× Expand Gene Johnson/AP Photo Swedish Medical Center nurses and other workers picket outside the hospital’s campus in Seattle, January 2020.

On January 28, a group of nearly 8,000 nurses, technicians, and other employees of Swedish Hospital in Seattle, Washington, went on strike for the first time in the hospital’s history. Their union, SEIU Healthcare 1199NW, claims it’s the largest health care strike in at least five years.

When the workers returned three days later to resume their work, however, many were turned away. Standing in cold, heavy rain, they were told they wouldn’t be let inside. Instead, the hospital said it had to honor a five-day contract with the replacements it had brought in to do work in their stead.

But at least some of those replacements weren’t properly licensed. When looking for the names of the strikebreakers in the Washington State Department of Health’s registry of credentialed health workers, no records appear for some of the substitutes. Even if they have a new license or a license is pending, their names would appear in the database; instead no records can be found.

In response, a spokesperson for Swedish emailed, “Everyone we contracted with during the strike period obtained all necessary and required licensing.” She did not explain how it is that some of the replacements don’t appear in the state’s licensing database.

The hospital’s unionized workforce took this as another sign that Providence, the giant Catholic hospital chain that controls Swedish, isn’t prioritizing patient safety, the very concern at the heart of why they went on strike. They say that after Providence took over, management has failed to create a safe environment for patients and staff alike.

As is required, hospital staff gave Swedish ten days’ notice about their strike, in hopes that management would use that time to bargain so they could avert the walkout. Instead, the hospital spent at least $11 million to bring in replacement workers. Swedish staff only planned a three-day strike because that’s what they felt members could afford. The hospital had to close two emergency rooms and one labor-and-delivery unit.

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“We felt that they would let us back in and open back up the hospital for the health and well-being of our community,” said Delores Prescott, a charge nurse at Swedish. “We were very surprised that they felt the need to be that stubborn.”

In response to the workers’ allegations that they were locked out, the Swedish spokesperson said, “To continue to provide care for patients during the period SEIU-represented caregivers were on strike, we brought in experienced and qualified replacement staff. Our contracts with the agencies required that we guarantee the replacement workers five days of work,” adding, “A five-day guarantee is standard practice in this industry. The two-day transition minimized patient disruption as the patient population grew and more caregivers were brought back based on need. Despite what the union says, we were not engaged in an unlawful lockout … Our doors were open and we were allowing caregivers to work.”

As of Sunday morning, everyone was back at work. But a two-day lockout has consequences. Laura Wood, a social worker at Swedish, reported to her campus with about 350 co-workers on Friday morning, who linked arms and tried to walk in. They were told to enter in small groups of five to ten people, but as each checked in, they were told they weren’t needed that day. That felt “very cold, very demoralizing,” she said. Several co-workers were in tears after being told not to work.

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The lockout “just reconfirmed that the folks in charge right now at Swedish and at Providence don’t have the interest of patients in mind,” said Robin Wyss, secretary-treasurer at SEIU 1199NW. “It’s going to take workers standing up for patients for things to get better.”

Providence is a large hospital chain, operating 51 facilities across eight states, that made $970 million in profit for the first three months of 2019 and had $15.5 billion in net assets. It took over Swedish in 2012. There has been a recent wave of this kind of hospital consolidation in recent years—there were 870 such deals between 2010 and 2018. Despite promises that merging companies would improve the quality of care, that doesn’t seem to be the case; instead, some studies have found that mortality and major health setbacks increase as competition drops.

After Providence took over, there was “cut after cut to both nursing staff and all of the other ancillary staff that helps contribute to patient care,” Wyss said. Staffing in the labor-and-delivery department was reduced such that nurses were assigned to two women in the first stages of active labor rather than focusing on one at a time. The hospital got rid of the entire specialty IV team, which led to “people being poked multiple times,” Wyss said. There isn’t a social worker available for the emergency room 24/7 as is the industry standard. Sitters, who stay with patients dealing with mental illness or drug abuse, have dwindled even though the hospital had previously committed to having one for every patient who needs it. Even the cafeteria has been reduced such that food is only available at certain hours, not around the clock. There isn’t enough cleaning staff, workers say, to turn rooms over fast enough or to adequately deal with garbage piling up.

And yet the hospital’s services are even more in demand. “Our population of patients continued to get so much more sicker, so much more difficult,” Prescott said. Increased drug use in the city has put a strain on resources and required more complex treatment than just diagnosing and treating an injury or illness.

“We acknowledge that staffing issues are important,” said Margo Bykonen, chief nursing officer at Swedish. “We must work together to find long-term solutions to challenges, such as recruiting enough nurses into the pipeline, retaining qualified staff, and continuing to upskill our workforce.” The Swedish spokesperson also noted, “In our proposal to the union, we proposed adding new positions to address specific needs that have been identified at our hospitals as well as a stronger voice for caregivers in the staffing committee process that determines appropriate staffing levels for the units.”

Workers say that even the quality of their raw materials has declined. IV tubing is so shoddy that it breaks while giving medication, which can mean, for example, chemo dripping onto patients instead of going into their veins.

Prescott has been working as a nurse at Swedish for 18 years. When she first started her job, “The environment was so positive,” she recalled. “The culture that we had … was so pro-employee.” But soon after Providence acquired Swedish, she said, staffing became a big issue and quality started to decline. Prescott witnessed “a continued deterioration ever since Providence took over.”

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“We’re bleeding nurses, we’re bleeding techs and social workers,” Wood said. “The staffing ratios are completely unsafe here.” She’s had patients and their family members ask her if they were safe at the hospital. “Those are really stressful conditions to work under,” she said.

That’s why, when the union went into the bargaining process for a new contract a year ago, one of its core demands was a commitment from management to increase staffing and address patient and provider safety—one more example of the wave of labor actions falling under the rubric of “bargaining for the common good.” They are also asking for pay raises and better benefits. As housing costs skyrocketed in Seattle, “a lot of nurses … felt that they could not live close to the hospital because of the pay that they were receiving,” Prescott said. It’s not just a hardship for people already on staff; it makes it harder to attract and retain new people. “There is no reason for them to come, and if they do come and get experience, there’s no reason for them to stay,” she said. On top of the insufficient pay, the company has taken away dental and vision coverage and increased the deductibles on its health care plans.

The strike was a last resort. “This strike was not something that any of us wanted,” Prescott said. But they decided to do it because “we’ve done every action possible, we’ve done everything that we can, and we’re still not getting any real agreement from management.”

Going on strike was “bittersweet,” Wood said. “We want to be here at the hospital caring for our patients, that’s what we signed up to do.” But it became clear that even after management made some concessions on pay, they weren’t moving on staffing levels. “That is the biggest thing,” Wood continued. “If money was all we were fighting for, that might be something we could have settled for. But we need safer conditions for our patients and ourselves.”

Now they’re back to work, but the fight isn’t over. Things are still tense between employees and management. “If anything, they doubled down since we’ve been back,” Wood said. “Now we’re seeing retaliation.” She said that her manager is trying to “exert more control” and is no longer letting others approve overtime without sign-off.

Some workers are prepared to strike again if management still won’t budge. “We don’t know what the future is going to hold,” Wood said. “I know we’re going to hold their feet to the fire and continue with our actions … We want to make the hospital better and they’re just refusing to put the money into where it needs to go,” she added. “Our community is suffering.”