More than 1,700 nurses at Robert Wood Johnson University Hospital (RWJUH) in New Brunswick, New Jersey, began a strike on Friday. The nurses’ main demands are increased staffing levels and a ratio of one nurse to every five patients, instead of the current one to six. The workers are also fighting for better raises, medical benefits in retirement and a limit on health insurance costs.

“It’s about safe staffing,” Carol Tanzi, a pediatric nurse, told News 12 New Jersey. “Getting nurses who are appropriately trained [is necessary] to take care of the very high acuity patients we have here,” she said.

Understaffing is a crisis in healthcare systems in general. A 2022 survey conducted by the Health Professionals and Allied Employees union found that 53 percent of nurses cited inadequate staffing levels as the reason that they either had left the profession or were considering leaving it. Among nurses with five or fewer years of experience, 95 percent said that they were seriously considering finding a new career.

The nurses are ready to strike for as long as necessary. “We are going to fight this fight,” Nancy Lipschutz, an adult critical care nurse, told News 12 New Jersey. “We want to protect our patients.”

RWJUH is the main hospital of Robert Wood Johnson Medical School, which is part of Rutgers University, a state institution. Each year, the hospital provides care for more than 30,000 inpatients and has more than 70,000 emergency room visits. RWJUH also has campuses in Somerset and Rahway, but they are not affected by the strike.

United Steelworkers Local 4-200 began negotiating with the hospital in April. When the contract expired on June 30, the union dragged its heels, keeping workers on the job and eventually signing a 14-day extension. Under pressure from the nurses, the USW finally held a strike vote on July 10. But instead of providing strike notice to RWJUH, the union negotiated an inadequate tentative agreement that the nurses quickly voted to reject. On July 21, the contract extension expired.

Still trying to block a strike, the USW held a seven-hour negotiating session with the hospital two days later, but the parties could not reach an agreement that the union thought it could force onto its members. The next day, the USW finally gave RWJUH the required 10-day strike notice. Another round of negotiations on August 1 produced no results, and the strike began yesterday.

The bureaucracy of the USW will do everything to isolate and betray the strike. To fight this, workers must form a rank-and-file committee at RWJUH that they themselves, and not well-paid union bureaucrats, control democratically. The nurses must reach out to the other healthcare workers at all RWJUH campuses and beyond for unity and support. Only on this basis can the nurses carry out a genuine struggle.

Last week, Robert Wood Johnson Medical School sent an email to second-, third- and fourth-year medical students urging them to volunteer if the nurses went on strike. The students would be “answering call bells, checking in on patients and supporting the replacement nursing staff,” wrote Dr. Carol Terregino, one of the deans at the medical school, in the email. They would not be paid or get credit for course work, she explained, but their absence from class would be excused.

The medical students rejected the attempt to get them to scab on the nurses. “We can’t even believe they are asking this of us,” a medical school student told Patch. “The school is framing this as an altruistic volunteer opportunity because ‘we care so much about our patients,’ when, in reality, it’s just a way for them to get free labor. The whole reason the strike is happening is because the nurses want to be paid more. Instead, they [want to] get us to work for free.”

By the night after the school sent its email, a petition by students denouncing the request had already gained hundreds of signatures.

RWJUH said that using student volunteers would be a temporary measure until replacement nurses are available. It is prepared to hire replacements for more than 60 days if need be.

The nurses’ strike at RWJUH is part of a movement of healthcare workers around the world. Many nurses worked through the early days of the pandemic with inadequate staffing and personal protective equipment. They now confront not only overwork and record levels of burnout, but also inflation and the rising cost of living. Through strikes and protests in the United Kingdom, Sri Lanka, Germany and the United States, and many other countries, healthcare workers are refusing to work under these intolerable conditions.

But these workers are also increasingly coming into conflict with the trade unions, which focus their efforts on isolating strikes and imposing terms favorable to the healthcare corporations and governments.

Resident physicians at RWJUH in New Brunswick recently had their own bitter experience with the Committee of Interns and Residents (CIR). Residents are the cheap labor of the healthcare industry and make as little as $15 per hour. The RWJUH residents’ contract expired on July 1, 2022, and the workers demanded increased wages and better mental health coverage. Instead of calling a strike, CIR kept the residents on the job for nearly a year. Finally, on June 21, 2023, the union announced a three-year tentative agreement that included below-inflation raises of less than 4 percent each year. The agreement also established a meaningless “task force” to address mental health coverage which amounts to a talk shop that does not commit RWJUH to any concrete actions.

In their fight for increased staffing and better nurse-to-patient ratios, the RWJUH nurses should take warning from the experience of the nurses in the neonatal intensive care unit (NICU) at Mount Sinai Hospital in New York. The NICU nurses documented persistent understaffing in their unit and used the contract that the New York State Nurses Association (NYSNA) had negotiated to take the hospital to arbitration.

The arbitrator found that Mount Sinai had understaffed the NICU by as many as six nurses for three months. He calculated a penalty but deducted 20 percent from it because of management’s alleged efforts to improve staffing. The resulting $127,057 fine was divided between 150 nurses, which meant that each received little more than a day’s pay for three months of overwork. Although NYSNA had praised the contract for its “historic and precedent-setting safe staffing enforcement,” this paltry penalty provides no incentive for Mount Sinai to hire more nurses for its NICU or any other unit.