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Brian Lehrer: Brian Lehrer on WNYC, and yes, over 7,000 nurses, those at Mount Sinai, the main campus on the Upper East Side and at Montefiore in the Bronx went out on strike this morning after negotiations broke down overnight. At least tentative deals with other hospitals were reached, including with Mount Sinai West and Mount Sinai Morningside. Both hospitals currently on strike are rescheduling elective surgeries and hiring replacement workers, this after Governor Hochul intervened and called for binding arbitration. To talk about the issues at the heart of the strike and conditions in those hospitals right now, we're joined by Caroline Lewis, health reporter for WNYC and Gothamist, and we're very happy to have Nancy Hagans, president of the New York State Nurses Association, the union representing the striking nurses. Nancy, welcome back to WNYC, and Caroline, good morning.

Caroline Lewis: Good morning.

Nancy Hagans: Good morning.

Brian Lehrer: Nancy Hagans, let me start with you. What would you say is the situation in the two hospitals right now? Are any nurses working and are the patients safe?

Nancy Hagans: The situation right now in the two hospitals is because that we had a breakdown. We couldn't reach a tentative agreement with them due to our staffing condition. The nurses are really out there to advocate for our patients, to advocate for the safety of our patients. We did give management a 10-day notice where they had enough time to make proper arrangements in case of a work stoppage. It's really up to management to come to the table and negotiate a fair contract, and that will improve patient care.

Brian Lehrer: Caroline, just to stay on the conditions on the ground right now and the safety of patients who are hospitalized right now. Nancy just referred to 10 days of notice, enough for them to compensate in some ways temporarily. Do you have any reporting on that?

Caroline Lewis: Yes. As you said, they are hiring replacements, which can be very costly, especially for a strike, and have some management filling in for the rank-and-file nurses, but I definitely did hear from some people here that their colleagues on the night shift were held longer than usual to make sure that patients were safe before they got off. The hospitals are definitely strange right now. I spoke to one nurse in an outpatient oncology unit who said that some patients are not able to be admitted for certain treatments. It's something that she obviously said is very upsetting, but that she felt that their care was still affected by understaffing before the strike, and so she still feels that it's important.

Brian Lehrer: Listeners, does anybody happen to be listening from a hospital bed at the Mount Sinai main campus or Montefiore hospital right now? You're going to get high priority on the phones if you want to report what it's like from the inside as a patient, 212-433-WNYC, 212-433-9692. Also, if you are a nurse whose hospital has reached a deal because there were so many other hospitals also negotiating along the way, just these two did not reach a deal by the deadline, or if you are currently on strike, nurses, 212-433-WNYC, 212-433-9692. Everybody welcome in or tweet @BrianLehrer.

Nancy Hagans, can you explain the difference in the situation between the Mount Sinai West and Mount Sinai Morningside campuses where you did reach a tentative contract agreement and the offer on the table from the main Mount Sinai campus and those differences? A lot of listeners might be confused to hear that this building of Mount Sinai has an agreement with the nurses, that building of Mount Sinai a few blocks away doesn't.

Nancy Hagans: As you know, every hospital is different. We have different patients, different members and we have different ratios. The Mount Sinai main in the west, they are connected on by the same group, but however, they have different members and different representation. We were able to reach a tentative agreement with them that create a better staffing language, better staffing ratios, where at main Mount Sinai, the employer refused to come to the table and negotiate a fair contract that would make better and safe patient ratios, and that would include attracting nurses and returning nurses. We need to be able to recruit nurses and return nurses. Right now, Mount Sinai have over 500 vacancies open. With that being said, the nurses are being asked to do more tasks, and they are taking double of the patients. We really need management to come back to the table and negotiate a fair contract that would include safe patient-nurse ratio.

Brian Lehrer: The New York State Legislature passed the safe staffing law just in 2021, something the union had been calling for, for years. What happened that that law didn't solve the issue?

Nancy Hagans: Because the hospitals so far have refused, like Mount Sinai, they have not submitted a patient-nurse ratio to the Department of Health. They have not been compliant.

Brian Lehrer: Caroline, can you add to that based on your reporting, why that law didn't solve the problem and a contract was therefore easy to reach?

Caroline Lewis: Yes. I actually was curious about that, too. I had seen staffing plans submitted to the health department from most hospitals and including in the Mount Sinai system, but I didn't see the one from the main hospital and inquired about that. The Department of Health said they did finally receive it, and they have that staffing plan, but those are not supposed to be-- they're first being put into effect and enforced this year. I've heard from people at the nurses union that they aren't even close to being able to meet those staffing promises that they've made. I think that there's a feeling, and Nancy can speak to this, that having the promises in the contract is an important component as well.

Brian Lehrer: Would you speak to that, Nancy?

