The consciousness around the importance of strike action and fighting for the demands of workers has increased among youth and working people. After two years of monumental inequality, bosses made themselves richer and left frontline workers out to dry without hazard pay, PPE, and having to work long hours to keep the economy running during a pandemic. In this context, nurses had little to lose and stood everything to gain after being treated as disposable while propping up the entire healthcare system – so long as they took a bold, fighting approach to winning safe patient limits, adequate pay and benefits among other demands. 

The nurses at St. Vincent’s Hospital in Worcester, MA have been battling the hospital’s parent company, Dallas-based Tenet Healthcare, and its executives for decades. Tenet is a massive for-profit entity, ranked #167 in the Fortune 500 listing, with profits in the tens of millions from owning 60 hospitals as well as 450 other healthcare facilities across the country.

A successful strike in 2000 against Tenet ended mandatory overtime and won better insurance benefits for nurses. In recent times, the Massachusetts Nurses Association (MNA) continued the fight for safe patient limits with the 2018 Yes On 1 state ballot campaign to adequately staff every unit of state hospitals determined by a 1:3 nurse to patient ratio. While it was unfortunately beaten by a million-dollar propaganda campaign by hospitals across the state, the fight for safe patient care continued. The COVID-19 pandemic painted an even bleaker picture of the state of healthcare, reinforcing the demonstrated need for safe staffing and for healthcare workers as a whole to fight the reckless mismanagement of the bosses. Car caravans were organized in Spring 2020 to protest against the lack of PPE and unsafe staffing levels amidst the thick of COVID-19. When St Vincent nurses’ contract expired that summer, after months of weekly pickets to raise awareness of the need for safe patient limits in their contract, 700 Davids set off to take on Goliath on International Women’s Day in 2021. 

The longest nurses’ strike in MA history ended on its 301st day and the final contract agreement was ratified by 487 out of 502 nurses on January 3, 2022. 

The First 2 Weeks

The beginning days of an indefinite strike are always going to be crucial in telling what direction the strike can go, since this is typically when the rank and file is most engaged and ready to fight. The mood of the pre-strike rally and the first morning of the strike was electric. About 300 people attended a rally at the strike headquarters, overwhelmingly nurses and other union members standing in solidarity with them. 

The strike officially began at 6am on March 8th after the overnight nurses ended what would be their last shift for the entire year. They were met by hundreds of other nurses, community supporters and union members from at least ten different locals. The MNA’s 10-day notice to the hospital happened at the same time as the expiration of the UFCW contract and failure of the hospital to also bargain in good faith with 600 cafeteria, admin, PCA, and maintenance workers who are absolutely essential in keeping the hospital running. 

UFCW Local 1445, the same union that represents Stop & Shop workers across New England who went on strike in 2019, called for an informational picket to be held over a week after the nurses’ strike began on a Saturday afternoon. The picket lines were energetic and well-attended at each of the four different entry points. The mood was decisively on the side of the nurses and other hospital workers who were gearing up to serve a major blow to Tenet Healthcare by possibly striking together. It would have been very likely that if workers from both unions went on strike and hit Tenet’s bottom line simultaneously, the strike would have ended in its first few weeks.

Unfortunately, a considerably weak tentative agreement was passed through by UFCW leadership which meant the rest of the workers would return to a dangerous work environment with untrained scab nurses for less desirable wages and protections than what they could have won if they joined the nurses. This was a devastating decision that surely weakened the nurses’ leverage, and was also a clear indictment of the approach of conservative union leaderships, who compromise on key demands under pressure, instead of showing the rank-and-file a fighting path forward. The fact that there was even a choice for a section of workers at the hospital to go back to work, while 700 nurses were striking for things that every worker and patient needed, signals the desperate need for a change in the labor leadership’s approach. 

Union-Busting Tactics 

The MNA continued to fight on while UFCW workers were forced to continue to keep the hospital operating. With these other workers effectively out of the struggle, there was ample room for the hospital to try to demoralize the nurses into giving up, crossing the line, and going back to work. The hospital spent $5 million on police details and security cameras at every entrance and an additional $3 million to cover scabs throughout the strike. After having to shut down a considerable amount of beds and therefore decreasing operations at a time of significant patient need, the hospital CEO Carolyn Jackson continued to blame the MNA for not accepting weak agreements that would do nothing to ensure adequate limits are imposed on each unit of the hospital.

The attacks from the media were almost immediate, blaming the union for the inability of the hospital to care for patients and calling the strike “retaliation” for the failed Yes on 1 Safe patient limits campaign. While the mainstream attack on the nurses in 2018 was that they were “trying to win on the ballot what they couldn’t in bargaining,” now the cynical line was that they were trying to win in bargaining what they couldn’t on the ballot. This only goes to show that workers can’t rely on support from the establishment and corporate media – our real strength is in our movement’s ability to fight on every front for our own interests, and adopt a strategy to win. 

