A handful of New York City hospitals are scaling back services and preparing to bring in temporary staff as they brace for a potential nurses' strike that could start Monday morning.

Members of the New York State Nurses Association at seven hospitals and health systems across the five boroughs submitted 10-day strike notices on Dec. 30 after voting to authorize a strike last month. Since then, New York-Presbyterian, Richmond University Medical Center and Maimonides Medical Center have managed to narrowly avoid a strike by reaching tentative three-year contract agreements.

The threat still looms at some medical centers in the Montefiore and Mount Sinai health networks, as well as at Flushing Hospital Medical Center in Queens and at the BronxCare Health System. Some 10,000 nurses could still strike if negotiations continue to stall.

Nurses said they are fighting for better health benefits and pay raises that will keep up with the rate of inflation. But the biggest sticking point is the need for increased staffing, which they said is crucial to patient care.

“We do not take striking lightly,” said NYSNA President Nancy Hagans, who is also a nurse at Maimonides, at a press conference held by the union on Wednesday. “Striking is always a last resort. But we are prepared to strike if our bosses give us no other option to protect our patients.”

Nurses and other workers at hospitals across the country – including in California, Minnesota and upstate New York – have gone on strike over the past two years, often citing staffing issues that have been exacerbated during the pandemic.

But some New York City hospital representatives are now pushing back — and calling out nurses for not accepting their contract offers. They are highlighting how a strike could threaten patient safety.

“Make no mistake — a strike will have an immediate impact on the health and well-being of many New Yorkers,” Kenneth Raske, president of the Greater New York Hospital Association, said in a statement.

An oft-cited study of nursing strikes in New York between 1984 and 2004 found that they did have an impact on patient outcomes. Conducted by MIT and Carnegie Mellon University, the study found the in-hospital mortality rate went up nearly 20% for patients admitted during the strikes. Patients were also more likely to be readmitted within 30 days of being discharged.

Raske added that some hospitals are prepared to spend “tens of millions of dollars” to hire temporary staff in the case of a strike but that “even those institutions will experience dangerous gaps in care because of the nurses’ lack of experience on specific units.”

Mount Sinai administrators said patient services are already being affected at the hospitals where negotiations are ongoing. Locations include Mount Sinai Hospital, Mount Sinai Morningside and Mount Sinai West. The respective presidents of the hospitals sent a letter to staff Wednesday stating they are canceling some elective surgeries at the facilities, diverting the majority of ambulances to other hospitals, and transferring babies in the neonatal intensive care units to hospitals outside of the Mount Sinai system.

“We are working to safely discharge as many patients as appropriate,” the hospital presidents said in the letter, which was provided to Gothamist by Mount Sinai spokesperson Lucia Lee.

They added that, in the case of a strike, the plan is to continue inpatient services at Mount Sinai Hospital and Mount Sinai West, while limiting Mount Sinai Morningside to emergency room services and inpatient child psychiatry.

The letter said hospital management had offered nurses “a deal comparable to New York-Presbyterian’s agreement with NYSNA on wages and benefits,” but nurses had not accepted it. This claim was echoed by representatives from Montefiore Medical Center.

"New York State Nurses Association leadership at Montefiore refuses to come to an agreement despite a generous offer that includes an 18% wage increase [over three years], fully funded health care for life, and a significant increase in registered nurses in the emergency departments, among other benefits," said Joe Solmonese, Montefiore's senior vice president of government relations and communications, in a statement on Wednesday. He said these terms mirrored the offer recently accepted by New York-Presbyterian nurses.

Solmonese said Montefiore made this offer despite financial troubles at the health system, which lost more than $117 million on operations alone in the first nine months of 2022, according to financial statements.

Hagans of NYSNA countered that Montefiore “has some of the highest-paid hospital executives in all New York City.” Dr. Philip Ozuah, Montefiore’s president and CEO, had a compensation package worth nearly $7.5 million in 2020, according to public tax records. Crain's reported that the average cash compensation for NYC hospital executives was $4.48 million in 2020.

She also said at a NYSNA press conference Thursday that Montefiore and Mount Sinai may have offered similar salary increases as New York-Presbyterian but have not met their nurses’ staffing demands in the same way. She noted that staffing needs vary by hospital.

A state law that took effect in January 2022 required each hospital in New York to establish a committee of frontline employees and administrators to determine the appropriate staffing levels on each unit. Those staffing plans were submitted to the state Health Department and are supposed to be enforced starting this year.

But NYSNA spokesperson Kristi Barnes said hospitals are “nowhere close” to making those nurse-to-patient ratios a reality, which is why nurses are pushing for additional staffing provisions in their contracts.

All three hospitals and health systems that have reached tentative contract agreements so far have offered salary increases of 7% in the first year, 6% in the second and 5% in the final year. Nurses at those hospitals must now to vote on whether to accept the proposed contracts.