Nancy Hagans: Yes. Having it in the contract is one thing, but for the hospital to be able to enforce the contract as well. That's why we want enforcement language where the hospital will be held accountable for not following the ratios and the staffing promises. Unfortunately, we didn't make any progress on that, and that's one of the reasons the nurses decided that they need to exercise their right in order to safely care for their patients.

Brian Lehrer: Let's take a phone call. Here's Tom in Manhattan. Tom, you're on WNYC. Thank you for calling in.

Tom: Hey, Brian. How are you? I will just tell you, I'm a doctor. I work in one of the major New York hospitals. It's one in which a strike was averted. I work only on the inpatient side. I, of course, don't want to say much more than that. I want to first just express my solidarity with all of the NY State Nursing Association nurses and the strike. I just quickly don't want to speak on behalf of anyone, but just offer the perspective of a doctor who sees the consequences of some of this inadequate staffing. We want more nurses so that they can take care of our patients.

I'll tell you from my perspective, I take care of people who I'm admitting from the emergency room into the hospital. While these patients might have been stabilized, they're not suffering anything that is acutely life-threatening in the moment, there's a lot happening, a lot of moving parts. We order a lot of medications, we need a lot of data that nurses gather like vital signs and blood pressures, and so on and so on. When we have sometimes a nurse caring for 10, 12, 14 patients at a time depending on how many nurses might be on break, you could imagine that over the course of an 8 to 12-hour shift, a lot of the things that we need in order to make good, safe decisions about how to care for our patients might not be done in a timely manner. It is not the fault of the nurse. It is the fault of the staffing ratio. They're asked to do impossible tasks. I just want to put that out there for those who might think that the nurses are being selfish or they are putting patients at risk by doing this. The fact is that the ratios as they stand today, the ratios themselves, put the patients at risk.

Brian Lehrer: Doctor, let me ask you, is this a pandemic-era problem? Were the ratios okay before the pandemic because all of your jobs in hospital are so hard now, harder than they were before, nurses have walked away and then they haven't been replaced or how would you put this in a little bit of a timeline perspective, and with respect to the pandemic if it's relevant?

Tom: As far as how nurses might be leaving and being replaced, I can't really speak directly to that. I will tell you that collectively, yes, there is a lot more stress stressed since the pandemic, in part because of collective burnout. Those of us who've been practicing before and since COVID share a lot of trauma from that. It probably does magnify the sense of aggrievement for things that maybe were tolerated in the past, but now that we've been through this and we have seen just how hard it can be to practice medicine, and there hasn't been perhaps the reaction that we all wanted in terms of making our jobs a little easier and more tolerable and safer for patients.

Yes, I think that has worn on everybody. Again, not going to speak to the nursing side of things, but we've certainly experienced it as physicians and we work in tandem. We are teams with the nurses. We talk to them, we hear what they have to say. I do think that psychologically it's probably changed how we all think about it and how the hospital should be working for us.

Brian Lehrer: Thank you for your call, doctor. We have a few minutes left with Nancy Hagans, president of the New York State Nurses Association, the union for nurses on day one now of a strike at Montefiore and the main Mount Sinai campus. Also our health reporter for WNYC in Gothamist, Caroline Lewis. More of your phone calls at 212-433-WNYC. Nancy, I know we're going to lose you in about three minutes. The union I see reached a deal first with New York Presbyterian, and that deal was approved by the members over the weekend. What were the staffing guidelines in that deal?

Nancy Hagans: As the doctor explained to you, and I would like to say thank you for the solidarity from the doctor for calling in and speak on our behalf. As you know, every hospital has to operate in a different ratio. The Columbia Presbyterian, tentative agreement, they were able to address the staffing issues. They were able to do what we put on the table they needed to address. What we are asking Montefiore and Mount Sinai is to follow the rest of the other hospitals and come to the table and address the crisis that we've been talking about before the pandemic, and provide us with safe nurse-patient ratios. That's what we need them to do in order for us to continue to care for our patients and our communities.

Brian Lehrer: The governor urged both sides to accept binding arbitration and both of the hospitals where your members of striking agreed. Why is that not a solution or a path to a solution that you are willing to take on if you're not?

Nancy Hagans: The binding arbitration totally remove consistent general rights. We are not in the process of doing binding arbitration, what we are asking the governor to do is to encourage the hospitals to come back to the table and bargain in good faith and provide us the safe staffing issue that we are desperately needed in order for us to care for our patients.

Brian Lehrer: Can I ask you, Nancy, what part did the early part of the COVID pandemic play in setting up this conflict from your perspective? I know I've seen there's more distrust of management after the lack of preparation and PPE at the beginning, but are there enough nurses left in the profession? Didn't many frontline nurses quit entirely after dealing with that crisis, or at least leave hospital staffing?