After numerous weak tentative agreements were offered and resisted by the MNA, an agreement was finally looking like it would be reached at the end of August, until a sneaky back-handed condition was snuck into the return-to-work agreement by Tenet. Every striking nurse would be guaranteed a job back at the hospital, but not all of them would return to the same unit they had worked years in before. This was an attempt to solidify in the contract what the hospital had been threatening for months, that they would permanently replace MNA nurses. This would have represented an unofficial punishment for striking against the hospital’s deadly practices. After the tentative agreement was bravely denied once again, the hospital threatened to go after the nurses’ unemployment support, and filed a complaint with the state that was shamefully accepted and disqualified the nurses for benefits, requiring them to pay a portion back for August and September. 

All of this was of course to exasperate the nurses of all of their remaining resources in hopes that they will give up and return to work before the hospital would have to make any concessions. The nurses maintained high levels of support across different neighborhoods and sections of the working class in Worcester across the political spectrum. Community members and union locals donated to the nurses’ strike fund and dropped off donations to the headquarters. Solidarity can stretch a long way while a vital section of workers in our community are in the middle of an urgent battle to safely care for people who require medical treatment, but this can’t be substituted for real hand-in-hand struggle that’s required to defeat corporate greed in every aspect of the workplace. 

The End Result of “One Day Longer” 

MNA leadership acknowledges that there is more to be done and more room for improvements when the nurses return to the hospital. For a strike that lasted over 300 days, why was this the case?

What ended the strike was not only the persistence of waiting out the hospital’s recklessness and fighting off demoralization for 300 days (though this was essential for a victory), but it was the greater outside factors influenced by the pandemic that is causing a strain on hospitals everywhere which ultimately forced a tentative agreement right before Christmas. The spike in Omicron cases in Worcester combined with the forced closure of beds, the release of unvaccinated healthcare workers, and the continuation of an indefinite strike of 700 nurses likely brought Tenet to cave on the biggest sticking point since the last TA was offered – returning all striking nurses to the same positions and units they worked in prior to the strike. The outside factors pushing the healthcare crisis more and more on the brink of disaster assisted the brave nurses in their victory but it was their persistence to hold the line, even when there were no clear answers of how it would all end, that saved the day.

However, an underlying issue to what contributed to the strike going so long was the lack of initiative to escalate tactics and hide behind the slogan of “one day longer, one day stronger.” As one of the strongest army of nurses in the country, with the second-highest density of organized union nurses in the country, MNA was in a position to go all out, spreading the strike battle to other hospitals and spearheading a powerful offensive fight. What would make the nurses stronger is a fighting leadership that knows when to leave the status quo middle ground to step in war-footing with the corporate profiteers of healthcare who are trying to break their union. When the time comes to once again wage a fight against Tenet, it is essential for the rank-and-file nurses to stay connected in their own initiated strike committees to democratically discuss what more militant tactics the union must pursue.

The Establishment Is No Friend of Labor 

The Democratic Party has tried to position itself as the party of labor for decades, and Democrats are the typical politicians seen visiting picket lines with their wishy washy speeches, proclaiming to the workers that they will do everything in their power to bring the bosses to the table. For the nurses, this meant a rally every month or so visited by politicians like Elizabeth Warren and Jim McGovern to voice their support and boost morale, but these words were never accompanied by meaningful pro-union legislation to empower nurses or to help win the strike. Over 100 Democrats on the state and local levels accepted donations from Tenet Healthcare since the beginning of the strike, with the majority of them being from California where at least three Tenet-owned hospitals had voted to strike in the past year. 

Labor Secretary Marty Walsh has gotten credit for helping to end the strike as the mediator for the final negotiations, but where was he 9 months prior? Politicians have a lot of power from Day 1 to stand with workers taking on the bosses, but they can’t do that if they are serving two masters. Believing that Democrats are capable of being friends of labor, while they are being funded by the very corporations that exploit the workers who vote for them, doesn’t help the cause of the labor movement. 

While the St. Vincent Nurses were gearing up to meet CA nurses and attend a rally organized by Socialist Alternative and DSA members, unions, and other community supporters at Tenet’s Dallas headquarters in July, MNA leadership had submitted a petition in court for Tenet to pay back the misused CARES Act funds that healthcare workers didn’t see a dime of in 2020. While momentum was being pushed behind this, pursuing purely legal tactics was not going to end the strike, as litigation drags on with no meaningful way for workers and supporters to participate in the fight. While the egregious government handout to Tenet was a crucial issue to highlight in this fight, the courts are skewed in favor of the bosses – and a winning fight won’t be on their home turf.

