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By Bob Hennelly 

Earlier this month, rank and file members of HPAE—New Jersey’s largest nurses’ union working at three different hospital systems—voted to authorize strikes if they didn’t get provisions in their contracts guaranteeing safer staffing ratios. 

It looked pretty grim. HPAE is a small union compared to the United Autoworkers which managed to have a successful strike against all three of the nation’s biggest automakers, simultaneously reversing a generation of concessions.

Contracts at Englewood Hospital Medical Center, Cooper University Health Care, and HMH Palisades Medical Center expired on Friday, May 31. Within a matter of days, HPAE managed to win and ratify new contracts at Englewood Hospital and Medical Center, as well as Cooper University Health Care.

In the Englewood Hospital and Cooper University Health Care pacts, a resolute HPAE won both substantial wage gains, in addition to enforceable safer staffing ratios.

“Enforceable staffing ratios mean limiting the number of patients a nurse can care for at any given time,” said Debbie White, RN and HPAE president. “We congratulate Englewood and Cooper for agreeing with their nurses on this safe staffing language. In both hospitals, ratios will lead to improved reimbursements and less turnover of staff, so safe staffing also saves hospitals money.”

"We need to be able to care for our patients, to help them recover and return them to their loved ones. That is what motivates us every day when we come to work," said Doris Bell, RN, and president of HPAE Local 5118 at Cooper University Health Care, which represents 1,500 nurses. "We are determined to improve patient care by setting safe staffing ratios across our hospital, ones that can be enforced through our contract.” 

"Safe Staffing ratios will help us recruit new nurses as well as retain the nurses we already have, so they can grow in their profession to train the next generation of nurses while providing care to families in our communities," said HPAE Local 5004 President Alice Barden, RN, of Englewood Hospital & Medical Center.

Just a few days later,  HPAE Local 5030, representing 800 nurses and other healthcare titles, reached a tentative agreement after four long contentious months of bargaining with management at Hackensack Meridian Health’s Palisades Medical Center in North Bergen, NJ.

Last week, HPAE Local 5030 members overwhelmingly ratified what was an historic contract with Hackensack Meridian Health. For the first time ever in the hospital’s history, it established patient-to-staff ratios, as well as nine to 15 percent wage increases over the life of the contract.  

Now, patients and their families can be assured safer staffing with Med/Surg having a 1 nurse to 5 patient ratio; a 1 to 2 ratio in critical care, as well as a 1 to 4 ratio in Special Care Nursey.

The ER will now have one triage registered nurse along with five other registered nurses at 7 a.m.; eight RNs from 11 a.m. to 7 p.m.; and five RNs at 11 p.m. The contract also includes a commitment to hire as many as 50 additional staff— including 29 RNs. 

And there’s more. This new contract gets the union workforce a meaningful seat at the table with a provision that requires the hospital’s chief nursing executive and the local union president to discuss staffing guidelines for other departments and units where gaps have been a problem. 

“The staffing and economic gains in this contract will significantly reduce stress on the job for these dedicated healthcare workers—and go a long way in helping us retain staff in this hospital,” White said. “We hope this agreement means that HMH recognizes that the staff are the hospital's most valuable asset and should be nurtured and supported."

“We demanded safe staffing ratios in our contract to benefit our patients, to help us better care for them,” Tara Rojo, HPAE Local 5030 said. “It is a relief to finally put this behind us so we can get back to our jobs.”

Ever since California enacted such standards in 2004, and a few other states followed suit, independent medical research has documented better patient outcomes, a lower rate of hospital readmittance, reduced workplace injuries, better infection control, and increased nurse retention. 

It’s common sense that safer staffing would mean improving both the patient and healthcare workforce’s well-being. Yet, in a multi-billion dollar industry increasingly defined by the short term bottom line that pays its C-Suite millions, it’s the pursuit of profits that informs staffing decisions. Here in New Jersey and most of the rest of the country, the for profit health care system resisted fiercely both unionization and staffing requirements. The two are very much linked.

Our health care system in New Jersey and across the nation did not hold up well during COVID. The U.S. has 4% of the world's population, but at least 12% of its COVID deaths. Multiple peer-reviewed studies have documented the lack of N-95 masks and proper staffing in our health care system helped drive the infection and death rate, particularly in underserved communities of color. 

Even before COVID hit, killing 1.1 million Americans—including at least 3,600 healthcare workers—nurses had been voting with their feet by walking away from the hospital bedsides by the many thousands because they didn’t want to suffer the moral injury of having to try to do their jobs in ways that let down their patients and their families.

Nationally, that means that over one million nurses have sidelined themselves from the hospital bedside. New Jersey has 147,000 nurses licensed and only about half are working. Hospitals have become revolving doors for nurses because New Jersey has a shortage of staff willing to work under the current stressful conditions.