Nancy Hagans: The short staffing was created by management way before the pandemic. The pandemic just exposed how vulnerable we were. Just remember, as nurses, we saved New York. Without proper PPE, we went there, we put everybody ahead of us, ahead of our families. Once the pandemic is management froze all the positions, look at Mount Sinai. They have over 500 positions open, Montefiore, over 700 positions open. Instead of going and hiring nurses. Nurses became, as the doctor mentioned to you, physically and mentally tired. They decided to walk away from the profession, not because they don't want to work. We don't want to work because we are tired, we are burned out, and we are overwhelmed.

If management would have come and sit there and provide safe, proper nurse-patient ratios, some nurses will come back to the profession but they need to be able to hire nurses and retain the nurses by providing a safe working condition.

Brian Lehrer: Nancy Hagans, president of the New York State Nurses Association, I know you've got to go. You've got so much on your plate today, obviously with this strike now by some of your members at two hospitals just a few hours old. Thank you for making some time for us today.

Nancy Hagans: Thank you.

Brian Lehrer: Our health reporter, Caroline Lewis, is still with us. Let's take another phone call from a nurse, Bernadette, and the Catskills. You're on WNYC. Hi, Bernadette.

Bernadette: Hey there, Brian. Good morning. Thanks for taking my call. I'm actually glad that the nurses are striking. I think that Nancy hit a lot of the high notes, and I think the doctor who called in hit a lot of the high notes. I would love to see somebody follow the money because hospitals are lucrative and they do have the means to staff accordingly. However, I feel that the nurse's goodwill and desire to care for people is often exploited and under-attended to. We saw it exploited in this recent pandemic. It was also exploited in the HIV pandemic in the early '90s, which got much less attention because it was a different audience that was suffering. I think it's about time for hospitals to really put their money where their mouth is with regard to nursing care.

I worked in intensive care at Presbyterian for 10 years and it was the best hospital I worked in. I will say that. The spirit of the people who worked there was amazing. In other hospitals I worked in, the nurse-to-patient ratio was just wacko. It was dangerous. I sympathize, empathize, and completely support with the nurses at this point, and feel like management had plenty of heads-up time, decades worth of heads-up time to take care of this matter.

Brian Lehrer: Bernadette, thank you for chiming in. Let's take another nurse's phone call. Giselle on Long Island. Giselle, thank you for calling in. You're on WNYC.

Giselle: Hi. Thank you so much for taking my call. What Bernadette just said and what our physician colleague just said, I also believe in how safe staffing has been an issue before the pandemic, exacerbated after the pandemic. Another thing that we need to take into accountability is not just ratios, but the amount of care a patient needs. While there are different types of acuity levels, like an ICU or a med surg floor, or ER floor, we also have to consider what conditions those patients have. Some of them do require more nursing care than others. It's not just about the number of patients, the patients in the hospital, they're there for nursing care so that they can get the medications, the interventions prescribed by the providers, but also for the lab work and everything.

Nurses just are so flexible that if there aren't phlebotomists, if there aren't nursing assistants, they have to pick up the slack. Not only are they doing the nursing work, but they might be doing other support work as well. As far as the safe staffing laws, right now as mentioned before, there's no punishment if the hospitals don't follow plans. It would just be great if there was some teeth in those policies to help support the nurses and make sure that the hospitals are accountable.

Brian Lehrer: Giselle, thank you very much for chiming in. I hear all those points. This is WNYC FM, HD NAM, New York, WNJ TFM 88.1, Trenton. WNJP 88.5, Sussex, WNJY 89.3, net con, and WNJO 90.3 Toms River. We are New York and New Jersey Public Radio and live streaming @wnyc.org. Get a minute before 11:00, few more minutes still with our health reporter, Caroline Lewis on the nursing strike that began at the main Mount Sinai campus today in Montefiore Hospital in the Bronx. Caroline, what is the staffing level in the settlements and how is it expressed? Is it patient to nurse ratio numerically like that? Clearly, after listening to the last caller, and we could assume this anyway, the staffing levels would be different in the neonatal intensive care unit than it might be on "regular wing". Can you numerically go into that at all?

Caroline Lewis: Yes, I don't have the exact numbers but in each unit, these plans typically lay out how many patients are there when it's at capacity, and how many nurses would be required typically to care for those patients. I think one thing is that the hospital management, especially like at Mount Sinai, this was expressed to me by the chief nursing officer there, they're really reluctant to commit to really strict nurse-to-patient ratios. They claim that they need a certain level of flexibility to handle different situations. I think there really is still some tension and I think we will have to see how these ratios are actually, or these staffing plans are actually enforced by the state, if at all.

