Nurse Strikes in NYC Raise Short-Term Patient Risks, but May Buy Longer-Term Gains

The city’s recent nursing strike offers a painful lesson in the costs—and limits—of industrial action in a strained health system.

It was a near-empty corridor in the cardiac unit at Mount Sinai, not the noise of picket lines, that captured the city’s nerves last week. As nearly 15,000 nurses across three of New York’s most prominent hospital systems abandoned their posts in a dispute over pay and staffing, the true drama unfolded away from TV crews: patients in need of intensive care found themselves in the hands of unfamiliar, often temporary, staff. For all the hard talk at bargaining tables, the data offer little comfort to policymakers or their constituents. Strikes like these, research warns, exact an immediate toll on patient health.

This is not conjecture. Economists Jonathan Gruber of MIT and Samuel A. Kleiner undertook a rigorous 20-year study of nurse strikes across New York, examining outcomes from 1984 through 2004. Their analysis found a grim consequence: patient mortality in hospitals experiencing such strikes rose by close to 19.4%. Thirty-day readmission rates ticked up by 6.5%. The authors, sifting through decades of hospital records, estimate roughly 138 more patients died during those actions than if the strikes had never occurred.

The circumstances of the current strike—involving the New York State Nurses Association at Mount Sinai, NewYork-Presbyterian, and Montefiore Medical Center—are starkly familiar. The union’s contracts lapsed on December 31st, talks soon broke down, and after failed last-minute overtures, the orderly halls of flagship hospitals emptied of experienced caregivers. While hospital executives, such as Montefiore’s president, Philip Ozuah, insisted patients were “cared for in a calm, compassionate, and collegial atmosphere,” the data suggest a less placid reality. Even with replacement nurses flown in for the occasion, patient outcomes failed to match pre-strike standards.

For New York, the repercussions are immediate and tangible. The city depends on high-capacity hospitals to weather public-health surges and chronic demand. Even brief disruptions ripple outwards, particularly where nurses are the fulcrum of care for the most vulnerable. Research makes clear: nurses’ institutional knowledge—intimate familiarity with patients, ward procedures, and the quirks of each hospital’s machinery—cannot be swiftly replaced by even the most qualified outsiders.

The costs, of course, are not born solely by the hospitalised. Delays in elective surgeries, clinic closures, and reconfigured emergency rooms magnify the inconvenience for ordinary New Yorkers. Families already struggling to obtain timely care in an overburdened system find appointments suddenly off the calendar or rerouted to unfamiliar facilities. In a city where health disparities and chronic illness gnaw at life expectancy, even brief service interruptions bode ill.

Yet the second-order effects may be harder to measure but equally consequential. Successful collective bargaining, champions argue, can eventually buy improvements for both workers and those they treat. Decent staffing ratios, higher morale, and better working conditions ought in theory to yield smoother-functioning wards and less burnt-out employees. The data, Mr Gruber contends, “portend long-term gains for patients,” not merely for union pay packets or management’s ledgers.

Pessimists, with some justification, see a more intractable malady afflicting the city’s healthcare. Systemic forces—declining government reimbursements, relentless cost pressures, nursing shortages exacerbated by the pandemic—have rendered even city hospitals with international reputations increasingly fragile. Strikes, they reckon, are a feverish symptom, not the disease itself. The longer-term prognosis is grim: staffing crunches and wage stagnation spur further industrial action, eroding public trust and ultimately endangering the very patients all parties profess to serve.

In the American context, New York’s travails are distinctive but not unique. Industrial action in essential services remains rarer here than in much of Europe, where periodic walkouts are, if not expected, at least familiar. But few societies have found a cure for the productivity crisis afflicting modern healthcare. America spends more per head on hospitals than any other country—well over $4.3 trillion nationally in 2021—yet patient outcomes lag behind peers. The cumulative effect of nursing strikes is thus both chronic and acute: a temporary jolt laid atop a creaking system.

Strikes as symptom and signal

International comparisons cast the city’s striking nurses in a less villainous light. In Britain’s National Health Service, for instance, walkouts are typically preceded by elaborate contingency planning, with ‘life and limb’ care maintained throughout. In France, legal guarantees of minimum service levels blunt the sharpest impacts on patients. American strikes, by contrast, take on a more transactional character, reflecting industrial relations in a sector where the market logic—dollars and beds—prevails over the social compact. New York’s complex layers of public, private, and non-profit hospitals lack the harmonized crisis response that might cushion the blow.

The public, meanwhile, is forced to reckon with the paradox of supporting both striking nurses—whose complaints of overwhelming workloads and stagnant wages strike a sympathetic chord—and hospitals laboring to keep doors open and clinicians paid. Politicians, wary of appearing anti-union, offer platitudes about mutual understanding but rarely suggest systemic reform. The repeated recourse to industrial action in healthcare signals a sector caught in an unending cycle of confrontation and patchwork compromise.

There is little comfort for New Yorkers in the knowledge that their city is not alone. The national shortage of nurses, projected to reach 450,000 by 2025, ensures that similar dramas will continue to unfold elsewhere. Unless labor relations in healthcare become less adversarial and spiteful, short-term pain and strategic myopia will continue to characterize the way America’s cities manage their most essential resource: human care.

The verdict, then, is not one of unalloyed dismay—nor buck-passing optimism. Strikes by caregivers in the city’s hospitals reveal both the depth of dysfunction and the necessity of change. Industrial action exacts a punishing toll in human terms but, in the absence of lasting reforms, remains one of the few levers available to those who animate New York’s bustling hospitals.

Until the fundamentals shift—toward better staffing, sustained investment, and a more functional labor-market equilibrium—the cycle of disruption and weary reconciliation will persist. The city may survive each strike, but the aggregate damage risks becoming irreversible. ■