Multiple Bay Area Health Care Strikes Reflect a Workforce Under Increasing Strain

Nearly 2,000 registered nurses at Alta Bates Summit Medical Center campuses in Oakland and Berkeley began a five-day strike Monday in response to high turnover rates, staff shortages and workplace safety issues.

The nurses, represented by the California Nurses Association and National Nurses United, called on Sutter Health to implement workplace violence prevention plans, increase staffing and provide more robust safety resources, including better access to medical-grade safety equipment.

"I am seeing nurses leave the medical center for other nursing positions on a regular basis. We have nurses working overtime, and even double shifts, day after day to keep the hospital running," said Mike Hill, a nurse in Sutter's intensive care unit.

Hill said that while workplace violence in hospitals — mostly of patients toward staff — has always been a concern, there was an uptick in incidents during the pandemic, when many patients didn’t have the family support they needed.

"Sometimes it’s intentional. Other times, it’s from anger, fear or a medical condition that causes them to lash out at staff. Either way, it’s dangerous for us as professionals," said Hill. "It's not just physical violence. Sometimes it's verbal threats."

When workplace violence occurs, hospitals announce "code gray" on the intercom system to alert security, Hill said. But like the nursing team, the security department at Alta Bates is understaffed, and in some cases it takes too long for guards to arrive at the scene, Hill said, forcing other nurses to step in to help their colleagues. Hill said more security guards are needed both inside the hospital and in the parking garage, to prevent vehicle break-ins, thefts and attacks on staff.

Those concerns about violence, he added, are compounded by the hospital failing to take the necessary measures to effectively protect nurses from COVID exposure and other diseases.

Last year, the California Division of Occupational Safety and Health (Cal/OSHA) fined Sutter Health for violations tied to COVID-related workplace safety issues after an investigation was launched in response to the July 2021 death of an Alta Bates nurse, who contracted the disease.

“Sutter must create working conditions to enhance patient care while also providing a safe work environment that retains nurses," said Hill.

Ann Gaebler, a registered nurse of over 40 years, said she has never seen Sutter "act this disrespectfully" toward nurses, and it's causing experienced health care providers to leave.

"Without proper mentorship, we see young nurses suffering the moral injury and the moral distress of having to care for patients without the support they need, and so they leave," Gaebler said in a statement. "This is not how you grow the next generation of nurses or how to take care of a community. We need Sutter to step up to address our concerns about retention, so we can continue to provide excellent care to our patients."

In response to the walkout, Sutter management faulted local leaders in the nurses unions, accusing them of putting "politics above the patients and the nurses they represent" despite Sutter being willing to bargain, a spokesperson said in a statement on Monday.

“Our attention remains on providing safe, high-quality care to the patients and communities we’re honored to serve, and we are confident in our ability to manage this disruption," the statement said. "We are hopeful the union shares our desire to reach an agreement and enable our nurses to turn their focus back to the patients the union has asked them to walk away from.”

Sutter Health's proposed contract includes a pay increase of more than 20% over four years and a commitment to pursuing initiatives aimed at promoting diversity and advancing equity among its employees, along with continued health coverage for nurses and their families.

The Sutter nurses strike is just the latest in a slew of labor actions in recent months among health care workers throughout the Bay Area, mirroring a larger nationwide trend.

The walkout comes less than a week after some 2,000 Kaiser Permanente mental health care employees approved a four-year contract, ending an unprecedented, grueling 10-week strike over staffing shortages, wages and patient care, and just days after the Valley Physicians Group, a union representing about 450 doctors employed by Santa Clara County, announced its intention to hit the picket line on November 1 over similar issues.

Even though less than 7% of health care workers nationwide were unionized as of 2020, the health care sector also has seen renewed interest in unionization since the pandemic.

“I think the pandemic revealed and exacerbated a lot of problems that existed already, and some of those problems were brewing around stress and burnout and workloads, as we're hearing from physicians and nurses and other health care professionals,” Dr. Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies at UCSF, told KQED.

The pandemic, she added, also laid bare the extent of labor shortages across a wide range of essential jobs within health care settings, including custodial staff, nursing assistants, food-service workers and delivery people.

“When those jobs are all in short supply, that puts even more pressure on physicians, nurses and others,” Spetz said.

And many health care workers are finding that their most common demands — for reduced workloads, more support services, more time for administrative tasks and, in a growing number of instances, tougher security measures — are often not sufficiently met by employers, who often cite nationwide labor shortages and rising costs of doing business.

Unionization is more popular than it’s ever been, even across political lines, with a recent Gallup poll showing that 71% of Americans approve of labor unions, the highest approval rating since 1965.

But questions remain over how financially well positioned hospitals are to hire and train more people and meet their employees’ increasingly vocal — and organized — demands.

“Health care is competing against a lot of other industries and sectors that also are having difficulty recruiting,” Spetz said.

“A skilled trade or retail or a restaurant can change their prices pretty quickly, but for health care, they are in these often multiyear insurance contracts and they cannot immediately drum up more revenue in order to pay those higher wages,” said Spetz. “They're likely to be going back to the insurance industry in the next few years as their contracts come up for renegotiation and ask for more money. And then the insurance companies eventually are going to need to figure out how to pass that on in the price of higher premiums.”

And, Spetz added, the pressure of keeping costs down at a time of rampant inflation in a labor-intensive field like health care is exacerbated by the rising costs of supplies and equipment.

“Because it takes a while to have the ability to raise revenue … that just puts more financial pressure,” Spetz said, adding that as the pandemic relief money fades, hospitals will be facing financial shortfalls and worrying about “how the money's going to play out for them.”

“A lot of it comes down to building a workplace where health care workers really feel valued, are able to use all their skills, are respected as professionals, regardless of what level they work within the organization … and have the autonomy to use their knowledge and skills to the highest ability,” Spetz said. “You need to be adequately staffed in general. And so that's going to be the big challenge for employers, is how to create that healthy, supportive work culture. And you have to do that while you’re dealing with labor shortages and plugging all the holes that need to be plugged.”

Additional reporting was contributed by Bay City News and KQED's Laura Klivans.