Massachusetts Nurses Face Down For-Profit Health Care Giant Tenet in Daring Strike

On the same day that their employer announced it had made more than $400 million in profits during the Covid-19 pandemic, the nurses of St. Vincent Hospital in Worcester, Massachusetts, declared their intention to strike.

“St. V’s” is part of the Dallas-based Tenet Health—one of the largest and most profitable for-profit hospital corporations in the country. It is refusing to back down on the number one issue for nurses: safe staffing ratios.

As of this writing, close to 90 percent of the 800 nurses have been on strike since March 8.

The strike comes after two years of bargaining and a long ramp of escalating actions designed to bring attention to dangerous conditions that arise when nurses have too many patients to care for safely. Nurses report a rise in patient falls, delays in getting patients their medicine and food, and even having to put people in adult diapers to save time.

On medical floors where patients need a lot of care, St. Vincent nurses are fighting for a four-patients-per-nurse cap, plus additional support staff. Nurses say this would make a huge difference in reducing burnout, improve patient care, and keep nurses from moving to nearby hospitals with better staffing.

St. Vincent’s administration hasn’t claimed it can’t afford to hire additional staff. It is reportedly paying replacement nurses twice the hourly rate of union nurses, and has installed new security cameras that overlook the picket line. The city of Worcester confirmed that Tenet is paying more than $30,000 a day to the Worcester police department for overtime security.

Not to mention that Tenet Healthcare has picked up $2.3 billion in federal stimulus funds, on top of its record earnings.

Management’s willingness to weather such an expensive strike shows St. V’s nurses what they knew all along: that this strike is about who controls the hospital.

NO END DATE

Nurses unions often use one-day, three-day, and other short-term strikes to show their power against the employer. This approach has advantages—it delivers a financial blow upfront as hospitals scramble to move patients, cancel procedures, and find replacements. It also delivers the media attention of a strike, which can be tricky to maintain in a long fight.

But at St. Vincent, the Massachusetts Nurses Association has declared an “open-ended” strike, and both sides seem to be settling in for the long haul.

MNA Vice President Marie Ritacco, a member of the bargaining committee, is frank: “The bottom line is we have to impede their business and prevent them from making money. An open-ended strike is clearly much more of a problem for them. It gives us the most leverage at the table to win the demand.”

This isn’t their first rodeo. In 2000, the newly organized nurses at this hospital struck for 49 days for a first contract, in a struggle that would become legendary. They would not agree to mandatory overtime and “flexing,” policies the union said were being used to avoid hiring additional nurses.

That strike culminated with the bargaining team being flown to Washington, D.C., to bargain in Senator Ted Kennedy’s office; it ended in an overwhelming win for the nurses. Shortly after that, Tenet was embroiled in a series of scandals involving unnecessary coronary surgeries, kickbacks to physicians, and Medicare fraud, captured in a dramatic episode of 60 Minutes.

STAFFING FEUD

Only one state, California, has nurse-to-patient staffing ratios in law. The MNA angled to make Massachusetts the second in a 2018 statewide referendum. The union mobilized a huge grassroots effort to educate members and the public about patient safety and ratios.

But hospitals are big business in Massachusetts, and health care lobbying groups spent upwards of $30 million to defeat the measure—threatening that, if it passed, patients would lose services and other health care workers would be put out of their jobs. Ultimately the referendum went down to defeat.

St. Vincent’s CEO is claiming that this strike is a ploy by the MNA, seeking retribution from the loss of Question 1, and that ratios are not a chief concern of nurses.

Nurses had been raising alarms about unsafe staffing for a long time. Right before the pandemic surged, 200 nurses attended a bargaining session to give testimony on poor patient outcomes due to low staffing—including suicidal patients being left on their own, patient falls, and complications developing because of delayed attention.

DESPERATE TIMES

Bargaining was suspended at the height of the pandemic, as the hospital was stretched to its limits.

With the ICU filling up with Covid patients, Ritacco and her colleagues turned a recovery room into a non-Covid ICU unit. They scoured other departments for equipment and nurses who could switch to a critical care unit; management agreed to assign only one or two patients per nurse, with support staff. On their own, these hospital workers built an additional 10-bed unit for seriously ill patients.

