By Marty Harrison, Vice President of Temple University Hospital Nurses Association (personal capacity)

Healthcare workers bore the brunt of their employers’ and both political parties’ criminal mishandling of the pandemic. The hundreds of millions of dollars in pandemic stimulus relief granted to the hospitals by state and federal government agencies have not been invested in frontline, bedside care. For-profits, like the behemoth Tenet Healthcare Corporation, have squandered it on stock buybacks to enrich their portfolios. Our own not-for-profit, Temple University Health System, has purchased one hospital outright and has announced it has acquired a 60% share in another.  

We are fighting to retain our experienced staff, attract new grads, and pull enough of those who threw in their scrubs back to the bedside to ensure safe staffing and quality care for our patients. To recruit the staff our patients need, we are demanding wage increases that compensate for the loss of buying power inflation has already inflicted on us and that will keep pace with future inflation. We are also demanding student loan payment assistance; paid parental leave; full tuition remission for our dependents at Temple University; and enforceable, safe nurse-to-patient staffing ratios. 

At Temple, we have experience with tough labor fights. In 2010, nurses, techs, and professionals struck together for 28 days and successfully defeated administration’s best efforts to bust the union and muzzle our calls for safe staffing legislation at the state level. The contracts we won in 2010 set the standard for wages and benefits. On the strength of our victory, 5,000 other healthcare workers in Philadelphia and its suburbs voted to join Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP) in the following few years.

2022 is not 2010. In many ways, the union is in a much stronger position now than it did then: PASNAP has grown, as has each local at Temple. The labor market is tight; healthcare workers are in high demand, forcing hospitals to compete for staff. 

Perhaps the most significant difference compared to 2010 is the fresh momentum in the labor movement. In addition to last year’s “Striketober” and new unionization drives at Starbucks, Apple, Trader Joe’s, and Amazon, healthcare workers are fighting back, too. In January, a 300-day strike of nurses at St. Vincent Hospital in Worcester, MA ended with safe staffing language in the contract and every nurse offered their pre-strike position. Last month, 2,000 mental health workers at Kaiser Permanente in California and Hawaii began their open-ended strikes for the staff needed to provide the basic level of care required by law for their patients. 15,000 nurses in Minnesota made history when they struck 16 hospitals for 3 days starting on September 12th. 

Even with a strong track record of success and a favorable labor environment, victory is never guaranteed. Hospital administration signaled that they are not prepared to accept our terms by unleashing a wave of discipline and insisting on harsh concessions at the bargaining table. Winning in 2022 will require a strong campaign by both locals, armed with clear demands and united around a strategy – including a viable strike plan – that can make the hospital do what it doesn’t want to do.

Clear, Bold Demands Lay the Basis for an Effective Struggle

At Temple and across the country, healthcare workers are demanding safe staffing levels and wages that keep up with inflation. Short staffing did not start with the pandemic, but was exacerbated by it. More than 3,600 healthcare workers died from COVID in the first year of the pandemic alone. Lots of workers retired or otherwise left their professions entirely. Others quit their hospital-based job and signed up for very high-paying temporary positions with staffing agencies. All of this has left staffing levels dangerously low and patients and workers are suffering.

The simple answer to recruiting and retaining healthcare workers is to hire enough staff to allow us to do a good job and pay us a wage commensurate with the value of that work. Demands for safe staffing ratios challenge more than the hospitals’ profit margins. To hospital executives, these demands are an unacceptable intrusion into their control over the business. It is our position that there is no “nursing shortage,” only a shortage of jobs nurses are willing to take. 

Safe staffing ratios will attract enough of the 84,000 Pennsylvania registered nurses not working at the bedside to solve our staffing problem. Nurses never work alone. We need our entire team – from the loading dock to the IT help desk – fully staffed to provide quality care. Though ratios may not apply in all work areas, our members know what each of their departments needs to be fully staffed and it is their professional judgment which should be respected. 

After setting wage and benefit standards for the city after the 2010 strike, TAP and TUHNA members are now among the lowest paid. Hospitals all around us increased wages and overtime bonuses to compete for staff while Temple insisted on linking concessions on union rights with every incentive offer. Non-union facilities can afford to be generous in times of crisis because they cannot be held to account when the crisis has resolved – every raise they give can be taken back again without notice or negotiation. TUHNA’s first year wage demand is $5 plus 10% and TAP is demanding 12% across the board. The raises for the second and third years make sure we didn’t lose ground going forward. High, sustained inflation is pushing many unions to include cost of living adjustments in their contracts like the Minnesota transit workers are doing.

Unity of Our Locals is Key 

At Temple University Hospital, nurses are members of TUHNA; the technical and professional staff are members of TAP and both are locals of PASNAP, our statewide parent union. Management regularly tries to pit the two groups against each other by planting rumors and rehashing the very old lie that this is a zero-sum game, that is, anything the nurses win will be at the expense of the techs and vice versa. Earlier this year, the hospital offered nurses an immediate $5 per hour raise on the condition that we agree to a one-year contract extension and relinquish bargaining alongside TAP. We rejected this poison pill and the flagrant disrespect it demonstrated – both disrespect for the essential work TAP members do every day and disrespect for the nurses’ understanding that our unity is the foundation of our power.

