What Happens When Healthcare Workers Strike For Real?

When I first got hired as a CNA in a nursing home, the other aides went out on a two-day wildcat strike my first week on the job. It was a small facility in Hopkins, Minnesota that had been devastated by COVID; on a good day, our staff-to-resident ratios were 1:12. That meant in the first hour and a half of the day, you were each expected to get 12 elderly people out of bed, cleaned, dressed, and ready for breakfast. You’d always have at least one person to run downstairs in time to get picked up for dialysis. Then you’d immediately pivot into kitchen work–there were no dietary aides, so caregivers had to drop everything to set up all the meal trays.

On my unit alone, there were three people who needed feeding assistance, which might keep you for 45 minutes while your fellow workers picked up the slack. The droning beep of the call lights was constant; from 6:00 AM onward there was never a moment’s peace. By the time you finished changing every resident’s diaper, it would be lunchtime, and you’d scramble back to kitchen work the same fucking minute as the dialysis guy was getting back. One-person Hoyer Lift transfers might be illegal–the state requires at least two workers to be present when you’re moving a patient that way–but for us, the pace of work meant they were an everyday practice. If anybody called out, the ratios were more like 1:16. Nurses and aides alike skipped their breaks to keep up with our impossible task. The never-ending cortisol spike of rushing from one room to the next was all that kept you going.

But because the task was impossible, some tasks just didn’t get done. I saw incontinent people lay in their own shit with their call lights beeping for over an hour. Showers were rare and dental care was nonexistent. People didn’t get repositioned; some of them had pressure injuries so bad you could see bone through them. A man with multiple sclerosis who was paralyzed from the neck down was slowly wasting away because a lot of the time his aide wouldn’t feed him, or wouldn’t finish feeding him. It was chaos. Aides made $16 an hour. We were drowning.

The wildcat strike happened my second day on the job. Most of the workers were from Kenya, and spoke Swahili with each other. I didn’t know they’d been organizing for weeks on a private WhatsApp group. All I knew was that when I showed up at 6am, I was one of only two workers on the floor. I was terrified–it was all I could do not to panic. We got nobody dressed, we got nobody out of bed, we just answered call lights and passed meal trays and changed diapers all day. The Director of Nursing and the managers and the social worker and the activities people–all the white ladies who worked in the office–were forced to come out and help work the floor themselves. They had no idea what they were doing. It took four managers to change one big resident’s diaper.

The strike (or sick-out, really) lasted through the next day, the whole weekend. One of the older aides made a sock puppet gmail account to send an anonymous list of demands to management. The bosses caved and the workers won everything they wanted. Within two weeks, the nursing home had bumped everyone’s pay up to $18 and brought in agency workers to help with the staffing problems. This was a notably bigger wage hike than these same workers likely would have won in a first union contract, had they gone the official route. When they talked about it after the fact, my co-workers didn’t call it a “strike.” They called it “the crisis.”

People often talk about “crisis” when describing America’s crumbling healthcare system. Patients who can’t get outpatient appointment slots are shunted into urgent care. Patients who can’t get into urgent care are shunted to the emergency room. Uninsured people can’t afford care, and insured people can’t afford bills. The working class is saddled with a staggering $140 billion in medical debt. A coming “gray tide” is set to overwhelm the nursing homes as the baby boomers age into them. Some 15 million of these same baby boomers have been kicked off the Medicaid rolls since 2023.

Workers are squeezed between an overload of patient need and insufficient resources, and we are burning out in industrial quantities. According to the Bureau of Labor Statistics, the US healthcare sector has lost nearly half a million workers since February 2020. Eighteen percent of us quit during the first year of covid. One study projects that over 6 million healthcare workers will leave the field by 2026, with less than 2 million stepping in to replace them, leaving a national shortage of more than 4 million workers at every level. The collapse is already here. We’re living through a slow-moving disaster in real time.

