Thousands of healthcare workers have waged strikes this summer to demand better staffing levels as the pandemic brought greater attention to what happens when a nurse must take care of more patients than they can reasonably handle.
In New York, a report from the attorney general that found nursing homes with low staffing ratings had higher fatality rates during the worst COVID-19 surges last spring helped spur legislators to pass a safe staffing law long-advocated for by the New York State Nurses Association.
While unions elsewhere face a steeper climb to win the success found in New York, through strikes and other actions, they're attempting to get new staffing rules outlined in their employment contracts.
Most nursing strikes include demands for ratios, or limits on the number of patients a nurse can be required to care for, Rebecca Givan, associate professor in the School of Management and Labor Relations at Rutgers University, said.
"And employers are very anxious about that because it threatens their bottom line, so often when a compromise is found, it's something that approaches a ratio but maybe has a bit more flexibility," Givan said.
Some have been successful, like the 1,000 Chicago-area nurses at Stroger Hospital, Provident Hospital and Cook County Jail who waged a one-day strike on June 24 after negotiating with the county over a new contract for nearly eight months.
They reached a tentative agreement shortly after the strike, stipulating the hiring of 300 nurses, including 125 newly added positions throughout the system within the next 18 months.
The deal also includes wage increases to help retain staff, ranging from 12% to 31% over the contract's four-year term, according to National Nurses United.
Meanwhile, 700 nurses at Tenet's St. Vincent Hospital in Worcester, Massachusetts, have been on strike for over 100 days over staffing levels. Nurses represented by the Massachusetts Nurses Association have been trying to get an actual nurse-to-patient ratio outlined for specific units in their next contract.
The two sides haven't come close to reaching a deal yet, and some nurses will travel to Tenet's headquarters in Dallas on Wednesday in an attempt to appeal to corporate executives, according to MNA.
At the same time, federal lawmakers wrote to Tenet CEO Ron Rittenmeyer seeking details on the chain's use of federal coronavirus relief funds amid the strike and alongside record profits it turned last year.
The hospital denied lawmakers' claims in the letter that Tenet used federal funds to enrich executives and shareholders rather than meet patient and staff needs, saying in a statement it strongly objects to the "mischaracterization of the facts and false allegations of noncompliance with any federal program."
The strike is currently the longest among nurses nationally in a decade, according to the union.
A number of other major hospital chains have contracts covering their nurses expiring this summer, including for-profit HCA Healthcare and nonprofit Sutter Health.
Unionized nurses at 10 HCA hospitals in Florida have reached a deal on a new collective bargaining agreement, though members still need to ratify it, according to National Nurses United. The details are still unclear.
And after joining NNU just last year, 2,000 nurses at HCA's Mission Hospital in Asheville, North Carolina, ratified their first contract Saturday, which includes wage increases and the formation of a nurse-led staffing committee.
Newly-formed unions take an average of 409 days to win a first contract, according to an analysis from Bloomberg Law. In the healthcare industry, new unions take an average of 528 days to win a first contract, the longest among all sectors examined.
Across the country at Sutter's California hospitals, disputes haven't been so easily resolved. Healthcare workers at eight Sutter hospitals planned protests throughout July "to expose the threat to workers and patients caused by understaffing, long patient wait times and worker safety issues at Sutter facilities," according to Service Employees International Union United Healthcare Workers West, which represents the workers.
Similar to the ongoing Tenet hospital strike, SEIU is highlighting Sutter's profits so far this year and the federal relief funds it received.
Correction: A previous version of this story mischaracterized Sutter Health’s tax-exempt status. It is a nonprofit hospital chain.