Theresa Brown , 2025-12-12 09:30:00
There is plenty of bad news about health care these days — insurance companies refusing to pay for necessary care, astronomical drug prices, and hospital staff shortages — but there are still some reasons for hope. I first wrote about nurse staffing problems in The New York Times in 2010. Then, new research revealed a scary fact: When nurses are overworked, more patients die.
But recently in Pittsburgh, where I live, 860 registered nurses and advanced practice nurses at UPMC Magee-Women’s Hospital decided they’d had enough and voted to unionize, joining the Service Employees International Union (SEIU). As a nurse who has also worked too many shifts with too few staff, I can say that unions in health care are a reason for optimism.
The Magee nurses’ number one complaint echoed the objections of nurses around the country: They couldn’t care for patients the way those patients needed, and the hospital administration didn’t listen. Magee-Women’s Hospital is best known locally for its labor and delivery unit, and many Pittsburghers were either born at Magee themselves or have children or grandchildren who were. It’s a storied hospital and also the first hospital in the UPMC system to vote to form a union.
In their decision to unionize, the Magee nurses are following a national trend. From 2000 to 2024, union membership declined across the country, except in education and health care, where it grew by 0.2%. And it’s not just nurses joining unions: Roughly 400 physicians in the Allina Health Care System voted to form a union in 2023. A division of the SEIU that represents interns and residents now represents 81% of doctors-in-training in the Philadelphia area and has local chapters across the country. And in Jan. 2024, a group of health care workers at Sunrise Hospital in Nevada — including pharmacists, speech pathologists, and social workers — voted to unionize. National Nurses United, with a membership greater than 225,000 nationwide, is the largest union of registered nurses in the country.
Unions improve working conditions, which leads to better patient care. Research shows that nurses in union hospitals earn higher wages than nonunion nurses, tend to stay in their jobs longer, and have safer staffing ratios. Patient outcomes also tend to be better in union hospitals.
I spoke with some of the nurses who led the organizing effort at Magee and learned that their frustration had been building since the pandemic. Jean Stone, a member of the obstetric resource team, said nurses were overworked before Covid-19, but during the pandemic, their loads became impossible.
“Pre-Covid we were slammed all the time,” she said. “In Covid, it was apocalyptic.”
Many American health care workers hoped for a reset after the pandemic, a recalibration to make the system more responsive to patients and staff. Instead, many hospitals doubled down on increasing their profits and disregarding their employees’ needs. “Things did change after Covid. They saw what they could get away with [in terms of overwork],” Stone said.
For example, Magee had been giving nurses incentive pay to work extra shifts, but even as the pandemic continued to rage, the hospital ended the extra pay, leaving the nurses overworked and underpaid. Lucy Rose Ruccio, a neonatal nurse practitioner at Magee, said that the inadequate staffing meant the neonatal ICU staff were busy “putting out fires” instead of following through on more routine matters.
She described a chilling scenario where a baby in the NICU needed phenobarbital to control recurrent seizures. However, because the hospital’s electronic medical records system didn’t automatically continue listing patients’ prescribed drugs, the phenobarbital disappeared from the baby’s list. The error wasn’t caught for several days, when the medicine was restored. The baby was fine, thankfully. But it is easy to imagine an oversight like this ending tragically for another struggling neonate or a different fragile patient.
Like many national health care companies, UPMC is highly profitable and generous with executive compensation, but not frontline staff. In the fiscal year that ended in 2024, 25 executives at UPMC earned over $1 million a year. Retired UPMC CEO Jeffrey Romoff was paid $29.9 million in fiscal years 2023 and 2024, even though he had already left the company. (UPMC did not respond to requests for comment.)
Hospital executives around the country operate in an environment of abundance, while the frontline staff sweat it out in an environment of scarcity. That imbalance typifies the corporatization of health care in the U.S. Because nurses are hospitals’ chief labor cost, cutting the number of nurses is an easy way to boost revenue, and hospitals make these cuts, even as they pursue national rankings. Magee ranks 32nd nationally in U.S. News and World Report ranking on obstetrics and gynecology, but the hospital’s staffing is ranked “poor,” the lowest possible rating. Alix Levy, an emergency department nurse at Magee, captured the national feeling of malaise among nurses. “American health care is in a race to the bottom,” she said. “That’s how it feels writ large.”
The union vote, though, is giving the nurses hope, said Levy. “We did this one good thing, and that can’t be taken away.” Nationally, the importance of nurse staffing to quality care is getting acknowledged: This fall, for the first time, the Joint Commission added nurse staffing to its National Performance Goals of hospital accreditation. The Magee nurses look forward to crafting their union contract, because, as Ruccio said, “it just became increasingly clear that we could no longer effect meaningful change on our own.”
If corporate greed is the sickness ailing our health care system, unions could be what the nurse ordered to cure it. That, to me, feels incredibly hopeful.
Theresa Brown is a nurse, the author of “The Shift” and “Healing,” and a frequent contributor to The New York Times.
