When nurses go on strike, it is easy to assume the conflict is about pay or contracts. In reality, strikes are almost always a last resort. They happen when nurses believe patient safety has been pushed to a breaking point.
That is the situation unfolding in New York City. This strike will eventually be settled but the public should not be content to have labor unions have to battle hospital leaders repeatedly to maintain safe hospital care. There needs to be a safe nurse staffing requirement met by all hospitals to protect the public.
For more than two decades, our team at the University of Pennsylvania School of Nursing has conducted independent, peer-reviewed research on nurse staffing and patient outcomes in hospitals across the U.S. We have studied almost every hospital in New York State in detail at three separate points since 2019. Our results show that nurse understaffing was common in New York hospitals before the pandemic and remains so today. Indeed, hospitals in New York City, on average, were worse staffed than hospitals in the rest of the state, ironic and troubling given the city’s reputation as a mecca for medical care.
In our most recent survey of New York City hospital nurses in 2024, 66% report that their units are not staffed adequately to provide safe patient care. Nearly one in four nurses working in New York City hospitals say they plan to leave their employer within the next year. Most who leave do so because of nurse understaffing and related job burnout costing hospitals millions of dollars a year to replace them.
Hospital nurses, who went on strike on Monday at some of the city’s major hospitals, did not walk out lightly. They are sounding an alarm about unsafe nurse staffing risking patients’ wellbeing and violence impacting staff, which are related because delays and missed care can trigger reactions similar to road rage in tense medical situations.
When nurse staffing levels are too low, care is delayed and warning signs are missed. Patients wait longer for medications. Symptoms worsen before they are noticed. Patients spend longer in the hospital, adding to costs. Nurses are not confident that patients can care for themselves after discharge. Readmissions within 30 days of discharge are high.
Nurses must make impossible choices about which patient needs attention first, knowing someone else may be left waiting. Avoidable deaths occur.
Chronic nurse understaffing also takes a toll on the workforce. Our research shows that 70% of nurses in New York City hospitals lack confidence that top management will respond effectively to concerns about unsafe care. When nurses feel unheard and unsupported, burnout accelerates and turnover rises, creating a cycle that further undermines patient safety.
Hospital leaders often respond to strikes by emphasizing the short-term disruption they cause or by relying on temporary staffing arrangements. But the real disruption begins long before nurses ever walk out. It begins when chronic understaffing becomes normalized and years of evidence are ignored.
This strike did not have to happen. Legislation introduced in New York beginning in 2019 would have established a minimum safe nurse staffing standard for hospitals across the state. Hospitals would have remained free to staff above that floor, but they could not fall below it. Evidence showed that such a policy would have saved lives, reduced length of stay and readmissions, and lowered nurse turnover, making it both a patient safety measure and a cost-effective investment for hospitals. The legislation did not pass.
The hospital industry opposed the legislation citing increased costs, possible hospital and emergency room closures, and a worsening nurse shortage. Yet California for more than 20 years and Oregon more recently implemented similar legislation without negative unintended consequences and with improved nurse retention and patient outcomes.
The public understands what is at stake. In a recent national Harris Poll, 90% of respondents said hospitals should be required to meet safe nurse staffing standards. Patients and families expect hospitals to be staffed in a way that allows nurses to provide safe, attentive care.
The question raised by the New York strike is not why nurses are speaking out. It is why decades of research on the dangers of understaffing were not enough to prevent this moment.
When nurses raise their voices, it is worth listening. Their message, backed by years of rigorous research and frontline experience, is simple and urgent: Safe nurse staffing saves lives.
Aiken, Ph.D., RN, FAAN, is founding director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing and a senior fellow at Leonard Davis Institute of Health Economics at Penn.
