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nurses
What a Nurses’ Strike Says About the Meaning of Work Under Capitalism
The strike has led many of the nurses to discuss the ways that understaffing, paperwork, and the bottom-line efficiency fixation that are inherent in capitalist organizations eat into the quality of care they can give.
Oct 22, 2023
Since the nurses of RWJBarnabas hospital in New Brunswick, New Jersey, first struck early in August, I have had many conversations with them while visiting their picket lines. From the beginning, I have been struck by the extent to which they miss their work and their patients, and by their desire to increase the ratio of nurses to patients so the patients can get the care they need.
This obviously does not fit the stereotype that people only work for the paycheck. It also raises questions about the meaning of work, and about why capitalism creates pressures that operate to destroy the worthwhile and even fun parts of jobs.
Marxist and other theories of alienation often seem to say that workers hate their jobs because capitalism has created alienated work. In its narrowest sense, “alienation” simply means that much of the value of the work that workers do is taken away from the worker and becomes profit for the employers. More broadly, alienation means that employers control what workers do, the conditions in which they do it, and the product of the labor, and that the result is to remove control, creativity, and joy from the job.
The pleasure they should get from taking care of the patients is whittled away day by day as paperwork and understaffing mean they cannot give the patients the care they need.
Yet this is not what I am hearing from the nurses. And, I might add, it is not what I heard from truck drivers when I studied one of their Los Angeles local unions 50 years ago. (See Teamsters Rank and File, Columbia University Press, 1982.) Drivers saw what they were doing as useful, enjoyed “building up their routes” and pleasing the people to whom they made deliveries, and resented it when employers took action that might have increased their profits, but hurt their customers and the drivers’ relationships with the customers.
What does all this mean? To me, it means that people get joy and pleasure out of helping other people. This is particularly evident with the nurses: The ways they help their patients are very meaningful to them, and, when they are striking, they miss those patients who have recurrent need for care and who they have come to know. As they tell me, the replacement (scab) nurses do not know these patients and will not take as good care of them.
I think this goes very deep into who people are and what society is like. In Marx’s terms, I think helping other people is part of our “species-being,” built into our history and our cultures by many centuries of experience. We like to produce use values for other people, whether this is by taking care of them when they are sick or by delivering goods to them. Undoubtedly, nurses feel this more that truck drivers, since their involvement with other people is more intense and concrete.
Unfortunately, capitalism is a system built to produce and increase profits by focusing on exchange value rather than use value. In terms of the nurses, even though they work for what is ostensibly a nonprofit hospital, they are under constant pressure to work harder, and to serve more patients, and sicker patients, with fewer nurses, while the chief executive officer and other higher-ups make $10 million and even more each year. As one nurse phrased it to me, what they care about is the records we enter into our computers more than the patients. These records, it should be noted, are the basis for the billing that brings the money in. Record-keeping also takes nurses’ time away from the patients.
One nurse told me about what the pressure to do more with fewer people means in practice. She is one of a few workers assigned to an intensive care unit for children. One day, another unit had a staff shortage, so the employer moved all the nurses from her unit to another floor to work with other patients. Her primary assignment that day had been intake—to admit children who needed intensive care to the unit, including filling out the relevant paperwork on the computer. On this particular day, she was admitting a child to the unit when alarms went off for two other children on the unit. In human terms: One child needed to be admitted, and two others had potentially life-threatening emergencies at the same time. Although a particularly bad instance of how understaffing works, this ethical dilemma and associated pain and trauma to the nurses occurs in less acute forms every few days. Yet the paperwork gets filled out, the money comes in, and, in spite of the understaffing, some of the children do get good care even if others end up dead or seriously harmed by inadequate care.
What does this mean for the nurses? They feel guilt and conflict over the decisions their employers force them to make about who does and who does not get seen when. They see their dignity attacked, and their professional knowledge debased, when their supervisors ignore their warnings and their concerns. And the pleasure they should get from taking care of the patients is whittled away day by day as paperwork and understaffing mean they cannot give the patients the care they need.
One of the potential ways in which this strike can help is by forcing safe staffing legislation through the state legislature—although so far, the governor and legislature seem cool to this idea, perhaps because of their economic and personal ties to RWJBarnabas management and to the “healthcare” industry more generally. Another is that they may win contractual provisions that help them defend safe staffing levels. A third is that the heightened solidarity they have built up with each other will let them resist managers’ bad decisions more effectively on a day-to-day basis.
In addition, the strike has led many of the nurses to think and discuss the meaning of their jobs and the ways that understaffing, paperwork, and the bottom-line efficiency fixation that are inherent in capitalist organizations eat into the quality of care they can give, their sense of dignity, and the joy they should get from taking care of the sick. In my view, the only way to solve these problems for them and for future generations is to replace capitalism with a new system that some of us call “socialism,” with the understanding that we will only come to understand this new system as we build it. I hope some of these nurses, and billions of other people in addition, will come to agree with me on that before capitalism creates an unlivable environment for humanity.
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Sanders Announces 'Historic' Bipartisan Bill to Confront US Primary Care Crisis
"It is unacceptable that millions of Americans throughout our country do not have access to affordable, high-quality primary care and are unable to get the healthcare they need when they need it."
Sep 14, 2023
After weeks of negotiations, Independent Sen. Bernie Sanders of Vermont and Republican Sen. Roger Marshall of Kansas announced Thursday that they have reached an agreement on a bill to confront the United States' primary care crisis, which has left millions of people across the nation without access to critical healthcare.
Sanders, the chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, said in a statement that the new legislation marks a "historic" effort "to expand primary care and to reduce the massive shortage of nurses and primary care doctors in America."