I think they're also just dealing with a really challenging moment in healthcare staffing. We've seen strikes across the country at different hospitals since the pandemic began. Of course, people said these staffing issues began well before the pandemic but it has certainly exacerbated it especially because it's become so much more lucrative to be a temporary or travel nurse. Now, even more nurses are leaving to do that, leaving the hospitals to fill in with even more to have than travel nurses. It's a vicious cycle there and they have to--

Brian Lehrer: What I gather is that the pay is not actually the crux of the matter here. They do have pay raise offers on the table and accepted at some of the other hospitals of close to 20% over the next three years, like seven, seven, and five. Those kinds of things, 20% pay increase almost over the next three years. It really is more about the staffing as everybody's been saying. The New York State Hospital industry group put out a report that four out of five state hospitals have "negative or unsustainable operating margins". Yet there are reports of sky-high executive salaries and some large hospital systems doing better financially than before coming out of the pandemic. Do you have any insight into the financial health of the institutions in question?

Caroline Lewis: Certainly Montefiore lost a lot of money last year. I would have to check on Mount Sinai, but as the nurses have said, the financial health of these institutions has never affected the compensation packages for executives which are always worth multiple millions of dollars. I think that's always something that's frustrating for people when they're negotiating. Of course, the staffing and the pay cannot really be decoupled. There's the idea that if they want to compete with the ability to be a temp or travel nurse or pay at some other institutions, then they have to increase pay and benefits.

Brian Lehrer: Here is a striking Mount Sinai nurse calling in, Cheryl in the Bronx. Cheryl, thank you so much for adding your voice here on WNYC.

Cheryl: Thank you so much for taking my call. Really appreciate this time that you're dedicating to us, nurses. I've just left the picket line and I'm now taking a little bit of a break because it's been very cold. The nurses are just amazing. They are out there. We are there for the patients and we are really steadfast to how we really want to make sure that our patients are taken care of. The way that can be done is by having patient ratios. We've asked for that. It's been written in our contracts in the past, but nobody has been able to uphold it. We're asking for new verbiage and how this is done and this is where we're heading talking against a stone. They're just really undetermined right now. They're just steadfast. We had to walk this morning and we are there up at Mount Sinai. I know that we're causing traffic problems, but I know that many people are supporting us in endeavor that we're doing so that the community and the nurses can practice safely and have good patient outcomes.

Brian Lehrer: You're on strike from the Mount Sinai main campus. Are the patients in the hospital now safe? Are you putting their lives at risk?

Cheryl: I believe that we have given our reports this morning. We gave reports to everyone. There was plenty of people there to take reports from us. They are now making decisions as to whether or not they need to move people out because maybe their expertise is not up to par. We've done our best to give them information. We've asked all along for them to provide better patient ratios. I think that the numbers have come down that they've had to send people out. Many of our babies where I work in the NICU have been moved to other units within the city or even up in Westchester.

Brian Lehrer: Let me ask you one last question. Is this a post-pandemic strike? Of course, we're not really post-pandemic. We're in a certain later phase of the pandemic.

Cheryl: We're still in a pandemic. This problem started way before that as other people have attested to, I think, on the phone. It's happened before that, we can't own it up to that. We have a lot more nurses that are becoming nurses because of them pandemic because so many senior nurses took retirement because they didn't want to be sick because at an older age, they're more opposed to getting COVID, so many people at the beginning who were had relatives or themselves losing life because we lost a lot of nurses from COVID, they left. Then we've got these new nurses coming in, they're working, they're on orientation, but then they find that the patient ratio and the atmosphere that they have is not conducive to the way that they want to experience their lives.

Even years ago you would stay at a hospital for at least a year before you moved on but the nurses aren't doing that anymore, they're moving on. Mount Sinai is spending a lot of money and within six, seven months the nurse is gone and they've got to start again from scratch. They'll give you numbers saying that over hiring, we're hiring, but that's why we're also asking for better pay so that we can be comparable to the other hospitals that are in the neighborhood.

Brian Lehrer: To the travel nurses who can demand so much, right?

Cheryl: Yes.

Brian Lehrer: Cheryl, thank you very much for your call. Thank you very much. To wrap this up, Caroline Lewis for a little context for our listeners, the union of course authorized this strike with these two private hospitals, Montefiore and Mount Sinai main campus. Nurses at the city's public hospitals, for people wondering, are covered by New York State's Taylor Law which prohibits strikes by public employees. Are those hospitals facing similar issues under the nurses there have any bargaining clout? We have a minute left.

Caroline Lewis: Like I said, I think these are issues that have affected all hospitals in terms of staffing issues. I'm not aware of any threat of a strike at the public hospitals but certainly, there are other hospitals in Brooklyn that are private and are currently in the midst of negotiations and could still potentially strike.

Brian Lehrer: WNYC Health reporter Caroline Lewis. Hear her on the radio, read her and Gothamist. Thanks a lot, Caroline.

Caroline Lewis: Thanks.

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