Under pressure that hasn’t eased since the pandemic, some health care workers are preparing to strike

As the US hovers on the edge of another season of respiratory viruses, some health care workers are preparing to swap their medical instruments for picket signs, sounding the alarm about a staffing crisis that they say is already affecting patient care.

“Workers are up at night, the day before their shift, just thinking about what they’re going to walk into the next day because of short staffing,” said Gabe Montoya, an emergency room medical technician at Kaiser Permanente Downey Medical Center in Southern California. “I’m being honest. It’s not hyperbole.”

Montoya, who has worked for the medical center for 15 years, is also part of the bargaining team at Service Employees International Union-United Healthcare Workers West, a local union that is part of the Coalition of Kaiser Permanente Unions.

Montoya and other union representatives are meeting for bargaining sessions with health care giant Kaiser Permanente ahead of the end of their contract on Saturday. If negotiations fail, more than 75,000 Kaiser health care workers could strike for three days next month at hundreds of locations across California, Colorado, Oregon, Washington, Virginia and Washington, D.C.

The union is concerned about chronic staffing shortages. On any given day, Montoya walks about 40,000 steps, according to his Apple watch, serving patients at the 85-bed medical center in what he describes as an intense and high-stress job.

“It definitely takes a lot of skill, because you’ve got to prioritize what’s most important, right? Oftentimes, everybody thinks their thing is most important. And so our job is just to provide the best care we can and kind of prioritize,” Montoya said.

He said his department should have about 15 EMTs to be considered fully staffed, but on a typical day at the hospital, there are only about five to seven to serve the emergency room, triage area and the waiting room.

“I call us the bloodline or the lifeline of the ER, because we do it all,” Montoya said. “In one hour, I can do four or five EKGs, have to take someone to CAT scan, have to clean out a child’s wounds and help a nurse clean a patient up.”

He’s worried that with respiratory virus season just around the corner, more patients will inundate the hospital and overwhelm staffers he said are already stretched too thin.

“It doesn’t make sense to me, as a union leader in my department, that every year we know this surge is going to come up at this time of year, and we’re waiting till the surge gets here to deal with staffing rather than preparing months ahead,” Montoya said.

Kaiser Permanente said in a statement Friday afternoon that it has hired more than 50,000 people since 2022 and plans to hire more.

“Kaiser Permanente and the Coalition agreed to work together to accelerate hiring this year, setting a joint goal in bargaining of hiring 10,000 new people for Coalition-represented jobs in 2023. Kaiser Permanente’s efforts to date have resulted in more than 9,700 positions filled, and we are aggressively recruiting to fill more,” the statement said.

Health care workforce burnout

Nationwide, burnout is part of what’s driving shortages of doctors, nurses and other health care workers.

Among doctors, for the third year in a row, 6 in 10 reported often having feelings of burnout, compared with 4 in 10 in 2018, according to a recent survey

Among nurses, a survey in April found that about half felt emotionally drained at work. Another survey in May found that while many cared very much about their work, their work satisfaction has declined and stress levels have increased.

And among other types of health care workers, a survey from the height of the Covid-19 pandemic found that more than half of clinical staff — not including doctors or nurses — and 46% of non-clinical staff reported feeling burnout.

“We had an already very fragile health care system before the pandemic, and since then, it has gotten only worse. We are at crisis levels,” said Corey Feist, co-founder and chief executive officer of the Dr. Lorna Breen Heroes’ Foundation. The foundation was established in memory of Feist’s sister-in-law, Breen, with a goal to reduce health care workers’ burnout. Breen was a frontline emergency department physician who treated Covid-19 patients before she died by suicide in 2020.

Feist said that one of the main drivers of burnout is the administrative work that doctors and nurses have to trudge through, tasks such as insurance preauthorization forms and updating electronic medical records.

“We both have burnout driving the health care workforce to leave, and we have this compounding mental health crisis that is making the environment untenable,” Feist said. “And so, people are leaving, people are striking, they need a different work environment because they’re just trying to do the job they trained for, and there’s all this administrative burden and all of this additional regulation. It gets between them and taking care of patients.”

Feist said that what people need to know about the health care workers going on strike is that they “are at the end of their rope, and we need to recognize that they didn’t get there overnight.”

“It’s hard to remember that in order to take care of patients, you must first take care of the workforce. That’s where the focus needs to be,” he said.

When burnout leads to staffing shortages, it can have harmful consequences for patients, such as decreased time for consultations and increased medical errors and hospital-acquired infections, US Surgeon General Dr. Vivek Murthy warned last year in an in-depth advisory.