But they soon found out that the “shared sacrifice” that the hospital preached was one-sided.

Soon St. Vincent administrators started ignoring staff requests and ideas; then the hospital started strong-arming nurses into taking furloughs, sometimes for weeks on end. As Covid surged, secretaries, critical care techs, nursing assistants, and others suffered furloughs, too. Many have been brought back, but others found new jobs. A significant number of clerical and transport tech positions were eliminated.

Furloughs were also a daily occurrence; management would send staff home from the operating room and recovery room rather than have them support Covid units.

Managers tried to pit the nurses in Covid and non-Covid units against each other, but strong union relationships ensured that people kept in touch between units and couldn’t be divided.

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Bill Lahey, a member of the executive committee and bargaining team, reports that executive committee members would come in early, stay after shift, and use their break times to go to staff rooms to talk with other nurses. He would refuse to be flexed down in order to pitch in on other floors and make sure co-workers weren’t falling for management’s claim that other floors didn’t want to help.

EYES WIDE OPEN

Communication and solidarity helped the nurses get through the height of the pandemic. Even now as vaccinations rise, the ICU is often at capacity, and acute care patients aren’t getting the treatment they need for lack of available staff.

Lahey recounts the devastating story of one married couple who were roomed together in a Covid unit. While the husband’s condition stayed stable, his wife’s condition rapidly deteriorated towards the end of a shift. It was after some nurses from the pulmonary care and critical care units had been “flexed” off and released for the day, so there wasn’t staff available to move her to a more intensive unit of the hospital. She coded and died in front of her husband.

Nurses took a vote of no confidence in the hospital CEO and chief nursing officer last summer, and have been doing informational pickets three to four days a week since December. The pickets really took off—many nurses took the initiative to coordinate who from their units would walk the picket line each day.

By February the union easily reached a strong majority in its authorization vote for an open-ended strike.

Lahey, a nurse at St. Vincent since 1977, was a member of the bargaining committee during the 2000 strike. This time, “we’re going in with our eyes wide open,” he said. “We went 49 days last time. I think the members are willing to take it longer.”

ON THE LINE

St. Vincent’s nurses take shifts working the strike office across the street from the hospital, helping their colleagues with things like unemployment insurance and donations. The office is packed with donated diaper boxes for younger strikers with infants.

A substantial number of the nurses striking are veterans of the 2000 strike, but many are younger nurses who regularly bring their small kids to the picket line. Creative actions like a family Easter day, complete with a visit from the Easter Bunny and a parade from the strike office to the picket line, are keeping energy and morale up.

MNA says that Tenet has spent over $35 million since the strike began, much of that on replacement nurses and police coverage. But patients report chaos on the hospital floors as new nurses learn equipment on the fly; one surgical stay was reportedly extended because a patient didn’t get her medicine on time.

Tensions run high outside on the picket line as well. Roughly 100 of the 800 nurses have crossed the line, and when entering the hospital they are often met with pressure from their striking colleagues.

Pressuring co-workers not to “scab” is a key element of an effective strike, but CEO Carolyn Jackson has spun it as bullying. The hospital issued a press release with a photo of a few people wearing T-shirts with the acronym “Supporting Colleagues Above Bullying,” or S.C.A.B. The press release says that nurses were selling the tees as a fundraiser for a local anti-bullying organization.

WHO’S THE REAL BULLY?

The irony isn’t lost on St. Vincent nurses that a huge hospital chain that could easily hire more staff, but spends the money instead on police details and surveillance cameras, is pretending to care about bullying.

As the strike enters its sixth week, Ritacco says the solidarity feels stronger than ever. The MNA is expecting unemployment insurance claims to come through very soon, and a piece of the recently signed federal CARES Act will provide subsidies for health insurance COBRA payments for strikers, meaning that soon a substantial financial burden for many should be lifted.

St. Vincent nurses believe the combined force of their union strength, blowback over poor patient care, pressure from political allies, and astronomical spending on replacement nurses and police will drive the bosses back to the bargaining table.

Tenet’s stock prices have doubled during the pandemic, but the company may be no match for the enthusiasm and organization that St. V’s nurses are bringing to this fight. “The feeling right now is very good and hopeful,” said Ritacco. “The power is obvious because the nurses know they are doing the right thing.”