Two years after the Kenyan workers at my old job staged their sick-out, 15,000 Minnesota nurses walked out in what was (at the time) the biggest nursing strike in US history. This was a high point in a wave of class struggle sweeping over our industry. Two years ago, the union-busting law firm LRI published an article called “The Plague of Healthcare Strikes.” The number of nurses’ strikes in this country more than doubled in 2023 compared to 2021. There were at least 15 strikes in 2021, 17 strikes in 2022 and 36 strikes in 2023–and nearly a hundred since the pandemic hit. This explosion of labor militancy has been at once inspiring and bleak. On the one hand,healthcare workers are rising up and fighting back; on the other, the mixed outcomes of these struggles puts into sharp relief exactly how desperate the situation is. Nurses at St Vincent’s Hospital in Worcester, MA went on a bitter 9+ month strike to win a piddling 3% increase in staffing levels. We’re hanging on by the skin of our teeth, and the hedge funds and private equity firms that profit off our failing system aren’t giving an inch.

It’s a common sense truism in our industry that strikes don’t stop production. Nobody wants to walk off and abandon the sick and elderly and let people die. Last year, the American Nurses Association even added language to its Code of Ethics suggesting that nurses, and not our employers, should be responsible for finding our own replacements during a strike. By law, our unions already have to give an employer 10 days notice before we strike, so they can hire travel nurses to scab. Reps at the healthcare union I belong to are always at great pains to explain this: we’re not irresponsible, we don’t shut the place down, the mechanism by which we win a strike is by costing the company hundreds of thousands of dollars in travel nurse wages. Most of the time, healthcare strikes aren’t even open-ended; they last 1 or 2 or maybe 3 days to make a point during bargaining. The idea of withholding our labor to actually stop a clinic, nursing home, or hospital from operating seems unthinkable.

It hasn’t always been that way. There’s a hidden history of worker rebellion in hospitals and nursing facilities–a whole constellation of nurses’ and aides’ mutinies flaring up in the not-so-distant past. Our class enemies don’t want us to know about these events, but they did happen, and as inevitably as the tide coming in, they will happen again.

It is the opinion of this nursing assistant that, in the middle of a slow-moving disaster, any action we take to push back against the disaster is necessary, legitimate, and in the best interest of our patients and the public. Just like I don’t believe a protest has to be nonviolent to be legitimate, I don’t believe a nurses’ strike has to be “harmless” to be valid. Disruption in the immediate is what it’s going to take to save lives in the long run. Our employers, and the healthcare investors behind them, are already maintaining a status quo that steadily kills our patients by policy murder. Before helping others, it is the worker’s prerogative to first put on her own oxygen mask.

The following are 6 examples of healthcare workers’ strikes that either A) stopped production, B) dramatically reduced the level of care, or C) interrupted profit-making by providing care free of charge:

1968: The “Revolt of the Aides” Low-wage psychiatric aides staged a one-day sit-down strike at the mental health ward of the Topeka State Hospital in Kansas. The facility was a real shithole, colloquially known as “the snake pit.” The aides didn’t call it a “strike” but rather a “takeover.” They kicked out management and the billing department, and stayed on the job for 12 hours (longer than their usual shift), to prove they were dedicated to giving better patient care than the institution would allow. They demanded a 35% pay raise, a 40 hour work week, and union representation. The hospital fired many of the aides, and superintendent Albert Bay talked about ending the disorder “before it spread to the patients.” After a series of hearings, the Kansas civil service board ordered all of the fired aides reinstated.
1969: The Charleston Hospital Strike. On March 17th, 1969, the Charleston Hospital fired 12 Black workers for being vocal about racial discrimination and pay disparities for Black people. On March 19th, 60 workers, most of them Black women, walked off the job in protest of the firings and to demand union recognition. The next day 400 more workers walked off in solidarity. The hospital was forced to greatly reduce the level of patient care, and private taxi companies were hired to transport patients to other hospitals. The strike lasted 2 months, and eventually attracted the attention of Coretta Scott King and the Southern Christian Leadership Conference. The governor ordered the hospital not to negotiate, claiming the workers didn’t have the right to collective bargaining because they were paid out of public funds. On April 25th, he ordered 1000 National Guardsmen to Charleston to suppress and brutalize the strikers. Eventually the hospital did negotiate and made concessions around racial equality on the job, although they never recognized the union.
1970: The Lincoln Hospital Offensive. 150 members of the Young Lords Party (a militant Puerto Rican organization) and their affiliated hospital workers organization the Health Revolutionary Union Movement (HRUM), seized a building on the Lincoln Hospital campus in the South Bronx. In 1970, infant mortality at the hospital was more than 3 times the national average. Reports of malpractice were common, including doctors leaving surgical instruments inside people after surgery. The Young Lords’ demands included better conditions for patients, an end to cutbacks in jobs, a daycare program, preventative care for lead poisoning, and the opening of a drug detox clinic. The militants were forced out of the building after a 12-hour standoff with police. A lot of workers who weren’t part of the occupation couldn’t get inside during it. A subsequent negotiation with the hospital administration led to the opening of its first detox clinic.
1971-72: The Popular Hospitals in Uruguay. On October 22nd, 1971, during a period when labor struggle in every industry was shaking Uruguay to its core, a radical union called the Uruguayan Health Federation seized control of 4 private clinics in Montevideo and provided free care to the public for 2 weeks. The union had strong ties to revolutionary anarchists, Marxists, and the Tupamaros guerrillas. These “popular hospitals” were the culmination of a campaign for universal healthcare the union had launched over a year before, which included strikes at 2 of Montevideo’s largest hospitals. One of these strikes at the Hospital Britanico was attacked by police and 3 nurses were badly beaten; the Popular Hospitals were conceived as a response to this repression. The following year, in March 1972, 13,000 hospital workers struck for 52 days to demand universal healthcare.
1980-82: The Alberta Nurses Strikes of 1980 were illegal, organized by rank-and-file nurses in defiance of legislation that banned public service workers from striking. A subsequent strike in 1982 lasted 1 month and, despite the union giving management advance notice, closed 57% of acute beds in Calgary, including 47% of intensive care beds.
1982: The UK Nurses Pay Campaign was a reaction to the Thatcher government’s cap on NHS nurses’ and ancillary staff pay raises at 4%. On January 24th, 4000 striking nurses rallied in Trafalgar Square. In May, 180,000 nurses went on strike, and in many places the NHS was forced to shut down everything except emergency services. Sympathy strikes in support of the nurses broke out, including one-day strikes of 26,000 coal miners, 30,000 hospital ancillary staff, as well as dockworkers, printing workers, and firefighters. On September 22nd, 2.25 million people struck all across the UK. By December of that same year, the government was offering NHS workers a 12% raise. The UK outlawed sympathy strikes following the victory.

These are only a handful of those healthcare strikes that spilled out of their legally prescribed limits and posed a real threat to capitalist profit-making. There have been others. When the system starts to crack, there will be others still. They won’t come from our union leadership. They will be as grassroots, as desperate, as unexpected, and as illegal as the West Virginia teachers strike was.

At the nursing home where I work, there’s an expression of frustration and despair that you hear from your coworkers almost every day: “If State were here right now, we’d be fucked.” We know very well that our facilities are factories for the mass production of elder abuse and neglect. Our cutthroat industry deserves to be shut down and remade anew, if not by the government then by us, the workers, ourselves.

So let management run to the floor to change diapers. Let the National Guard evacuate the hospitals and the army scramble to run the ambulances. As healthcare workers, our collective power lies precisely in our ability to force a national emergency, and to force a conclusion to the existing emergency. It is our historic mission to confiscate America’s $800 billion dollar medical system from its profiteers and put it to work for the people. We are uniquely positioned to push on the contradictions of the present moment until they break through to the other side: to turn the existing health crisis for our class into a political crisis for the ruling class. It falls to us only to rise to the occasion.

What Happens When Healthcare Workers Strike For Real?

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Sean Geraghty

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