Nurses at Dozen Private City Hospitals Authorize Strike, Citing Pay, Staffing, and AI Fears

Nurse unions and private hospitals in New York City are bracing for a high-stakes confrontation, as nearly 20,000 nurses threaten to strike at year’s end—a test of the city’s fragile healthcare labor balance with ripples for patients and hospital solvency alike.

In a city where even a routine visit to Accident & Emergency can run into hours, the threat of 20,000 nurses walking off the job bodes ill for New Yorkers’ holiday health. On December 11th, the New York State Nurses Association (NYSNA), representing staff at a dozen private hospitals, revealed that a staggering 97% of its membership had voted to authorize a strike should contract talks collapse by December 31st. Hospitals now face an anxious countdown as the union enjoys a fresh mandate and hospitals prepare for a battle of attrition—one that could paralyze swathes of the city’s health care.

The impending drama features familiar foes: a potent union seeking double-digit wage gains and guarantees on staffing, and hospitals pinched by surging costs and slashed federal funding. NYSNA’s demands include an eye-catching 10% annual salary increase for each of the next three years, enhanced enforcement of nurse-to-patient ratios, and new protections against what it considers the excessive use of artificial intelligence in patient care. The city’s big private health systems—from Mount Sinai to Montefiore and New York-Presbyterian—have responded with a mix of resigned preparations and public protests, claiming the union’s terms are “unaffordable.”

The timing is, from the perspective of hospital CFOs, spectacularly ill-starred. A raft of cuts to Medicaid, implemented as part of H.R. 1—the 2017 Tax Cuts and Jobs Act—are about to take a sizable bite out of hospitals’ budgets. According to Ken Raske, who leads the Greater New York Hospital Association, the proposed compensation jumps would “push our hospitals to the brink.” Montefiore, hardly a paragon of fiscal excess, estimates the union’s demands would cost it $1.2 billion per year.

To New Yorkers, this is more than the familiar thrum of labor unrest. It portends the possibility of delayed surgeries, longer emergency wait times, and the hasty conscription of temps and administrators to patch the gaps. Most of the affected sites are major medical centers—backbones of care not only during pandemics, but also for routine traumas, childbirth, and chronic disease management. The city’s public hospitals, already stretched, would struggle to absorb much spillover.

While NYSNA claims its demands will safeguard not just nurses’ livelihoods, but also patient safety, its wage requests outpace not only inflation but the compensation growth in other city professions. As Raske acidly pointed out, nurses’ base pay now eclipses that of police officers, teachers, and firefighters—an irony not lost on city budget hawks who watch similar union negotiations draw more modest outcomes. Union leaders argue, with reason, that pandemic sacrifices and ongoing staffing shortages argue for redress; hospital managements reply, perhaps more quietly, that their own margins are not nearly as plump as the city imagines.

The threat of AI looms in the background, with NYSNA insisting on contractual safeguards against technologies that, it warns, may erode the “human touch” of nursing or—more likely—be used as a cudgel for cost-cutting at the expense of patient care. Hospitals see such objections as premature: AI is being deployed, for now, more for logistics and triage than for hands-on bedside care. But no one doubts that future labor contracts across sectors, not just health care, will increasingly tangle with issues of automation and digitization.

The strike authorization vote is not unprecedented, but its scale is notable. In early 2023, more than 7,000 nurses staged the largest strike in decades, shuttering non-emergency surgeries and galvanizing sympathy from patients and politicians alike; within three days, the action netted higher pay and staffing concessions. The precedent looms large, not only for New York hospitals, but for care networks nationwide that have since seen their own workforce uprisings—in California, Minnesota, and much of the Northeast.

What makes the current standoff more perilous is the tighter squeeze on hospital finances. The Medicaid cuts engineered in Washington may save federal dollars but threaten to send some local providers into a tailspin. At Montefiore and Mount Sinai, administrators fret that strike or no strike, cost discipline will become ever more draconian. For health care workers, this crimps both bargaining leverage and prospects for future gains beyond today’s acrimonious negotiations.

Nursing in the balance: a local dispute with global echoes

In other global cities, the challenge of balancing public health and provider pay has produced creative, if sometimes patchwork, solutions. In London, the National Health Service has struggled with strikes of its own, but its single-payer model at least allows centralized wage-setting. New York’s patchwork of public, private, and nonprofit hospitals is if anything less nimble, and thus even more exposed to funding shocks or fierce union activism. The city’s own population density and heavy dependence on large teaching hospitals further complicate any workaround to a major strike-induced staffing shortfall.

There are, of course, ways to dodge mutual ruination. Federal regulators could mollify Medicaid reductions (unlikely this Congress); hospitals could agree to less extravagant, but still significant, raises bolstered by better guarantees against burnout; the union could deploy its strike threat more tactically, choosing rolling walkouts or high-visibility protests over all-out stoppages. Yet the level of brinkmanship on both sides suggests a long, rancorous negotiation.

We do not doubt the valour of nurses, nor the very real crisis posed by understaffing and burnout. Equally evident, however, is the unsparing arithmetic of hospital finances and the dangers of driving providers into red ink for the sake of short-term wage wins. The peculiarities of American health-care funding—fragmented, awkwardly supplemented, and politically volatile—give neither side a truly tenable fallback.

Until then, anxious administrators and union leaders continue their ritual skirmish—each, one suspects, hoping the other will blink first. New Yorkers, for their part, can only hope that year’s end brings not a mass walkout but a grudging peace—however stingy or makeshift—on which the city’s health depends. ■