“The only thing workers have to bargain with is their skill or their labor… the strike is therefore not a breakdown of collective bargaining — it is the indispensable cornerstone of that process.”
– Paul Clark
Ethics patient safety

When all else fails, sometimes the only thing left to do is walk. 

Some will try to tell you that you should not, that you should tolerate the same working condi­tions that have led you to this point. But what about the patients!” they exclaim. Think of what you are doing to the commu­nity,” they implore.

Have you ever noticed how hospital admin­is­tra­tors’ arguments for patient care only seem to be utilized againstnurses, and never for patients? Have you ever tried to refuse an unsafe assign­ment? Advocated for better staffing ratios? Stood up and made yourself heard on unsafe situa­tions on your unit?

Where was the emphasis on patient care then?

Here’s the truth: admin­is­tra­tors and others try to use the morals and ethics of nurses against them all of the time. As you have no doubt heard, we are the nation’s most trusted profes­sion: it makes our moral compass a huge target.

It works 99% of the time. But we’re catching on.

In a recent article entitled The Business of Health Care Depends on Exploiting Doctors and Nurses,” Dr. Danielle Ofri makes this very argument. I’ve come to the uncom­fort­able realiza­tion that this ethic that I hold so dear is being cynically manip­u­lated,” she says. By now, corpo­rate medicine has milked just about all the efficiency’ it can out of the system. With mergers and stream­lining, it has pushed the produc­tivity numbers about as far as they can go. But one resource that seems endless — and free — is the profes­sional ethic of medical staff members.”

Nurse blogger Kelsey Rowell puts it this way: What I’ve realized is that hospi­tals capitalize on the hearts of health­care workers, especially nurses. They know we care about our patients. They know [nurses] care about their team. And they know that nurses [are terrible] at saying no. So we are constantly filling the holes that we didn’t dig for almost nothing. But to be honest… we kind of have dug them. Because we always say yes.’”

Standing together in solidarity on the strike line is the biggest no” our profes­sion has to offer. No more margin­al­iza­tion of patient care, no more slashing of the benefits that allow us to take care of our families and our patients, no more treat­ment of staff that leads too many to walk away.

Any time a nursing strike looms, hospi­tals turn to the same tired playbook. Don’t fall for it: we know better. As Dr. Ofri made clear, the business of health care depends on exploiting nurses, and we are on to it.

Keep the following in mind:

1. You have the right to strike.

You are not an inden­tured servant nor a physician’s, or administrator’s, servant. You have the right to withhold your labor, and indeed it is one of the most powerful tools avail­able to you. Although health care workers are required to give 10 days’ notice prior to a strike, the right to strike is clearly laid out by federal law in the National Labor Relations Act.

2. Striking is not patient abandonment.

According to WAC 246840700, patient abandon­ment occurs when a nurse has a) accepted a patient assign­ment, and b) left that patient without trans­fer­ring care to an appro­priate caregiver.

In the case of a strike, the hospital is given 10 days’ notice that care for all patients will need to be trans­ferred to another caregiver on the date and time of the strike. The hospital then has the oblig­a­tion to ensure that appro­priate caregivers are present to accept the handoff. Once handoff is complete, the nurses’ oblig­a­tions under patient abandon­ment” rules have been fulfilled. Striking is in no way, shape or form patient abandonment.

3. In some cases, striking may be an ethical imperative.

Sometimes, allowing a hospital to continue along its current path is more harmful than any negative conse­quences resulting from a strike. In such instances, and when all other alter­na­tives have been exhausted, we are called to act collec­tively on behalf of our patients. Indeed, this is enshrined in our ANA Code of Ethics, Provi­sion 6 of which reads: The nurse, through individual and collec­tive action, estab­lishes, maintains, and improves the moral environ­ment of the work setting and the condi­tions of employ­ment, conducive to quality health care.”

A strike is partic­u­larly critical when the employer engages in bad faith bargaining and commits other unfair labor practices. Nurses must be free from illegal coercion and intim­i­da­tion so they can effec­tively advocate for their patients’ needs. Such unlawful manage­ment tactics cannot stand unanswered, and for many may be a key consid­er­a­tion in deciding how to vote. When it comes time, vote for yourselves with the best inter­ests of your patients in mind. Not for today, not for tomorrow — but what’s best over the long haul.