Yet, here in New Jersey and most of the rest of the country, the for-profit health care system resisted fiercely both unionization and staffing requirements. The two are very much linked.

Historically, Hackensack Meridian has always played hardball.

Hackensack is affiliated with over 4,500 physicians and has close to $7 billion in revenues and paid its CEO Robert Garrett an eye-popping $5.2 million a year. Of course, Hackensack is technically a non-profit, but with that kind of pay for their CEO and other executives, you’ve got to wonder where they are willing to squeeze to make their numbers.

In 2022, the National Labor Relations Board (NLRB) ruled that Hackensack Meridian Health had  failed to bargain with the nurses union in good faith. 

“Adam Witt, HPAE Local 5058 president, was terminated on April 5, 2020,” according to HPAE.  “The union disputed the termination and filed a whistleblower charge with the Occupational Safety and Health Administration (OSHA), as well as a charge of retaliation with the NLRB for the termination. In addition to firing Witt, HMH also posted his photo at all entrances informing everyone entering that he is not allowed to enter the Jersey Shore University Medical Center. 

“There was a level of disrespect shown throughout the previous negotiations that did not benefit anyone,” HPAE’s White said in a statement at the time. “The ‘one-size-fits all’ approach on policies that HMH has forced on workers, the refusal to bargain, and the bypassing of labor law has created a difficult environment for our members. We hope this NLRB decision will help HMH understand the need to develop a better relationship with their union members.”

In 2022, Michael Diamond, reporting for the Asbury Park Press, reported that Hackensack Meridian Health’s Jersey Shore University Medical Center “unlawfully interrogated employees and offered benefits during a union's organizing campaign in 2020.”

Diamond further reported, “The hospital and its parent company, Hackensack Meridian Health, also hired a third party that falsely claimed to be neutral government agents during mandatory meetings.”

"It is the right of employees—and not their employer—to decide whether or not they will be represented by a union," Suzanne Sullivan, the NLRB's regional director, said. "Workers must be permitted to exercise this right freely, unencumbered by employer intimidation or coercion.”

The Hackensack Meridian Health press office did not respond to an email seeking comment.

For decades now, unions have been complaining that when it comes to violating labor law, companies like Amazon see violating it—and the minimal sanctions they might get hit with—as just the cost of doing business. So, workers can indeed win a union election and the right to bargain, but the employer can slow walk their response for months, and even years until the union drive collapses.

This case of Hackensack Meridian Health using consultants to pose as federal labor officials would seem to have crossed the line.

“Whoever falsely represents himself to be an officer, agent, or employee of the United States, and in such assumed character arrests or detains any person or in any manner searches the person, buildings, or other property of any person, shall be fined under this title or imprisoned not more than three years, or both,” reads USC 18 Chapter 43 False Personation.

HPAE was trying to organize housekeepers, technicians and other services workers. Whether or not they were legal, the tactic of having union busting consultants pose as federal labor officials was effective. Jersey Shore workers voted 585 to 246 against joining the union. 

No federal criminal charges were brought. The sad reality is that when it comes to U.S. labor law, corporations know it’s more a suggestion than a requirement and there’s absolutely no real world consequences for violating it.

So, what accounts for HPAE’s recent success in navigating what could have been three separate strikes? Could it be the ground is shifting post-COVID in labor’s direction?

No doubt, the struggle and sacrifice of United Steelworkers Nurses Local 4-200, who went on strike from August to December at Robert Wood Johnson  University Hospital in New Brunswick for safer staffing, helped to radically alter the power dynamic where New Jersey’s politically connected hospital behemoths could run the table with a few phone calls and multi-million dollar ad campaigns.

The RWJBarnabas system is a not-for-profit health care giant with a dozen acute care hospitals and a partnership with Rutgers University. The system has 38,000 employees and $6.6 billion in revenue. It relies on hundreds of millions of dollars in tax-exempt state issued bonds for capital construction.

The system's now retired CEO and president, Barry Ostrowsky, earned $16 million in the second year of the pandemic, making him the highest paid hospital executive in the New York area, according to Crain’s New York. RWJ spent well over $150 million in replacement nurses in a bid to break the union. 

In the middle of the strike, George Helmy, Gov. Phil Murphy’s chief of staff, went to work for RWJBarnabas.

The battle for safer staffing continues in Trenton, where the nurses’ unions, patient advocates, and consumer groups like Citizen Action are trying to get the legislature to codify in law basic staffing ratios.

It all comes down to the power of collective action as exemplified by the 1,700 members of USW Local 4-200 under the leadership of Judy Danella. They knew safer staffing saves lives and the lack of it killed too many of their colleagues around the country and too many of us. So, they went on strike to get it and they got RWJBarnabas to move in the right direction.

As their parent union says "It hasn't always been easy but nothing worth doing is. In fact, the hottest fires forge the hardest steel."