The effect of a nursing strike on emergency department operational metrics

Abstract Background In July of 2017, after more than 15 months of negotiations, an academic teaching hospital in Boston failed to reach an agreement on the terms of contract renewal with its nursing union resulting in a strike. Replacement nurses were hired by the hospital to fulfill nursing duties for five days. Objectives This study aims to measure the effects of this nursing strike on the patients seen in the emergency department (ED) by examining operational metrics before and during the strike. Methods: Retrospective analysis of patient visits occurring for the five days of the strike (July 12-16, 2017) compared with the analogous five-day period immediately preceding that of the strike (July 5-9, 2017). Results During the strike, ED volume decreased by 23.6% (691 vs. 528 visits), and the decrease was more pronounced for adult vs. pediatric visits. There were no differences in patient sex, race/ethnicity or age groups. EMS transports decreased by 49.1% (171 vs. 87 transports). Although patient dispositions were similar in both periods, length of stay decreased for discharged patients (median 204 vs 178 minutes, p=0.01), and did not change significantly for admitted patients (median 322 vs. 320 minutes, p=0.33). There was one patient death in each of the periods. Conclusion Although rare, nursing strikes do occur. These data may be useful for hospitals preparing for a strike.