Healthcare workers are lamenting heavy workloads and limited staffing two years into the pandemic as hospital volumes pick back up. Unions in California have been especially active as more contracts expire and nurses and other staff get an opportunity to negotiate their working conditions.

About 5,000 nurses at two Stanford hospitals in Northern California started an open-ended strike April 25, but were back to work May 3 with new contracts with measures they say will better recruit and retain nursing staff — a key issue that led them to strike in the first place.

On the same day nurses returned to work, over 1,000 Stanford residents and fellow physicians won a union election for representation by the Committee of Interns and Residents (CIR-SEIU).

Stanford staff haven't been alone in California

Some 8,000 nurses at 15 Sutter facilities who waged a one-day strike on April 18 still haven't reached a deal on new contracts with the system, according to the union representing them.

And on May 9 hundreds of certified nursing assistants, technicians, environmental service and food service workers at Cedars-Sinai Medical Center in Los Angeles began a five-day strike. They returned to work after the strike without reaching a deal on new contracts, according to a statement from the system.

While the state is the only in the country with mandated nurse to patient ratios, current workforce challenges are shifting healthcare workers' views on what exactly safe staffing means to them and what kind of working conditions they’re willing to endure beyond the pandemic.

New York passed its own staffing law, prompted by the pandemic, but it does not impose ratios. It stipulates hospitals form clinical staffing committees that include front-line nurses and other direct care staff when setting annual staffing standards for units.

Stanford cardiac ICU nurse Kimberley Reed said nurses got several wins after their strike. That included competitive wages to incentivize staff to stay and attract others to come work for the system, better mental health supports and a greater focus on acuity during patient assignments.

Wages are key amid current shortages as burned out nurses quit or take early retirements, and as higher-paying traveling positions entice permanent nurses away from their current jobs.

Both traveling and permanent nurse staff have seen pay rise amid pandemic-driven shortages, though not equally.

Contract nurses’ median hourly wages rose 106% from 2019 to 2022, from $64 an hour to $132 an hour, while employed nurse wages increased 11% over that period, from $35 an hour to $39 an hour, according to a Kaufman Hall report.

Stanford nurses’ new contracts include a 7% wage increase in the first year of the contract, followed by two 5% increases in the second and third years.

It also stipulates that nurses in units with high-acuity patients that have been difficult to staff — like emergency departments and intensive care units — will receive incentive pay.

Language around staffing based on acuity was another big win for Stanford nurses.

California's nurse to patient ratio law includes language to account for acuity, and stipulates additional RNs must be added to minimum ratios based on a patient classification system used to measure how complex and severe a patients’ condition is.

But it falls short in some cases, "which is leading to a lot of nurses who are overworked,” Reed said.

Patients in the cardiac ICU unit where she works “are extremely sick patients,” often requiring medical devices, frequent monitoring and skilled staff to safely manage them and their conditions, she said.

The law also excludes a few units — though not ICUs — from mandated ratios. Stanford nurses wanted to make sure that language applied to all units and got that in new contracts, Kathy Stormberg, a radiology nurse at Stanford and VP of the union representing the nurses, said.

Other recent labor actions at Stanford came from physician residents and interns who won an election for union recognition May 3.

A majority — 835 out of 1,478 total residents — voted in favor of unionization, and Stanford does not plan to contest the election results, according to an emailed statement from the system.

Those physicians in training will be represented by CIR-SEIU, and negotiations for their first bargained contracts will begin in the coming months.

They will push for a number of items in their first contracts, such as pay raises to reflect the cost of living while accounting for the student loan debt many carry, Philip Sossenheimer, a resident physician in internal medicine at Stanford said.

When residents feel their clinical burden is unsafe or they are being worked too much, having union representation will give them a mechanism to bring grievances to the hospital, he said.

“We started to realize that things don't have to look like this, and that this isn't necessarily the best way to train physicians or to take care of patients, and that we're able to speak up and ask for something better,” he said.

The pandemic ramped up organizing among residents and interns who have historically been less active on the labor front than registered nurses.

While CIR-SEIU is the largest national union representing residents and interns with 20,000 members, National Nurses United, the country’s largest nursing union, has 175,000 members.

So far in 2022, interns and residents at four hospital systems across the country have won representation with CIR-SEIU. That compares to five election wins in 2021, one in 2020, and two in 2019, according to the union.