Why Do Nurses Strike? (free issue)

The situation is becoming dire

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It used to be that the public respected people who worked in healthcare. No matter what field in medicine, a common refrain was, “Wow, I couldn’t do what you do.” In the same breath, we were often told that our chosen profession is a calling and we are special people. That way of thinking is meant as a compliment, but it has a negative side that rears its ugly head from time to time—like when we try to fight for our rights and better working conditions.

Sure, nurses deserve decent salaries but…

The public agrees with the idea that nurses deserve decent salaries, good benefits, and fair working conditions. After all, we help them when they need us most.

But when working conditions become untenable and our paychecks/cheques don’t stretch as far as they used to, if nurses threaten to go on strike, that public support starts to fade. We’re told that we shouldn’t be in it for the money and that nursing is a calling. We’re told that we should think of the patients and not ourselves. We’re told that nurses should be above petty politics and shouldn’t demand things. We should compromise (meaning, give in). Because nursing is a calling.

When nurses reach their breaking point and finally go on strike, public support drops even more. But what many people don’t realize is a strike by nurses is not the same thing as a strike by many other professions. Things don’t grind to a halt. In many jurisdictions, especially here in Quebec, nurses must maintain essential services, guaranteeing a certain level of staffing. The ironic thing here is that often, staffing can be better in some units when nurses are striking than during non-strike times because it’s now required by law.

What do nurses strike for?

Yes, nurses want to earn a fair salary. I don’t see anything wrong with that. Nurses have bills to pay, families to support, retirement to save for and, yes, dreams of doing things outside of work, like traveling, working on hobbies and fun activities, and volunteering in their community. They need money for that. Salaries that don’t keep up with the cost of living means that they end up earning less than they should. Is wanting a better salary too much to ask?

Nurses also want to be compensated for working outside of so-called normal work hours. I can’t tell you how many holidays, weekends, and overnight shifts I worked over the course of my clinical career. Yes, we knew that we needed to work these “off shifts” when we entered the profession, but should there not be compensation for working when most others are sleeping, going away for the weekend, or celebrating holidays with families?

I remember people telling me, “At least you get paid more for working those off hours.” That wasn’t the case here. We did get a few dollars extra per shift, but it was nowhere near the time-and-a-half or more that many thought we received.

Nurses strike for patient safety

Nurses don’t just strike for money. We strike for public safety. This includes fighting for issues like mandatory overtime and nurse to patient ratios.

Did you know that in many places, including many states, nurses can be forced to work overtime against their will? That is the case here in Quebec. Mandatory overtime means you are working your regular shift and you are told that you can’t go home at the end. You must stay and work another 8 hours.

You’re tired; you’ve been on your feet since your shift started at 7:30 a.m. looking after very sick people. Your children are waiting at daycare or school so they can go home, you have an older relative you need to care for, or you have plans for the evening that you’ve been looking forward to for weeks. But you can’t leave. You’re told you have to work until 11:30 p.m. By the time you get out home, you’re lucky if it’s midnight. And you have to be back at work for your regular shift at 7:30. And who knows? You may be told you must work another mandatory overtime shift. You’ll only find out once you’re there.

In what world is that OK?

Nurses are tired enough at the end of a regular shift. Tired nurses make mistakes. Imagine how tired and stressed you would be after working a second forced shift of your own work. Imagine how many mistakes you might make. Do you want your nurses to be so tired that they misread a medication label or miss a treatment?

In a study published this year, researchers looked at 38 studies that investigated the connection between medication errors/near misses and nurse fatigue. The researchers found that 82% of the studies identified fatigue to be a contributing factor to these types of errors or near misses. “Fatigue is associated with reduced cognitive performance and lack of attention and vigilance. It is associated with poor nursing performance and decreased patient safety,” the authors wrote. “Components of shift work, such as disruption to the circadian rhythm and overtime work, were identified as contributing factors.”

Then there are the patient ratios.

Hospital patients are sicker now than they were just a few decades ago. Thanks to medical advances, many patients who would have been hospitalized back when I started nursing in the 1980s are now treated at home. Patients who are hospitalized now require more time and attention.

It’s a proven fact that the number of patients a nurse cares for over the course of a shift is directly related to patient safety. The sicker the patients, the fewer a nurse should have to care for. Nurses who are too busy may not be able to complete their tasks, or they may rush through them and introduce errors. They can miss vital orders or treatments. And nurses don’t just complete tasks. While interacting with their patients, nurses observe and look for subtle changes in appearance and behavior. If nurses don’t have time to check on their patients regularly or spend time with them, they can’t get to know who their patients are, how they act, and how they appear. Therefore, nurses can’t discern if there is a subtle decline until it is no longer subtle and becomes so obvious that it’s become an urgent or emergency situation.

Good, fair patient ratios result in fewer patient deaths, shorter hospital stays, and actually save hospitals money in the long run. You would think this would be a win-win situation and hospitals and healthcare systems everywhere would jump on the bandwagon.

There are other reasons too

There are so many other reasons why nurses would feel the need to strike. I remember years ago I read about some hospitals that forbade their nurses from napping on their break on night shifts. On. Their. Break. Check out this old Reddit thread for some eye-opening posts.

I was shocked. I was shocked that in some places nurses were not allowed to do what they wished on their own time. I was also shocked that while physicians who work overnight are encouraged to sleep whenever things are quiet (and I was often instructed “don’t wake the doctor unless you absolutely have to”), nurses were forbidden to sleep - again on their own time.

[fatigue] is associated with poor nursing performance and decreased patient safety

We know that fatigue causes errors. People are told not to drive if they are sleep-deprived because they can cause accidents. Yet some hospitals force sleep-deprived nurses to give life-altering care to patients. Oh, and then many of them have to drive home. Exhausted. I’m not saying doctors shouldn’t be allowed to get much-needed sleep. But how is it that their need for sleep is well recognized and encouraged, but not the nurses? On. Their. Own. Time.

For those of you reading this who have never worked night shifts, it can be hard to imagine the overwhelming fatigue that can set in. Yes, we can sleep during the day, but it’s never as refreshing as a good night’s sleep. It just isn’t.

Nursing is such a tough job. It’s rewarding in so many ways. It can be fun. It is challenging. It is a profession like none other. But nurses are people. And nurses deserve to be treated like the important people they are.

What do you think? Leave your comments below. Let’s get a conversation started.

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