Up to 16,000 NYC Nurses Prepare to Strike as Contract Talks Stall Over Staffing and Safety

The night before a possible mass walkout, ICU nurse Maria Alvarez* left her shift at Mount Sinai Morningside and headed not home, but to her union hall.

She said she had just finished 12 hours on a medical-surgical floor where, during colleagues’ meal breaks, she briefly covered 10 patients at once.

“It’s not that we want to leave our patients,” Alvarez said. “We’re at the point where the only way to make this safe is to draw a line.”

On Monday, that line could become visible on sidewalks across New York.

Up to 16,000 nurses at five of the city’s largest private hospitals are preparing to strike as early as Jan. 12 after contract talks with management stalled over staffing, pay, benefits and workplace violence protections. The walkout threat follows the expiration of contracts on Dec. 31 and months of bargaining that union leaders say have failed to address what they call unsafe conditions at the bedside.

If no last-minute deals are reached, the action would be one of the largest nurse strikes in New York City history and a crucial test of a state law meant to guarantee safe staffing in hospitals.

From 20,000 nurses to 16,000 — and a narrower battlefield

The New York State Nurses Association, which represents more than 42,000 nurses statewide, issued 10-day strike notices on Jan. 2 to 12 private-sector hospitals in the city and three Northwell Health hospitals on Long Island. The notices warned that nearly 20,000 nurses could walk off the job on Jan. 12 without new contracts.

Since then, the conflict has narrowed but intensified.

Over the past week, several smaller “safety-net” hospitals that serve large numbers of Medicaid and uninsured patients — including Flushing Hospital Medical Center, Maimonides Medical Center, Interfaith Medical Center and Kingsbrook Jewish Medical Center — reached tentative agreements with the union. Other facilities, such as Wyckoff Heights Medical Center, Richmond University Medical Center and The Brooklyn Hospital Center, rescinded their strike notices after progress in talks.

On Long Island, Northwell Health and nurses at Huntington Hospital, Plainview Hospital and Syosset Hospital struck tentative deals by Jan. 10, leading the union to withdraw its notices there as well.

That leaves the standoff centered on five large hospitals: Montefiore Medical Center in the Bronx; Mount Sinai Hospital on Manhattan’s Upper East Side; Mount Sinai Morningside and Mount Sinai West on the West Side; and NewYork-Presbyterian Hospital’s Columbia University Medical Center campus and related facilities.

NYSNA says nearly 16,000 nurses at those institutions remain prepared to strike if agreements are not reached.

“We are ready to settle fair contracts at the bargaining table, but hospital executives are giving us no choice except to prepare to strike,” NYSNA President Nancy Hagans, a critical care nurse at Maimonides, said in a recent statement. “Striking is always a last resort. What we’re asking for is safe staffing, fair wages, and protections from violence so we can provide the care our patients deserve.”

A fight defined by staffing and safety

While pay and benefits are on the table, nurses and hospital leaders agree that the most contentious issue is staffing — how many patients each nurse can be assigned and how those staffing levels will be enforced.

NYSNA is seeking contract language that sets specific nurse-to-patient ratios in emergency departments, intensive care units and medical-surgical floors, building on a 2023 strike settlement that secured enforceable ratios at Montefiore and Mount Sinai. The union says chronic understaffing leaves nurses spread too thin, endangering patients and driving burnout and turnover.

At some hospitals, nurses say, it is routine for one nurse to temporarily cover their own assignment plus a colleague’s during breaks, doubling the number of patients they are responsible for.

“This isn’t about being tired. It’s about being responsible for too many critically ill people at once,” said one Mount Sinai nurse who asked not to be named for fear of retaliation. “If your parent was in that bed, you’d want guaranteed staffing, not ‘we’ll do our best.’”

Hospital executives say they share the goal of safe staffing but argue that rigid ratios and automatic penalties could reduce flexibility and strain finances, especially during surges in respiratory illness or other emergencies.

In a joint statement about the looming strike, Montefiore, Mount Sinai and NewYork-Presbyterian said they were “bargaining in good faith” and accused the union of planning a walkout that would “recklessly put patients at risk.”

“Leaving the bedside is not in the best interest of patients, especially during a busy winter season,” the statement said. The hospitals said they had offered what they called competitive wage increases and staffing commitments, and accused NYSNA of pressing for “extreme economic proposals.”