The capitalist courts, the Democratic Party, and a continuation of business unionism will not be the force that rescues nurses and patients from the dysfunctional parasitic for-profit system. Democrats and bureaucratic union leaders are often trained in the same school of de-mobilization and pep-talk to mask the fact that they don’t really believe in the strength of the working class, and they see their jobs more as mediators to negotiate and come to agreements with bosses. Only the unity of the rank and file nurses and solidarity from the rest of the labor movement can win a strong contract for all workers!

Back to Work, but the Battle Continues

The nurses were victorious in defeating Tenet’s threats to replace them permanently and are returning to their same jobs and shifts they held prior to the strike at the end of January. This means they are also going back to a chunk of co-workers that continued to work during the strike, as well as the replacements who were hired and kept on, which will be a tense situation. The hospital has undoubtedly been operating at a crisis level these past few months, with many community members sharing horror stories of themselves or their families receiving botched care from scab nurses. It’s a no-brainer that the average hospital needs a couple hundred more nurses at least to keep up with the COVID-19 surge. 

There was an alleged unionization effort of the replacement nurses during the strike by AFSCME which was swiftly denied ever being pursued by a spokesperson of the union. This was backed up by the MNA who stated AFSCME had sent a letter of solidarity to the nurses. Nonetheless, one of the replacement nurses, C. Richard Ayola, has been leading this back-handed scab unionization effort that could lead to decertification of the MNA at the hospital, an outcome which was narrowly dodged during the strike. He is now represented by a national Right to Work Organization that will be pushing this to a vote. If the vote goes through to decertify the MNA, no nurses will be able to be represented by any union for at least a year. It would also mean that the hospital would not be obligated to honor the new contract’s terms, and the nurses would be subjected to absolute hell at the whims of reckless hospital management. From this, it’s clear that even though the strike is over, the union-busting has not disappeared, and it’s crucial that nurses are prepared to fight this threat tooth and nail. . 

The main highlights of the contract to note are the new limits to staffing levels on each unit. While a majority of the medical, surgical, and telemetry floors will operate on a mix of 1:4 and 1:5 staffing ratios, the cardiac post surgical unit was strictly limited to 1:4 from its previous 1:5 ratio and the behavioral health unit was limited to 1:5, down from its previous 1:6. In terms of benefits, part-time nurses were given the same insurance pay out of 80% that senior nurses only had before the strike, which puts their benefits up to par with neighboring UMass Medical Center. Also within the contract is assault pay for when a nurse is attacked on the job, and at least 2% annual wage increases for all nurses in addition to other lump-sum bonuses. Overall, a strong contract was won despite some concessions on the safe patient limits, specifically within the emergency department and maternity units. 

Fight Against For-Profit Healthcare Not Over: Fighting Approach Needed

The nurses on the picket line over these months never lost sight that this was not just a fight for safe patient limits at their individual workplace but part of a broad fight against for-profit healthcare in general. Tenet’s profits have grown exponentially since the 2000 strike where the nurses won a strong contract after 49 days of picketing. The senior nurses who participated in this strike served as the working memory of class struggle for the younger nurses who were scared and uncertain about whether striking is worth the sacrifice. The proof over 20 years ago that nurses can go up against a big company and win carried them through a long haul of attacks and challenges. But the truth is that when we strike, it puts us in a much stronger position of winning, but victory is still not guaranteed. The outcome of a strike is determined by the class struggle in which the bosses’ power – their deep pockets, their political and institutional backing, and their cynical maneuvers – is challenged and tested by the organization, strategy, and tactics of the workers and their union. . Not every strike ends in a decisive victory or without particular setbacks, but it will always end with takeaway lessons that can be used to make strikes in the future more effective.

There’s a serious opening for a bold approach to not just preserve the hard-fought gains we win by striking, but to advance workplace demands and inspire broader movements for change in society. The California Nurses Association is currently taking up a bill that would introduce a form of universal healthcare in the state that has passed to the next stage. While costly and limited in scope, the MNA would have a much stronger footing if the safe patient limits ballot was proposed again at the state level. Hospitals at the time put on mandatory disinformation meetings for health care workers to scare them into thinking hospitals will close if they were mandated to hire enough nurses to keep up with a staffing ratio. Today, that narrative is completely undercut by the objective reality of nurses who have been working for years understaffed and are dealing with over-exhaustion and burnout as the pandemic surges. Dozens of hospitals across the state have organized some sort of workplace action to raise the demand of safe staffing after the St. Vincent Nurses strike began. There is potential to win safe patient limits for every hospital and ultimately a fight for Medicare for All. 

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