Strike or Resign
Health care workers take action to have their working conditions improved while others decide to resign
Yessenia Villalobos
Overview
The COVID-19 pandemic has highlighted the occupational hazards health care workers (HCW) encounter and has increased their burnout. This has led to HCWs requesting changes from health care administrations and an increasing number of HCWs resigning.
Health care workers will be defined as they are defined by the Oregon Administrative Rules (OAR 333-019-1010) as follows:
Healthcare providers and healthcare staff:
(A) Means individuals, paid and unpaid, working, learning, studying, assisting, observing or volunteering in a healthcare setting providing direct patient or resident care or who have the potential for direct or indirect exposure to patients, residents, or infectious materials, and includes but is not limited to any individual licensed by a health regulatory board as that is defined in ORS 676.160, unlicensed caregivers, and any clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, student and volunteer personnel. (Oregon Secretary of State, n.d.)
Kaiser Permanente Strike
The United Nurses Association of California/Union of Health Care Professionals (UNAC/UHCP) had been negotiating a new contract with Kaiser Permanente (KP) for months and had yet to reach an agreement. The union had planned to strike on November 15th, if Kaiser Permanente did not meet their proposals.
On November 18th, other KP unions had intended to hold a 24-hour sympathy strike in solidarity with those who had planned to strike on November 15th (Coalition of Kaiser Permanente, 2021).
Quick Summary of Both Proposals
KP proposal:
Low wage increases of 1%
A two tier system where new hires get paid less than everyone else (ABC News, 2021)
UNAC/UHCP Proposal:
Wage increases for all
Reject the two tier system
Request that KP addresses labor shortage (Alliance of Health Care Unions, 2021)
Full bargaining proposal between Kaiser Permanente and Alliance Unions.
Fortunately, on November 13th, 2021 the union and KP reached a tentative agreement. The planned strike was canceled. Demonstrating how power in numbers can be a successful way to demand changes from hospital administrations like KP.
The new tentative agreement includes:
higher wages
racial justice improvements
a committee that will address staff shortages
& removes two tier system (OPB Staff, n.d.)
Resignation Rates
As the pandemic has continued, the rate of resignations among HCWs has steadily increased over time. In the month of September 2021, the US Bureau of Labor and Statistics reported that approximately 589,000 people quit in the health care and social assistance sector (U.S. Bureau of Labor Statistics, 2021).
Possible contributors to HCWs striking or resigning
Number of nonfatal occupational injuries and illnesses by selected industry and case types, private industry, 2019-20 (thousands)
Occupational Hazards
The hazards they encounter on the job includes (United States Department of Labor, n.d.):
Blood borne pathogens
Biological
Respiratory
Ergonomic from physical excursion moving patients
Chemical and drug exposures
Occupational hazards are common in the healthcare industry. According to the United States Department of Labor, in 2020 there were 806,2000 cases of injury and illness reported in the private industry (United States Department of Labor, 2021)
Infectious Disease Exposure
A major concern is their exposure to infectious diseases, and the COVID-19 pandemic highlighted the risk infectious diseases impose on health care workers (HCW).
In the health care and social assistance sector, 74.1% of cases were due to other viral diseases resulting in at least one day away from work (United States Department of Labor, 2021).
As of November 12th 2021, there have been a total of 735,464 of COVID-19 positive cases and approximately 2,565 deaths among healthcare personnel (Centers for Disease Control and Prevention, n.d.).
Centers for Disease Control and Prevention https://covid.cdc.gov/covid-data-tracker/#health-care-personnel
Stress & Burnout
However, HCWs are not only resigning due to hazards. Possible contributing factors include:
labor shortages
being overworked
working conditions (NSI Nursing Solutions Inc., 2021)
A study conducted in Finland, explains that study participants who had more experience with time-related pressures and being required to multitask expressed more exhaustion than their healthcare counterparts (Huhtala et al., 2021). Additionally, a different study described increased stress—not to be confused with burnout—among healthcare staff as being associated with unpleasant workplaces (Kendrick, 2020). One study suggests that stress which HCWs feel specifically due to COVID-19 has a relationship with COVID-19 burnout (Yildrim, 2021). As the evidence suggests, there are many contributing factors to HCWs burnout, such as pressure to complete multiple tasks in a short amount of time, not having enough staff to ease the work burden, and work-related stress.
