By Arthur Caplan, PhD

Strikes by nurses are not common -- but they do happen. The longest recent nurses' strike took place at St. Vincent Hospital in Worcester, Massachusetts during 2020-2021. That one lasted 301 days. In 2022, 15,000 nurses went on strike at 16 hospitals throughout Minnesota for 3 days. In 2025, nearly 5,000 nurses across Oregon walked out at eight Providence hospitals for 46 days.

Most recently, approximately 15,000 nurses with the New York State Nurses Association (NYSNA) went on strike on January 12 at multiple New York City medical campuses including Mount Sinai, Montefiore, and NewYork-Presbyterian/Columbia. The nurses' demands include increased staffing levels, better pay, job security guarantees, better support for nurses with substance abuse issues, and improved security to provide more protection from violent patients.

Despite the high volume of nurses striking, some nurses are still working at the impacted hospitals. Mount Sinai reported that 23% of its unionized nurses chose not to strike or have returned to work. Meanwhile, the hospitals are reportedly using travel nurses -- temporary contract hires -- to help stay open. A striking nurse claimed that at least one death resulted from reduced care because of the strike, but the New York City Department of Health, the NYSNA, and Mount Sinai all pushed back and said there were no records to support this.

Legally, nurses in the U.S. can strike, but their exact rights and the terms of striking are dependent on adherence to specific federal and state labor laws. This includes the requirement of advance notice of the intent to strike.

The law aside, strikes by nurses raise tough ethical questions. Do the professional ethics of nurses permit strikes? What makes strikes by nurses justifiable? And, if they are justified, should temporary nurses cross nurse-manned picket lines?

The Code of Ethics section 6.3 briefly addresses strikes and ethics. However, it appears to show some discomfort with making judgments about professional organizing, only mentioning the word "striking" once (and "strike" zero times). The code primarily addresses the morality of "collective action," and says that collective action can be ethical and professional.

"Despite its risk, nurses need to acknowledge the potential benefits of collective action, whether through bargaining, voting, and/or striking. Nurse-led entities should represent nurses in addressing unjust practices."

One former nursing leader told me that it is "absolutely ethical for nurses to strike. Who else will look after safe staffing ratios -- certainly not regulators, investors, et cetera."

Many nurses feel that, as their Code of Ethics indicates, they can strike. But the reasons why are not open-ended. The code maintains nurses have a duty to advocate for patient safety, and that includes adequate staffing and a secure work environment. Some nurses may see striking as a means to that end. Ethically, if nurses feel that patient health and safety is severely compromised, then a job action or strike can be defended if they give reasonable advance notice.

Other nurses see striking as incompatible with patient health and safety. So, they continue to work.

Meanwhile, some registered nurses are willing to accept lucrative short-term contracts negotiated by private agencies. These travel nurses go in despite having to cross picket lines.

If patient safety is the key nursing concern, then temporary workers crossing a picket line is hard to justify and could even worsen patient safety due to a lack of experience in a particular hospital setting (although the evidence here is mixed). In fact, some nurses who choose to work may refuse to fully cooperate with any temporary nurses, seeing them as high-risk "strike breakers."

On the other hand, if salary or benefits are the main issue (as opposed to patient safety), then nursing strikes seem harder to justify. Putting vulnerable patients at risk to gain more pay is, from an ethical perspective, tougher to defend.

And what about patients who cross the picket line? Some may choose to postpone elective procedures or even go to another institution -- but that conduct is not anything striking nurses can expect or demand. Patient well-being is always central in any labor dispute in the healthcare sector.

All this said, perhaps the best answer to the morality of strikes by nurses, doctors, or other health professionals is to take strikes off the table. Finland, Zimbabwe, the U.K., and other regions have moved to restrict healthcare worker strikes, with some turning instead to mandatory arbitration.

In the U.S., transport and public utility disputes are often mandated for arbitration due to the negative public impact strikes would have. Mediation and arbitration by professional third parties seems like the better path to dispute resolution in healthcare too, where the stakes (patient health and well-being) are high and the damage done to institutional morale could be grave.

At the end of the day, isn't patient best interest served not through nasty labor fights but by mediation through independent, trained, neutral third parties? That is an avenue worth exploring.