The Greater New York Hospital Association, an industry group, has warned that steep federal funding cuts and rising costs are already pressuring hospitals, and says nurse wages in the city are already higher than those of many other essential workers.

Pay, benefits and claims of “hospital greed”

The economic gap between the two sides is wide, and both are using stark numbers to make their case.

Union officials say the city’s largest private systems — Montefiore, Mount Sinai and NewYork-Presbyterian — can afford stronger staffing and benefits. They point to public financial filings showing that the three systems collectively held about $1.6 billion in cash and cash equivalents as of September, roughly double their levels in 2017 when adjusted for inflation.

NYSNA also criticizes executive compensation and hospital expansion plans. At Northwell, which is not part of the remaining strike threat but is New York’s largest private employer, the union says the 20 highest-paid executives received more than $36 million in 2023, even as nurses complained of unsafe ratios.

“Hospitals say they’re broke when they’re at the bargaining table, but they have no problem spending tens of millions on executives, real estate and acquisitions,” Hagans said. “They’re even willing to pay almost $100 million a week for temporary travel nurses during a strike instead of investing in permanent staff.”

Hospitals dispute the union’s framing. In one recent public statement, Mount Sinai characterized NYSNA’s initial wage and benefit demands as so costly that they would amount to six-figure average compensation increases per nurse and push some to more than $270,000 a year in total pay and benefits. The union calls those figures misleading, saying they bundle pensions, health insurance and employer taxes and do not reflect base salary.

The precise terms on the table at each hospital have not been made public. Both sides say they remain at the bargaining table with mediators.

Violence inside hospitals adds urgency

Layered onto the staffing and pay dispute is a growing focus on workplace violence.

On Jan. 8, New York City police shot and killed a man at NewYork-Presbyterian Brooklyn Methodist Hospital after officers said he barricaded himself in a room with a patient and a security guard while wielding a sharp object. Police said Tasers failed to subdue him before officers opened fire.

The incident followed earlier episodes that nurses describe as assaults or threats by patients and visitors, and an “active shooter” situation at Mount Sinai referenced by the union. NYSNA is pushing for explicit contractual language on hospital security protocols, de-escalation training and staffing patterns meant to reduce chaotic, potentially violent conditions, especially in emergency departments.

“Violence is not ‘part of the job,’ but that’s how it feels some days,” said a NewYork-Presbyterian nurse who was not authorized to speak publicly. “We need real plans and enough staff so we’re not alone in a room when things go sideways.”

NewYork-Presbyterian has said it is cooperating with investigations into the shooting and that “the safety of our patients, visitors and staff is our top priority.”

A law — and a previous strike — on the line

The showdown is also a test of a 2021 New York law that requires hospitals to create joint labor-management staffing committees, file staffing plans with the state Department of Health and meet minimum nurse coverage standards in critical care units.

The 2023 strike involving 7,000 NYSNA nurses at Montefiore and Mount Sinai produced contracts that turned some of those plans into enforceable ratios with financial penalties for violations. The union now argues that hospitals are seeking to weaken or sidestep those enforcement mechanisms in new contracts, while hospitals say they remain committed to safe staffing within the law’s framework.

Labor experts say whatever emerges from the current talks is likely to influence negotiations well beyond New York.

“New York City is a bellwether,” said one health policy researcher who studies nursing strikes. “If nurses here secure strong, enforceable staffing and safety language at major academic medical centers, you can expect unions across the country to try to replicate it.”

Hospitals prepare, city braces

Hospital systems say they are preparing contingency plans to maintain services if nurses walk out. Those plans include hiring temporary travel nurses, reassigning nonunion staff to inpatient units, transferring some patients to other facilities and postponing elective procedures.

The New York City Office of Emergency Management has said it is coordinating with hospitals and ambulance services to ensure emergency care remains available and to redistribute patients if needed.

Nurses argue that relying heavily on short-term replacements who are unfamiliar with the hospitals and their communities will itself create risk.

“You can’t just plug in strangers and expect the same level of care,” Alvarez said. “We know our patients, we know our units. That’s what we’re fighting to protect.”

As bargaining teams met through the weekend, both sides said they hoped to avoid a strike. But on the sidewalks outside the hospitals, picket signs were already stacked and ready.

By Monday morning, New Yorkers will find out whether some of the city’s most storied medical centers start the week with nurses at the bedside — or on the picket line.

*Name changed at source’s request to protect employment.