Wage Compensation
The healthcare industry is not solely composed by nurses and doctors, it is also composed of:
medical assistants
personal care aides
housekeepers
janitors
Without them to support physicians and nurses, upkeep the facilities, and to care for the patients, it would be incredibly difficult to maintain a quality health care system. Although health care support workers are necessary, their wages may demonstrate otherwise. An article published by Brookings notes that in 2019, the median wage for health care support workers is $13.48 per hour. (Kinder, 2020). Further in the article, a few health care support workers were interviewed about their experiences as COVID-19 front line workers, where many described feeling unappreciated and underpaid (Kinder, 2020).
Photo by Ehimetalor Akhere Unuabona from Unsplash
Photo by Alex Mecl from Unsplash
Personal Protective Equipment (PPE)
Early in the COVID-19 pandemic several news articles described the shortage of personal protective equipment (PPE) available to HCWs.
Examples of PPE shortage:
Many hospitals had to ration their supplies, leaving many of their staff ill equipped to combat the spread of disease (Jacobs et al., 2020).
Other hospitals had to rely on cloth masks, which have been determined as less effective in protecting HCWs than medical masks (MacIntyre et al., 2015).
Many HCWs were tending to patients without proper PPE, increasing their exposure to COVID-19 and other hazards. Lack of PPE may have contributed to the increase of HCW COVID-19 related deaths early in the pandemic.
Did the vaccine mandate contribute to the resignation rates?
HCWs who did not get vaccinated and did not voluntarily resign, were suspended for two weeks until compliance, and then fired if they were still non compliant after the two weeks.
According to the U.S. Bureau of Labor Statistics, terminations are included in their separations category and defined as “...layoffs and discharges includes involuntary separations initiated by the employer...” (2021). Therefore the total of terminated HCWs does not add to the total number of quits the U.S Bureau of Labor Statistics reported for September 2021.
Having to suspend and fire HCWs does exacerbate the hospital staff shortage, this was a problem before the mandate and continues to be a problem presently (Hsu, 2021).
ABC 10 from YouTube
Video where some health care protestors describe their opposition to the vaccine mandate (2:04m)
Interview with various health care administrators expressing concerns over HCWs labor shortage and repercussions of vaccine mandate (3:34m)
By Andrea Hsu from NPR
What more can health care administrations do?
The new agreement between Alliance of Health Care Unions and Kaiser Permanente shows a few examples of how administrators can provide better working conditions for HCWs. PeopleScout, an organization that provides talent acquisition and workforce management insight, has provided a few recommendations on how to retain HCWs. They focus on three areas for suggestions, during on boarding of new employees, maintaining engagement among current employees, and retaining current employees.
Here is a snippet of a recommendations they made:
Provide support structures for new hires
Establish professional development opportunities to learn and grow
Offer flexibility with work schedules to take into consideration complex life experiences (PeopleScout, 2021)
By implementing the requests of HCWs, similarly to how Kaiser did, and also including some recommendations from PeopleScout, it may address the retention of HCWs.
Conclusion
Increased Vulnerability Among non-White HCWS
Reported higher frequency of reusing PPE (Nguyen et al., 2020).
In July 2020 53% of COVID-19 cases were reported among people of color (Artiga et al., 2020).
Although HCWs are demanding change it is crucial to acknowledge that not all HCWs have the same opportunities. BIPOC HCWs are at a higher risk of infection and get paid less in supporting health care roles. Making it increasingly difficult for them to be able to afford resigning or striking. When advocating for better working conditions, it is important to elevate the voices of BIPOC HCWs and request equitable pay and proper protections be in place for all.
It is incredibly refreshing to see HCWs take control of their destiny by resigning and pursuing other career options. They are no longer feeling overwhelmed and putting their lives at risk caring for others when they do not have proper protections nor getting paid adequately. Although by quitting they are further perpetuating the HCW shortage, it is not their responsibility to recruit and retain HCWs. That responsibility is on the health care administrations. Looking forward to seeing the conclusions of the negotiation between Kaiser Permanente and their staff and witnessing what opportunities this opens for future HCWs.
Video Summary
Yessenia Villalobos from YouTube
Video that summarizes the content on the webpage (4:37m; link to video transcript)
References
ABC 10. (2021, August 2021). California Vaccine Mandate: Some vaccinated healthcare workers protest vaccine mandate [Video]. YouTube.https://www.youtube.com/watch?v=vlFhJJK3g4M
ABC News. (2021, October 12). Kaiser Permanente nurses union votes to authorize strike [Video]. YouTube. https://www.youtube.com/watch?v=U8wqSyZz8cU
Alliance of Health Care Unions. (2021, October 5). Where we stand: KP and alliance unions proposals at National Bargaining. Alliance of Health Care Unions. Retrieved 12, November 2021, from https://www.ahcunions.org/news/2021/10/4/where-we-stand-kp-and-alliance-unions-proposals-at-national-bargaining.
