working with the nurses and allowing the nurses to become respected professionals again—where we are actually able to help make decisions [regarding] what happens on a day-to-day basis with our patients. Because that’s what’s changed […] nurses don’t have any control over what happens within the decreases in quality of patient care items that we’ve seen over the years to try to help with budgetary issues.”

A spokesperson for UW Health deferred comment to a December 2021 letter to UW Health faculty and staff written by CEO Dr. Alan Kaplan, which also claims that the UW Health administration has not had the opportunity to review and confirm the union authorization signatures gathered by nurses. Nevertheless, Kaplan’s letter is very clear about UW Health’s position on unionization. 

“Because of these changes, and without our union being present, without us having a voice to say this is not appropriate, the hospital is able to do whatever they want, and it’s very much impacting our ability to care for patients.”

Shari Signer, University of Wisconsin Health System nurse

“While we believe that working directly with and empowering our staff in the workplace is important and can lead to real improvements, a union will not be part of that effort. Barring a change to state law, UW Health cannot legally recognize and bargain with a union on behalf of our employees,” wrote Dr. Kaplan. 

The nurses trying to unionize have rebutted Kaplan’s claim that, after the passage of Act 10, “UW Health cannot legally recognize and bargain with a union,” citing a recent memo from the non-partisan Wisconsin Legislative Council that finds the UW Health Board is not prohibited from voluntarily recognizing the nurses’ union—Act 10 only prevents UW Health from being legally required to recognize the union. 

These nurses recently received an endorsement from Wisconsin Governor Tony Evers, who expressed support for the unionization drive as Republicans still hold majorities in both the State Senate and House, obstructing the possibility of reforming Act 10. Meanwhile, the nurses continue to fight the legal assertions made by UW Health and push for voluntary recognition.

In California, the only state in the US with mandated safe nurse staffing ratios, understaffing still remains a significant concern that nurses face in the workplace. 

At the HCA-operated Good Samaritan Hospital in San Jose, California, John Pasha, an ICU nurse and chief nursing representative for the union (California Nurses Association), was terminated on Jan. 7. Pasha’s firing was a result of his participation in delivering a petition to management along with 25 nurses and two physicians in early December 2021 addressing the fact that widespread understaffing in the hospital has gotten so bad that surgeries have been canceled and patients have been turned away, even as nurses are forced to constantly work overtime shifts. 

“We were still not getting breaks and they weren’t agreeing to overtime for people to come in and for resources and nurses to come in and help.”

John Pasha, ICU nurse and chief nursing representative for the California Nurses Association

“The media or whoever calls us heroes. But the truth is, we do things that are stressful, and we take a lot out of us—that takes us away from our families and our loved ones. And to have our employers treat us with disrespect, and without proper protections and without relief, it’s the most unfair thing that anyone can go through, and we’re already going through the most unfair time in all of our lives,” said Pasha. 

He explained that nurses at the hospital have been pressuring management to resolve these worsening issues throughout the pandemic, and though nurses narrowly averted a strike in August 2021, the long-term staffing concerns have yet to be resolved. 

“We gave them four months to turn it around,” added Pasha. “We were still not getting breaks and they weren’t agreeing to overtime for people to come in and for resources and nurses to come in and help.” 

He characterized his termination as retaliation for union organizing and an intimidation tactic by the new Chief Nursing Officer, who was recently brought in from Texas and had refused to engage with nurses about their concerns with the current working conditions. 

Two current nurses at Good Samaritan Hospital—Stephanie Lander, a float nurse at the hospital since 2008, and Beleta Searon-Coote, a telemetry unit nurse since 2018—also participated in attempts to deliver the petition to management, and they echoed similar sentiments about Pasha’s firing being retaliatory and an intimidation tactic. 

“When they fired him, it was nothing but a scare tactic and a bullying tactic to try to get nurses to fall in line and be quiet,” said Lander. 

She also noted that nurses have been working through breaks and working overtime throughout the pandemic, as nurses have left the hospital, vacant staff positions haven’t been filled, and contract nurses on per diem or travel contracts are not properly scheduled or compensated enough to fill the shortages. 

“Nurses are doing 16-hour shifts without getting something to eat or drink sometimes because we’re so busy,” added Lander. “This pandemic has really worn us down, mentally physically and emotionally. It’s really taking a toll on nursing as a whole profession.” 

“This pandemic has really worn us down, mentally physically and emotionally. It’s really taking a toll on nursing as a whole profession.”

Stephanie Lander, FLoat Nurse

Searon-Coote added that her department would be unable to maintain mandated safe staffing ratios if nurses didn’t constantly work overtime or extra shifts. 

“Every day, every shift, we feel pressured not to put our coworkers in that situation because it’s not safe for the patient. It’s not safe for my coworkers’ licenses to have so many patients to take care of,” said Searon-Coote. “Something is going to get missed.”

Since his firing, Pasha and other nurses have also participated in protests demanding better investment in COVID-19 safety protections for nurses. 

An unfair labor practice charge in response to Pasha’s firing was filed by the union and is currently under review at the National Labor Relations Board. 

A spokesperson for Good Samaritan Hospital said the hospital remains in compliance with state-required safe staffing ratios. 

“Our needs are predominantly met by staff who volunteer for extra shifts. In certain instances, due to patient needs, we have required 4-hours overtime, which has led to nurses working 12-hour or 16-hour shifts,” the spokesperson said. “We continue to work hard to address staffing concerns as we stay compliant with mandated levels.”

The spokesperson claimed John Pasha’s termination was due to disrupting a management meeting during the petition delivery.

Michael Sainato

Michael Sainato is a contributor to The Guardian and a journalist based in Gainesville, Florida. Follow him on Twitter @msainat1.