After two months on the picket line, over seven hundred unionized nurses at Saint Vincent Hospital in Worcester, Massachusetts, are still out on strike. The walkout, which began on March 8, is the longest nurses’ strike in Massachusetts in decades and currently the longest active picket line in the United States. The nurses, represented by the Massachusetts Nurses Association (MNA), are demanding that the hospital improve staffing ratios so they can adequately care for each patient.

In the year leading up to the strike, nurses at Saint Vincent filed more than six hundred official “unsafe staffing” reports. A column in the Worcester Telegram and Gazette recounted one of these reports, wherein a nurse describes a shift in which she was assigned to care for

five patients — four of whom needed continuous oxygen monitoring. One of the patients, who also had COVID, needed peritoneal dialysis. This patient required a wide range of monitoring and analysis with any missed assessment possibly resulting in a sudden drop in blood pressure and possible cardiac arrest. Another patient was having multiple grand mal seizures — one after the other with each being more dramatic than the last. Another patient was in acute respiratory distress having multiple mucus plugs and high levels of secretions.

Nurses at the for-profit hospital say unsafe staffing levels have caused problems like patient bed sores and UTIs, dangerously delayed medication and treatment, and preventable injuries and deaths. Bill Lahey, a member of the bargaining team, told Labor Notes about a man who watched his wife code and die from COVID-19 before any staff became available to bring her to the ICU; the pulmonary and critical care nurses who would normally make that transition had been released for the day, per the hospital’s policy of “flexing” to keep costs down.

“You have nurses who punch out at the end of a shift, and they’re crying on the way home because they’re despondent about the care they’ve been forced to give,” Marlena Pellegrino, co-chair of the MNA bargaining unit and a Saint Vincent nurse for thirty-four years, said in an interview with the New Republic. According to the MNA, the hospital has lost more than one hundred nurses in the past ten months to hospitals like nearby UMass Memorial Medical Center that offer better staffing and working conditions.

Meanwhile, Saint Vincent’s parent company, Dallas-based Tenet Healthcare, is doing just fine. It opted to use widespread furloughs and layoffs to “maximize [its] cash position” during the pandemic, rather than spending the $2.8 billion it received in CARES Act relief. Tenet, one of the nation’s largest health care systems, has been so profitable in the past year that it plans to save $33 million in interest by paying back nearly half a billion in debt that’s not due until 2025. The company currently holds about $3 billion in cash — ten times what it boasted in 2019.

And Saint Vincent is one of Tenet’s most profitable hospitals. In 2019, it posted a profit margin of 14 percent, or $73 million, about four times the state’s average for hospitals. On February 10 — the same day MNA nurses at Saint Vincent voted overwhelmingly to authorize a strike — Tenet announced annual profits of $414 million.

Saint Vincent’s staffing issues are emblematic of a much larger problem with the United States’ profit-driven health care system: in recent surveys of nurses in Massachusetts and across the country, majorities of respondents reported that understaffing makes hospitals unsafe. A majority of Massachusetts nurses say conditions are deteriorating.

Research suggests that the chances of in-patient death jump by 7 percent with each additional patient a nurse is assigned to care for. Back in 2018, the MNA pushed hard for Massachusetts to follow California in putting safe nurse-to-patient ratios into law. The hospital industry defeated that measure, reversing initial public support with the help of a prominent Democratic-affiliated consulting firm. California’s nurse staffing law, which has been in effect since 2004, has improved care outcomes, particularly for poor patients.

In the lead-up to the Massachusetts referendum, nursing economist and former MNA president Judith Shindul-Rothschild argued that hospitals could “trim administrative fat” in order to free up the funds to hire more nurses. Tenet’s CEO, Ronald Rittenmeyer, earns about 452 times the median pay for Tenet workers. As of 2019, Rittenmeyer’s total compensation package was over $24 million.

Before going out on strike, Saint Vincent nurses tried a range of more conciliatory means to convince the hospital to address their concerns. They sent emails to management, issued a petition, shared gut-wrenching testimony at a bargaining session (they’ve been in contract negotiations since 2019), gave Saint Vincent CEO Carolyn Jackson a vote of “no confidence,” and engaged in extensive informational picketing.

When these tactics proved fruitless, the nurses decided to strike — the MNA’s first open-ended walkout since 2001 and Saint Vincent nurses’ first since 2000. The latter action occurred when they were freshly organized; it lasted forty-nine days and ended with a historic win for the MNA in Ted Kennedy’s Senate office in Washington. The current strike is now in its tenth week.

Tenet has shelled out massive amounts of money to break the strike, with replacement nurses reportedly costing twice the rate of union nurses. The hospital has installed high-tech surveillance towers to monitor picket lines, and it’s paying Worcester police more than $30,000 daily for what it calls “security.” Management is playing hardball, knowing that a strike victory could spur staffing challenges at other facilities.

Negotiations have again come to an impasse. Tenet offered the nurses a proposal on May Day that the union said “opens the door to substantive discussion” and lacks ”ironclad” staffing upgrades. Hospital leadership rejected the union’s counteroffer and stepped away from the bargaining table.

The outcome of the strike — the most high-profile action in a wave of US labor struggles related to hospital staffing — will reverberate around the state and, potentially, the country. Other health care workers are no doubt keeping their eyes on Saint Vincent. Anyone who uses hospitals or long-term care facilities, or has loved ones who do, should probably stay tuned as well.