Artiga, S., Rae, M., Pham, O., Hamel, L., & Muñana, C. (2020, November 11). COVID-19 Risks and Impacts Among Health Care Workers by Race/Ethnicity. KFF. https://www.kff.org/racial-equity-and-health-policy/issue-brief/covid-19-risks-impacts-health-care-workers-race-ethnicity/
Centers for Disease Control and Prevention. (n.d.). CDC Covid Data tracker. Centers for Disease Control and Prevention. Retrieved November 5, 2021, from https://covid.cdc.gov/covid-data-tracker/#health-care-personnel
Coalition of Kaiser Permanente Unions. (2021). Strike wave hits Kaiser. Retrieved November 12, 2021, from https://www.unioncoalition.org/wp-content/uploads/2021/11/Strike-Wave-Hits-Kaiser-Permanente-no-local-edits-updated.pdf
COVID-19 Vaccination Requirement for Healthcare Providers and Healthcare Staff in Healthcare Settings. (n.d.). Oregon Secretary of State. https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=280799
Jacobs, A., Richtel, M., & Baker, M. (2020, March 19). Doctors Say Shortage of Protective Gear Is Dire During Coronavirus Pandemic. The New York Times. Retrieved November 12, 2021, from https://www.nytimes.com/2020/03/19/health/coronavirus-masks-shortage.html
How to engage and retain healthcare workers. PeopleScout. (2020, February 10). Retrieved November 19, 2021, from https://www.peoplescout.com/insights/engage-and-retain-healthcare-workers/
Hsu, A. (2021, September 23). Nurses Are In Short Supply. Employers Worry Vaccine Mandate Could Make It Worse. NPR. https://www.npr.org/2021/09/23/1039228806/nurses-are-in-short-supply-employers-worry-vaccine-mandate-could-make-it-worse
Huhtala, M., Geurts, S., Mauno, S., & Feldt, T. (2021). Intensified job demands in healthcare and their consequences for employee well‐being and patient satisfaction: A multilevel approach. Journal of Advanced Nursing, 77(9), 3718–3732. https://doi.org/10.1111/jan.14861
Kinder, M. (2020, April 10). Meet the COVID-19 frontline heroes. Brookings. Retrieved November 12, 2021, from https://www.brookings.edu/interactives/meet-the-covid-19-frontline-heroes/
MacIntyre, C. R., Seale, H., Dung, T. C., Hien, N. T., Nga, P. T., Chughtai, A. A., Rahman, B., Dwyer, D. E., & Wang, Q. (2015). A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open, 5(4), e006577–e006577. https://doi.org/10.1136/bmjopen-2014-006577
Nguyen, L. H., Drew, D. A., Graham, M. S., Joshi, A. D., Guo, C.-G., Ma, W., Mehta, R. S., Warner, E. T., Sikavi, D. R., Lo, C.-H., Kwon, S., Song, M., Mucci, L. A., Stampfer, M. J., Willett, W. C., Eliassen, A. H., Hart, J. E., Chavarro, J. E., Rich-Edwards, J. W., … Zhang, F. (2020). Risk of COVID-19 among front-line health-care workers and the general community: A prospective cohort study. The Lancet Public Health, 5(9), e475–e483. https://doi.org/10.1016/S2468-2667(20)30164-X
NSI Nursing Solutions, Inc. (2021). 2021 NSI national health care retention & RN staffing report. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf
OPB Staff. (n.d.). Deal struck: Kaiser Permanente reaches agreement with union workers, strike called off. OPB. Retrieved November 19, 2021, from https://www.opb.org/article/2021/11/13/deal-struck-kaiser-permanente-reaches-agreement-with-union-workers-strike-called-off/
United States Department of Labor. (2021, November 3). Employer-reported workplace injuries and illnesses – 2020. U.S Bureau of Labor Statistics. Retrieved November 5, 2021, from https://www.bls.gov/news.release/archives/osh_11032021.pdf
United States Department of Labor. (n.d.). Healthcare. Occupational Safety and Health Administration. Retrieved November 3, 2021, from https://www.osha.gov/healthcare
U.S. Bureau of Labor Statistics. (2021, October 12). Job openings and Labor turnover survey - August 2021. United States Department of Labor. Retrieved November 5, 2021, from https://www.bls.gov/news.release/pdf/jolts.pdf