Judy Danella is a nurse on the stroke floor at Robert Wood Johnson University Hospital in New Jersey and the leader of the United Steelworkers Local 4-200 union, which represents nurses. Her union has been on strike since August.

Danella told independent Sen. Bernie Sanders at a town hall about safe patient-to-nurse staffing that she can’t spend time discussing her patients’ health with them because she is overworked.

“Having too many patients is limiting me from helping the patient along the way. The education part is suffering,” Danella said, adding that new nurses are also having a hard time keeping up with more patients.

“They’re coming in really fresh, really green, I should say, and they don’t have the wherewithal to say ‘I can handle six and seven patients.’ It’s overwhelming for them,” Danella told the townhall. “That’s why they’re leaving the profession. I believe if we solved the problem of staffing now, we would be able to retain more nurses in our profession. It would be a better profession to go into.”

Pediatric recovery room nurse Carol Tanzi, also at Robert Wood Johnson University Hospital, said she is worried about making a mistake.

“If you’re overburdened, if you’re overworked, the chances you’re going to make a mistake are greater,” she said at the town hall.

“We’re guardians of human lives,” Tanzi said. “We no longer want to be complicit in not having the right things to take care of our patients. We know it’s wrong. We know it can be better.”

Workers argue for higher wages

Low wages are another factor leading to staffing shortages.

Montoya said he sees colleagues whose wages have not kept up with inflation.

“There is a problem, right, when we have Kaiser workers in this huge conglomerate who are having to deal with living paycheck to paycheck,” he said, adding that some of his colleagues worry about being able to afford rent.

In a statement, Kaiser Permanente said it is deeply committed “to the economic well-being of our employees.”

“Kaiser Permanente is a leader in employee wages and benefits in every market we are in. In bargaining this year, we are offering across-the-board wage increases, an enterprise-wide minimum wage starting at $21 an hour, continuation of our existing excellent health benefits and retirement income plans, and much more,” it said.

It said that it helped support frontline workers with “$800 million in special benefits for housing, childcare, and paid leave for COVID-19” throughout the pandemic.

“We have been there for our people during the pandemic, and we will be there for them going forward,” Kaiser Permanente said Friday.

A possible turning point

Renee Saldana, a spokesperson for Service Employees International Union-United Healthcare Workers West, said health care workers are hitting “a breaking point.”

“They’re just exhausted, tired, burnt out,” she said. “But they still want to be there for their patients. They do this because it’s a calling for them. They want to be there to help people. They run into the fire while people are running away from it.”

Saldana said the workers she represents want to see patient care improve.

“They don’t like seeing their patients facing long waits in the ER,” she said. “They don’t like seeing their patients suffer in pain when there’s not enough staff to help them out.”

The health care workers’ breaking point may be arriving at a turning point for the industry.

According to the US Bureau of Labor Statistics, the health care industry added about 70,000 jobs in August, primarily in the ambulatory health care services, nursing, residential care and hospital fields.

But Susan Skillman, a senior deputy director with the Center for Health Workforce Studies at the University of Washington, said that producing more doctors, nurses or other health care workers isn’t going to solve the industry’s problems on its own.

It’s the work conditions that have led to the turnover that need to be addressed, she said.

“The workforce problems before the pandemic, and that remain, are as much or more about retaining the workforce in their jobs as [they are] about producing more workers,” Skillman said.

To try to offset the pressures health care workers face, President Joe Biden signed the Dr. Lorna Breen Health Care Provider Protection Act in March 2022, the first federal law that authorizes grants for programs that offer behavioral health services for front-line health care workers.

In addition, the Biden administration announced in August a $100 million investment to boost the nursing workforce through training and education programs.

And in California, where Montoya works, to address wage issues, the state legislature recently approved SB 525, a bill that would raise the minimum wage for health care employees, such as hospital security, gift shop employees or housekeepers to $25 an hour by 2026.

California Gov. Gavin Newsom has not indicated whether he will sign the bill. He has until October 14 to act on pending legislation, according to his office.

But for Montoya, the efforts may not be enough to avoid a strike early next month.

“We feel like we are the only ones taking the staffing crisis seriously. We are the only ones who are sounding the alarms to Kaiser, to our legislative leaders across the state that there is a crisis in health care, and no one wants to deal with it, and we have no other alternative but to go on strike,” he said.

CNN’s Deidre McPhillips and Jen Christensen contributed to this report.