Why so many healthcare workers are walking off the job

By Kate MorganFeatures correspondent

Hospital workers and pharmacists at companies including Kaiser Permanente and Walgreens are organising, demanding better conditions to help with pay, under-staffing and patient care.

On 23 October, more than 1,300 employees of PeaceHealth Southwest, a hospital system on the border of Oregon and Washington State in the US, walked off the job. They'd been asking their employer to address concerns about under-staffing, and offer pay rises that keep pace with a cost of living 16% higher than the US national average.

PeaceHealth Southwest didn't acknowledge their demands, says Shawna Ross, an ultrasound technologist and the chief negotiator on behalf of the hospital's techs. After the strike was announced, adds Ross, PeaceHealth "cancelled all of our bargaining dates and told us if the strike went past November first, they would take away our health insurance".

Healthcare workers around the country are experiencing similar issues, expressing that their departments are under-staffed and underpaid. They're burnt out, fed up and ready to act.

There have been walkouts at pharmacy branches around the country, and health workers at retailers Walgreens and CVS have reportedly planned a nationwide strike to begin 30 October. Workers at two different hospitals in Los Angeles County, California, went on strike, and in the first week of October, some 75,000 employees of the Kaiser Permanente health system across five states staged a three-day walkout thought to be the largest healthcare strike in history.

"In my time, this is the largest wave of healthcare strikes I've seen," says Ingrid Nembhard, professor of healthcare management at The Wharton School of the University of Pennsylvania, US. "I think it really reflects a plea for help, and that the dam has broken."

From heroes to zeroes?

Contrary to what many might believe, the major issues facing healthcare workers didn't start with the pandemic, says Nembhard.

"Even before Covid, the workforce was having a hard time," she says. "There were shortages that meant workload was high for everyone. The work environment was not optimal for many people, and culturally there was a feeling they couldn't speak up to say, 'there's a problem in this area, what can we do about it to make it better?' And then Covid happened, and the workforce experienced things it had never seen before in terms of patient care, patient burden, devastation and illness."

The staffing issue was particularly something people on the ground saw coming, says Caroline Lucas, the executive director of the Coalition of Kaiser Permanente Unions in the US. "A lot of the factors that led to the short staffing crisis were predictable and things that we had been monitoring for five, six years," she says.

Not only were nursing and medical school graduations not keeping pace with projected retirements, Lucas says Covid-19 led to a "mass acceleration in employees exiting, people taking early retirement, people leaving healthcare entirely".

The staff shortage was compounded by increased demands post-pandemic, adds Lucas, which only worsened feelings of burnout and exhaustion. "As the immediacy of the Covid pandemic kind of lessened, and people who had had delayed surgeries or had put off preventive care sort of flooding back into the health system, there weren't the people there to help support that influx."

Pharmacy workers also found themselves dealing with similar staffing shortfalls and drastically increased demands as a result of Covid testing and vaccination programs. "Pharmacy workers at CVS or Walgreens have been saddled with this exacerbation of workplace duties without a corollary growth of staffing," says Gretchen Purser, associate professor of sociology at the Maxwell School of Citizenship and Public Affairs at Syracuse University, US. "They feel very overwhelmed, very overburdened, very overworked. And none of that has come along with increased wages, either."

It's a "wild" swing, adds Purser, from the way those same workers were celebrated in the throes of the pandemic. "Three years ago, they were being lauded as heroes – literally heroes," she says, "and now they're just left to the aftermath of all this."

No other option?

The decision to strike wasn't taken lightly, says Lucas, but they felt it was necessary to provide the best care, 

"People would ask, you know, won't patients be at risk while you're on strike, and we would tell them patients are at risk every single day. Go to the ER [A&E], and you're waiting for eight hours. Get a mammography referral right now, and you're waiting six months," she says. "That's a crisis."

It's telling, says Nembhard, that striking healthcare workers believe their patients are at greater risk due to burnt out, exhausted, understaffed care teams. "Very few people go into healthcare who don't care about people, and don't care about humanity, and who are not willing to sacrifice in order to serve the mission of patient care," she says. "To see them walking out and saying I don't feel like we're in a place that we can provide good patient care and be sound as workers? That is an alarm bell."

In fact, says Purser, in negotiations between healthcare workers and hospital executives, concern over patient care has arguably become a more pressing matter even than pay. "They know that patients aren't getting the care they need and deserve. Like they're actually bargaining on behalf of patient care," she says. "They're saying, hey, if we're chronically understaffed and overworked, this employer is incapable of doing what it says it's supposed to be doing. So, big at the forefront of union strategy right now is thinking about patient care."

More collective action could turn the tide

Ultimately, the Kaiser Permanente strike resulted in an agreement Lucas says the union feels very optimistic about. If it's ratified by the membership and implemented, the deal will raise wages 21% throughout four years, and provide investment in staffing initiatives and training for existing employees. 

"There's a wage and benefit package that really helps keep up with the cost of living to attract and retain folks," says Lucas, "and a set of committees that are going to be formed to figure how we can staff better, which vacancies are most critical to fill and how we can change workflows to ensure that people are able to see their provider quickly and effectively."

Lucas says the deal should be a model for other healthcare organisations. While it's not a panacea for the system's problems, the mood among employees is proud and hopeful. "These problems were not born overnight, and they won't be solved overnight," she says. "But at least now people feel like they've been heard."

For Nembhard, the most exciting part of the Kaiser Permanente deal is the commitment leadership is making to utilise employees' expertise and insight about what's really needed on the ground.

"I think healthcare professionals and people at the front lines have a lot of creative ideas," she says, though often those ideas go unheard or unimplemented. "We need the support of leaders to be able to do some of those test cases and figure out which ones to prioritise. There will also need to be some patience on the side of workers. That's what one would hope comes out of these strikes; a partnership to make a difference. No side has all the answers, but I think we have the potential for a new day."

First, says Purser, there are likely to be more strikes and walkouts to force their employers to listen and address their needs.

"In general, there's a major upswing of union and strike activity in the United States, which is really exciting," she says. "I think that there is a kind of contagion effect that happens, where people see real gains that are being made in various industries. They themselves have felt underpaid, overburdened, under-recognized and under-compensated, and decide to take action themselves."

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