Bernadette LaWare was seated on a patch of grass in front of Ascension Seton Medical Center Austin, sweating profusely and visibly tired. The 64-year-old, who’s been a nurse for more than half her life, was among hundreds of RNs who withstood a record-breaking heat wave to participate in the largest nurse strike in Texas history. LaWare was taking a brief respite from picketing, but her exhaustion was symptomatic of more than just the heat.
She became emotional as she described the challenges of working in a hospital environment in which the ratio of nurses to patients is lower than recommended by health authorities such as the American Nurses Association, leaving nurses to juggle the needs of multiple patients at once. “It’s really hard to explain how overwhelming the work can feel,” LaWare said, “the exhaustion that you feel.”
Other nurses in attendance, some of them still in scrubs, echoed LaWare’s frustrations. They were protesting stalled union contract negotiations, claiming that Ascension representatives were “dragging their feet” after 72 percent of the hospital’s nine hundred nurses voted to unionize in September of last year. Many of the nurses have called out the hospital’s staffing shortages and retention issues, saying hospital management has created an unsafe environment for their patients.
One nurse working in the labor and delivery unit described a situation in which she was assisting with a patient’s C-section before having to rush to another, whose fetus’s heart rate was rapidly decelerating, then getting pulled away from that patient to handle the induction of another—all medical issues that necessitate one-to-one care. Vanessa Villarreal, another nurse in the neonatal intensive care unit (NICU), where the recommended nurse-to-patient ratio is 1:2, said she’s often forced to make decisions that “break [her] heart,” like choosing between soothing a crying baby or feeding two others. “Everybody knows how hard it is just to take care of one baby,” said Villarreal, who moved from the border town of Laredo four years ago to Austin, where she thought the medical system would be better supported. “Imagine three or four babies.”
Fewer nurses being available poses a threat to patient care. Studies show that the likelihood of a surgical patient dying within thirty days increases by 7 percent for each additional patient that exceeds the baseline nurse-to-patient ratio of 1:4. Recommended ratios vary by unit, and most nurses at the strike said the hospital regularly eclipses those guidelines. “We’ve been so fortunate nothing has happened,” said Roni Beer, who’s been working in labor and delivery at “Seton Main”—as the hospital is still known by locals, though it became part of Ascension in 1999—since 2000, adding that it’s only a matter of time before someone gets hurt. In the meantime, she and other nurses are taking the brunt of the burden. Others have simply chosen to quit. “Since October, we’ve lost at least 25 nurses,” Beer said of her unit alone, which comprises around 60 nurses total. “They can’t deal with it.” She added, “It’s the worst it’s been.”
Nursing shortages are a nationwide crisis. Some 100,000 nurses have left the workplace in the past two years, and more than 600,000 others have indicated they intend to leave by 2027. While the labor crisis is often linked to the pandemic and its associated burnout, a New York Times investigation last year revealed that staffing shortages within the Ascension health care system—one of the country’s largest—were, to some extent, intentional. Ascension spent years reducing staffing in order to increase the so-called nonprofit’s profitability, the report found, laying the groundwork for the labor crisis that was compounded by the pandemic. Now the hospital conditions created by the nursing shortage are causing more to leave. As one nurse’s picket sign read: “It’s not a nursing shortage. It’s an exodus.” Representatives for Ascension did not respond to a request for an interview or to specific questions about the strike and conditions at the hospital.
Lexi Mort, 27, who started at Seton Main immediately after graduating from nursing school, and who described the labor and delivery unit where she works as “very unsafe,” is one of the nurses who’s decided she won’t stay. She intends to break her two-year contract before it’s up. “I’m from California, where there’s safe staffing and union hospitals,” she said. Referring to her current employer, she said, “We’re a union but we’re new. I know the conditions are going to be a lot better in California.”
In response to the strike, Ascension informed nurses that they would be locked out for an additional three days following their planned one-day strike because the staffing agency that the hospital used to supply temporary nurses requires a four-day minimum contract. But union reps believe the move is punitive.
Hundreds of nurses marching up and down 38th Street chanting “How is all your money spent? We can barely pay our rent!” were supported by honks from passing cars and semitrucks. U.S. Congressman Greg Casar and Texas state representative Gina Hinojosa, both Democrats from Austin, were among the local politicians who rallied in support of the nurses. Also present was the president of the National Nurses Organizing Committee, Sandy Reding. “Who is the backbone of the medical system?” Reding shouted, eliciting cheers from the audience. “Who is there when a baby takes their first breath when they’re delivered into this world? Who is there holding the hand of somebody who’s taking their last breath in this world?”
Eventually, LaWare had cooled down enough to join up with the marching throngs again. “Think we’ll give up that easy?” one sign read. “Ask us how long we wait to pee.”
A group of Seton Main nurses returned to the hospital on Wednesday morning, prepared to work, but they were blocked by security guards at the entrance.