“The only thing workers have to bargain with is their skill or their labor… the strike is therefore not a breakdown of collective bargaining — it is the indispensable cornerstone of that process.”
– Paul Clark
Ethics patient safety

When all else fails, sometimes the only thing left to do is walk.

Some will try to tell you that you should not, that you should tolerate the same working conditions that have led you to this point. “But what about the patients!” they exclaim. “Think of what you are doing to the community,” they implore.

Have you ever noticed how hospital administrators’ arguments for patient care only seem to be utilized againstnurses, and never for patients? Have you ever tried to refuse an unsafe assignment? Advocated for better staffing ratios? Stood up and made yourself heard on unsafe situations on your unit?

Where was the emphasis on patient care then?

Here’s the truth: administrators and others try to use the morals and ethics of nurses against them all of the time. As you have no doubt heard, we are the nation’s most trusted profession: it makes our moral compass a huge target.

It works 99% of the time. But we’re catching on.

In a recent article entitled “The Business of Health Care Depends on Exploiting Doctors and Nurses,” Dr. Danielle Ofri makes this very argument. “I’ve come to the uncomfortable realization that this ethic that I hold so dear is being cynically manipulated,” she says. “By now, corporate medicine has milked just about all the ‘efficiency’ it can out of the system. With mergers and streamlining, it has pushed the productivity numbers about as far as they can go. But one resource that seems endless — and free — is the professional ethic of medical staff members.”

Nurse blogger Kelsey Rowell puts it this way: “What I’ve realized is that hospitals capitalize on the hearts of healthcare workers, especially nurses. They know we care about our patients. They know [nurses] care about their team. And they know that nurses [are terrible] at saying no. So we are constantly filling the holes that we didn’t dig for almost nothing. But to be honest... we kind of have dug them. Because we always say ‘yes.’”

Standing together in solidarity on the strike line is the biggest “no” our profession has to offer. No more marginalization of patient care, no more slashing of the benefits that allow us to take care of our families and our patients, no more treatment of staff that leads too many to walk away.

Any time a nursing strike looms, hospitals turn to the same tired playbook. Don’t fall for it: we know better. As Dr. Ofri made clear, the business of health care depends on exploiting nurses, and we are on to it.

Keep the following in mind:

1. You have the right to strike.

You are not an indentured servant nor a physician’s, or administrator’s, servant. You have the right to withhold your labor, and indeed it is one of the most powerful tools available to you. Although health care workers are required to give 10 days’ notice prior to a strike, the right to strike is clearly laid out by federal law in the National Labor Relations Act.

2. Striking is not patient abandonment.

According to WAC 246-840-700, patient abandonment occurs when a nurse has a) accepted a patient assignment, and b) left that patient without transferring care to an appropriate caregiver.

In the case of a strike, the hospital is given 10 days’ notice that care for all patients will need to be transferred to another caregiver on the date and time of the strike. The hospital then has the obligation to ensure that appropriate caregivers are present to accept the handoff. Once handoff is complete, the nurses’ obligations under “patient abandonment” rules have been fulfilled. Striking is in no way, shape or form patient abandonment.

3. In some cases, striking may be an ethical imperative.

Sometimes, allowing a hospital to continue along its current path is more harmful than any negative consequences resulting from a strike. In such instances, and when all other alternatives have been exhausted, we are called to act collectively on behalf of our patients. Indeed, this is enshrined in our ANA Code of Ethics, Provision 6 of which reads: “The nurse, through individual and collective action, establishes, maintains, and improves the moral environment of the work setting and the conditions of employment, conducive to quality health care.”

A strike is particularly critical when the employer engages in bad faith bargaining and commits other unfair labor practices. Nurses must be free from illegal coercion and intimidation so they can effectively advocate for their patients' needs. Such unlawful management tactics cannot stand unanswered, and for many may be a key consideration in deciding how to vote. When it comes time, vote for yourselves with the best interests of your patients in mind. Not for today, not for tomorrow—but what’s best over the long haul.