According to a report released earlier this year by the National Association of Community Health Centers, more than 100 million people in the U.S. face difficulty accessing primary care, which is often the initial point of contact for patients seeking care.
The U.S. underinvests in primary care compared to other wealthy nations, despite spending more on healthcare overall.
"It is unacceptable that millions of Americans throughout our country do not have access to affordable, high-quality primary care and are unable to get the healthcare they need when they need it," the Vermont senator said. "Every major medical organization understands that our investment in primary care is woefully inadequate. They understand that focusing on disease prevention and providing more Americans with a medical home instead of relying on expensive emergency rooms for primary care will not only save lives and human suffering, it will save money."
The new bipartisan legislation includes nearly $6 billion in mandatory annual funding for community health centers over the next three years, according to a summary of the measure. If Congress doesn't act by the end of the month, community health centers—which provide primary care to tens of millions of vulnerable Americans—will face steep funding cuts.
The Sanders-Marshall legislation also includes funding that would support an estimated 2,000 primary care physicians over the next decade.
Additionally, the measure would boost funding for the National Health Service Corps to support scholarships and debt relief for doctors, nurses, and other healthcare professionals.
Recent data suggests the U.S. could see a shortage of up to 124,000 physicians over the next decade. Elisabeth Rosenthal of KFF Health News noted last week that "the percentage of U.S. doctors in adult primary care has been declining for years and is now about 25%—a tipping point beyond which many Americans won't be able to find a family doctor at all."
The nursing shortage is also severe and could soon get much worse. One study released earlier this year estimated that around 100,000 registered nurses in the U.S. left their jobs over the past two years—often due to pandemic-related stress—and more than 610,000 more intend to leave over the next four years.
Sanders and Marshall's legislation, which is set to be marked up in the Senate HELP Committee on September 21, would provide $1.2 billion in grants to state universities and community colleges with the goal of boosting the number of students enrolled in registered nursing programs.
Marshall, the top Republican on HELP's Subcommittee on Primary Health and Retirement Security, said in a statement that the new bill "recognizes and addresses the challenges our healthcare industry is facing, like the shortage of nurses and primary care doctors, and includes programs to bolster the workforce in a fiscally responsible way."
According to Sanders' office, the legislation would be "fully paid for by combating the enormous waste, fraud, and abuse in the healthcare system, making it easier for patients to access low-cost generic drugs, and holding pharmacy benefit managers accountable, among other provisions."
In remarks on the Senate floor on Thursday, Sanders noted that "in Vermont and all over this country, our people often have to wait months in order to get an appointment with a doctor and, in some cases, they have to travel very long distances to get the healthcare they need."
"It is literally insane," said Sanders, "that millions of Americans with nonemergency healthcare needs get their primary care in a hospital emergency room."
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'Burnt Out, Stretched Thin, and Fed Up': Dozens of Healthcare Workers Arrested at Labor Day Protest
"We are prepared to do whatever it takes, even get arrested in an act of civil disobedience, to stand up for our patients," said one Kaiser Permanente worker.
Sep 05, 2023
Dozens of healthcare workers were arrested in Los Angeles on Monday after sitting in the street outside of a Kaiser Permanente facility to demand that providers address dangerously low staffing levels at hospitals in California and across the country.
The civil disobedience came as the workers prepared for what could be the largest healthcare strike in U.S. history. Late last month, 85,000 Kaiser Permanente employees represented by the Coalition of Kaiser Permanente Unions began voting on whether to authorize a strike over the nonprofit hospital system's alleged unfair labor practices during ongoing contract negotiations.
The current contract expires on September 30.
"We are burnt out, stretched thin, and fed up after years of the pandemic and chronic short staffing," Datosha Williams, a service representative at Kaiser Permanente South Bay, said Monday. "Healthcare providers are failing workers and patients, and we are at crisis levels in our hospitals and medical centers."
"Our employers take in billions of dollars in profits, yet they refuse to safely staff their facilities or pay many of their workers a living wage," Williams added. "We are prepared to do whatever it takes, even get arrested in an act of civil disobedience, to stand up for our patients."
Kaiser Permanente reported nearly $3.3 billion in net income during the first half of 2023. In 2021, Kaiser CEO Greg Adams brought in more than $16 million in total compensation.
According to the Coalition of Kaiser Permanente Unions, the hospital system "has investments of $113 billion in the U.S. and abroad, including in fossil fuels, casinos, for-profit prisons, alcohol companies, military weapons, and more."
Healthcare workers, meanwhile, say they're being overworked and underpaid, and many are struggling to make ends meet amid high costs of living.
"We have healthcare employees leaving left and right, and we have corporate greed that is trying to pretend that this staffing shortage is not real," Jessica Cruz, a nurse at Kaiser Permanente Los Angeles Medical Center, told LAist.
"We are risking arrest, and the reason why we're doing it is that we need everyone to know that this crisis is real," said Cruz, who was among the 25 workers arrested during the Labor Day protest.
A recent survey of tens of thousands of healthcare workers across California found that 83% reported understaffing in their departments, and 65% said they have witnessed or heard of care being delayed or denied due to staff shortages.
Additionally, more than 40% of the workers surveyed said they feel pressured to neglect safety protocols and skip breaks or meals due to short staffing.
"It's heartbreaking to see our patients suffer from long wait times for the care they need, all because Kaiser won't put patient and worker safety first," Paula Coleman, a clinical laboratory assistant at Kaiser Permanente in Englewood, Colorado, said in a statement late last month. "We will have no choice but to vote to strike if Kaiser won't bargain in good faith and let us give patients the quality care they deserve."
A local NBC affiliate reported Monday that 99% of Colorado Kaiser employees represented by SEIU Local 105 have voted to authorize a strike.
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