“By 3:00 PM most days, the emergency room is often exploding with patients. Hospital gurneys stand inches apart. When beds run out, patients squeeze into tightly packed chairs. When the chairs run out, patients must stand. We go home feeling like failures. There are times when you can’t sleep because you’re thinking: ‘Did I do anything wrong today?’”
Benny Matthew’s testimony is nothing short of heartbreaking. As one of the 7,000 nurses that went on strike in New York City in January, he joins the tens of thousands of nurses nationwide who have gone on strike over the last year. In 2022, nursing strikes made up a quarter of the top 20 work stoppages, and one-third of all nurses planned to quit by the end of the year. They are burnt out and exhausted—and how could they not be?
At the height of the coronavirus pandemic, there was a push to recognize the contributions of nurses and other essential workers. People clapped on their balconies in New York City and posted thank-yous on social media, but their performative actions eventually subsided. What did not, however, were the nurses’ workloads; in the midst of shortages, nurses received little institutional support. That was 2020. Three years later, nursing, like many other female-dominated care professions, remains dramatically undervalued.
Judy Sheridan-Gonzalez, the president of the New York State Nurses Association, notes that nurses serve on the “front lines of a dysfunctional medical system they have no say in.” Suffering violence from patients’ frustrated family members and constantly blamed by hospital administrations, nurses feel intensified agony and despair when preventable deaths occur because of underfunding. With no time to emotionally process, they have to push down their grief and move on to the next patient. The undervalued emotional labor that permeates women’s experiences is not endemic to health care alone. Gemma Hartley characterizes this labor as invisible, arguing that women in these positions are not only responsible for shouldering emotional burdens but also face pressure to stay pleasant while doing so.
Our health care system is not set up to value this work. Nurses receive petite paychecks despite their colossal workloads. Many American hospitals run on a fee-for-service system, meaning they charge money for every service a doctor performs, not a nurse (for example, patients are charged for MRIs, but not routine vitals checks). Such a system is inherently problematic because it adopts a myopic view of the meaning of healthcare: Doctors are seen as valuable revenue-makers, while nurses are taken for granted in supportive roles.
When faced with budget cuts, nurses are first on the chopping block. Even when faced with a budget surplus, hospitals consistently invest money into administrative and self-serving ventures instead of changes that increase the quality of patient care. Men represent 85 percent of hospital CEOs who are making these choices. They are choosing to invest the money in themselves instead of giving nurses, 90 percent of whom are women, their fair share.
Likewise, our healthcare system is wickedly woven into a patriarchal society that suggests that “women’s work” is less economically valuable than men’s. Physicians are paid, on average, over $200,000 annually and nurses around $80,000, an unsurprising discrepancy given that women make up only 36 percent of physicians as opposed to 86 percent of direct care workers (e.g., nurses). These statistical gaps between salary and vocation are correlated. There is not a single occupational group in which women are paid more on average than men. In fact, when the percentage of women in any industry grows, the average pay falls—with sexism and patriarchy as the culprits.
These choices are life-threatening: Nurses conduct 86 percent of intensive care unit (ICU) patient-health care worker interactions—meaning they are the ones who evaluate symptoms, decide which conditions need critical care, administer the majority of treatments, and advocate for patients’ needs. One report estimates that a quarter of all unanticipated problems that cause death or injury can be directly attributed to hospitals’ choices to understaff nurses. Fundamentally, our health care system positions hospitals as for-profit businesses: As long as people are paying, quality of care isn’t a first priority. By extension, they overvalue doctors for bringing in revenue and underpay the nurses.
Fixing the nurse shortage requires turning nursing into a job worth keeping. If the hospitals will not do it, it is time for the government to step in. Some legislatures already have—states like California have passed legislation to impose mandatory nurse-to-patient ratios, which compel hospitals to hire more nurses and enable them to do so through additional funding from Medicaid and Medicare. Studies conducted in New York and Illinois predict that this would save thousands of lives annually.
Society views female-dominated professions like teaching, housekeeping, and domestic services as unworthy of significant compensation. Nursing is no exception. The pandemic illuminated to the country, and indeed to the world, the essential nature of not just these professions but the people who labor in them. It is time for us to have an economy and health care system that reflects that fact. These are the people who care for us and the world; it is time we care for them.