Solidarity is the foundation of our strength as a union but it doesn’t happen automatically, it must be built and nurtured to counteract management’s attempts to pit us against each other. As we prepared for bargaining, the two local negotiating committees’ met together to work out our common contract demands. Our first bargaining session was a joint session with our common proposals and opening statements from each local president. A few weeks into the bargaining process, 100 members of both locals marched on the boss to deliver our unity petition, signed by 90% of the membership. This type of solidarity will only become more important as the situation heats up and both locals approach contract expiration and a potential strike.

Building for a Strong Strike with a Clear Strategy to Win

While we are engaged in substantive bargaining at the table, we need to continue preparing how we will respond if Temple fails to make an acceptable counter offer. To prove to the hospital that we are serious and will not back down from our core demands, we will hold a strike authorization vote. The threat to strike must be real to be effective. Every member must be prepared to walk out if they want the choice to accept or reject whatever Temple offers. The strike is a union’s most powerful weapon but must be used correctly to be effective. 

In 2010, arrogant hospital administrators forced Temple nurses and allied professionals to go on an open-ended strike, confident that they could break the union in the slack labor market conditions of the lingering Great Recession. TUHNA and TAP thoroughly prepared for the grueling showdown, relying on the active and democratic participation of their members every step of the way to keep the strike rock solid. 96% of the membership was still out on the picket line on day 28 and we won a historic victory. We should be proud of that win and the work we did to get there.

Surrounded by economic, social, political and environmental instability, it’s not surprising that members are seriously discussing and debating the pros and cons of different strike strategies. There is no doubt that a balance sheet of the experience of the last 30 years with traditional weak, open-ended, “one day stronger, one day longer” strikes is not broadly in workers’ favor. The unfair labor practice (ULP) strike is seen by many unions, especially in healthcare and education, as a good alternative. 

The legal protection of a ULP strike is that it is linked to a violation of labor law by the employer, which means linking it to contract demands can lead to legal action against the union. This limits what workers and the union can say openly about their contract demands and about their plan to win them. The lack of clarity about strike demands can make it more difficult to mobilize workers to the picket line and to solidify community support for the strike. Another significant disadvantage is that it allows the employer to know what they’re preparing for because common practice with ULP strikes is to set the duration of the strike in advance. All they have to do is wait out the strike. This makes it easier to hire scabs as well. The scabs in Minnesota were hired for a 60 hour week at $10,000. 

A strong strike must have big, energetic picket lines which peacefully disrupt business as usual, especially elective and non-essential services at the hospital. It also requires real time bargaining updates on the picket lines with time and space for democratic discussion encouraging good turnout from workers. 

In the context of a boss standing their ground, an open-ended, non-ULP strike can be – while scarier and requiring more preparation – far more effective. A well-timed, all-out, open-ended strike using bold escalatory tactics can put far more pressure on management to concede directly on our crystal clear contract demands to stop us from striking longer. On balance, I think a strike will be necessary and an open-ended strike would be a shorter and more direct path to the contract we need in the long run. Critically, I think we have what it would take to organize a sharp open-ended strike that could win in this environment. Of course, even if I am out voted on this point, I will go all out to win. 

Mobilizing the Wider Working Class

Temple nurses and staff know our working conditions are our patients’ healing conditions and any strike would be about meeting the needs of the wider community. This is especially true at Temple which serves some of the poorest zip codes in the country, communities that have been failed most by capitalism and corporate politicians. Temple nurses and staff also know that the wider community, especially after the COVID-19 pandemic, will stand with them. However, it’s one thing to know this support exists, and it’s quite another to mobilize it into a force that can have a positive impact on our struggle. 

Temple students can also be mobilized in support, alongside TUGSA (the grad students’ union) and AFSCME members who are also bargaining with the university. There should be regular meetings to discuss how the community and students can support the strike, invitations to participate on the picket lines, and mobilizations to larger protests. Socialist Alternative members have already begun collecting thousands of solidarity petition signatures, especially from students, and will be mobilizing them to joint actions and picket lines.

If the union does not make serious efforts to organize students and the wider community ahead of any strike action, Temple’s anti-union propaganda will get an echo. The bosses will point out that many nurses and staff make better wages or have better benefits than most working class people. We should not be apologetic for demanding a living wage, especially when the average CEO makes 235 times the average worker. Better jobs and safer hospitals are better for the whole community.

We won big in 2010 by fighting unapologetically for the needs of our patients, our families and our co-workers. We based our fight on rank-and-file union democracy and relied on our unity and solidarity with the wider community and labor movement. When our contracts expire at the end of the month, we must be fully prepared to do it again. 

The drive for profits has completely broken healthcare in this country. Without another big win, both we and our patients will be at the mercy of those forces hellbent on stripping every remaining shred of care out of healthcare.  United with our patients, the community and other unions, organized healthcare workers have the power to reset the priorities and make “patients over profits” a reality.

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