About 900 nurses and 500 other employees are working without a contract at University Hospital in Newark, New Jersey. Health Professionals and Allied Employees (HPAE), affiliated to the American Federation of Teachers (AFT), the union to which these workers belong, has not held a strike vote, even though the contract expired on September 30. Instead, it is keeping its members on the job while it continues to negotiate with hospital administrators. 

University Hospital workers must be warned that HPAE plans to betray their interests and enforce the hospital’s demands. Preventing such a betrayal will require the nurses and staff to take the initiative away from the HPAE leadership by forming a rank-and-file committee. 

University Hospital is a 519-bed medical center and Level 1 Trauma Center owned by the state of New Jersey. It is the main teaching hospital for Rutgers New Jersey Medical School and a major provider of healthcare for Newark, which is the state’s biggest city. Many of the predominantly working class city’s residents have low-wage jobs, and 24.4 percent of Newark residents are living in poverty. 

The main demand of the University Hospital nurses is safe nurse-to-patient ratios. The workers are calling for a limit of five patients per nurse. No less important is the nurses’ demand for increased pay to keep up with the rising cost of living, especially food prices. 

The medical literature has demonstrated that better nurse-to-patient ratios are associated with improved patient outcomes, including reduced mortality risk. Lower nurse-to-patient ratios are also associated with improved quality of care and a reduction in workplace injuries. Along with adequate staffing levels, low nurse-to-patient ratios reduce overwork and encourage staff retention. 

The demand for safe staffing has motivated an upsurge in healthcare workers’ struggles worldwide in the past few years. The SARS-CoV-2 pandemic has only exacerbated the long-standing problem of understaffing at medical facilities. Since 2020, many nurses have retired early, left the bedside or left the nursing profession entirely. About 146,000 nurses are licensed in New Jersey, but only about 78,000 nurses are willing to work, according to HPAE. Stress, overwork and burnout are persistent problems among the nurses who remain on the job. 

Negotiations between HPAE and University Hospital have continued since July. “No member ever wants to go on strike, but we will do whatever it takes to bargain a contract that provides the best language to recruit and retain staff,” said Debbie White, RN, president of HPAE, in a statement on the day that the contract expired. In plain terms, White’s message is that HPAE will do everything it can to prevent a strike and impose the most pro-hospital agreement possible on its members. 

In its own revealing statement, University Hospital observed that “this contract has historically remained the subject of negotiation well past expiration. ...” This is an acknowledgment that HPAE has repeatedly prevented strikes at the hospital and collaborated with administrators against the interest of its own members. 

It is noteworthy that in calling for a contract that codifies nurse-to-patient ratios, the HPAE leaders are citing Robert Wood Johnson University Hospital (RWJUH) in New Brunswick as a model. Nurses at that hospital waged a determined strike for more than four months, only to be starved out and betrayed by the United Steelworkers (USW). Their current contract allows RWJUH to maintain understaffing of 18.5 percent without incurring a penalty. It also caps fines at $2 million per year, which is pocket change for a health system that reported total revenue of $8.6 billion in 2023. These terms allow RWJUH to cut costs and expose nurses to overwork and patients to the risk for worse outcomes. 

Like the USW, HPAE is marshaling nurses to call on state legislators to pass a safe staffing law. In January, the union brought nurses to the State House in Trenton to appeal to lawmakers directly. Specifically, HPAE leaders are promoting the Patient Protection and Safe Staffing Act, which was introduced in February. The bill would set nurse-to-patient ratios of 1:4 in medical/surgical units or emergency rooms, 1:3 in labor and delivery units and 1:2 in critical care, intensive care, neonatal and burn units. 

The purpose of the HPAE’s initiative is to sow illusions in the possibility of legislative reform among nurses. Bills like the Patient Protection and Safe Staffing Act have been introduced in the New Jersey Senate each year for the past 20 years. They have each died in committee, never reaching the full Senate (let alone the Assembly) for a vote. California and Oregon have mandated staffing ratios through state law, but these laws—like labor law in general—are poorly enforced. The Democrats and Republicans alike represent the interests of the corporate health systems, rather than those of healthcare workers or patients. In consequence, hospitals flout safe staffing laws with little fear of punishment. 

Besides organizing futile appeals to capitalist politicians, HPAE also collaborates with hospital administrators to divide workers and prevent strikes. In May, nurses at Englewood Hospital and Medical Center, Cooper University Health Care and Palisades Medical Center (which is part of Hackensack Meridian Health) voted overwhelmingly to strike for safe staffing ratios. But HPAE did not call a strike at any of these facilities. Instead, it reached agreements with Englewood Hospital and Cooper University that will not guarantee the ratios that nurses and patients need. Moreover, HPAE divided workers at these hospitals from those at Palisades instead of waging a more powerful, unified struggle. In the end, HPAE endorsed agreements with which hospital administrators were comfortable, at the expense of the nurses. 

In 2020, HPAE prevented a strike of about 1,200 workers at Jersey Shore University Medical Center (JSUMC) and kept them divided from workers at Southern Ocean Medical Center. Both facilities are owned by Hackensack Meridian Health, and workers at both sites were without a contract at the same time. One consequence of HPAE’s betrayal was that, in 2022, most nurses at JSUMC reported that they wouldn’t feel safe being treated at their own hospital. 

The nurses and staff at University Hospital must draw the appropriate conclusions from these experiences. If they are to win scientifically grounded nurse-to-patient ratios and wages that keep up with the rising cost of living, then they must wrest control of their struggle from the HPAE leadership. The first step is to form a rank-and-file committee that the workers themselves control democratically. Through such an organization, the workers can develop a strategy for winning their demands and appeal to healthcare workers and workers in other sectors for support.