Thousands of nurses walked off the job Monday morning, calling for two major NYC hospitals to lower nurse-to-patient ratios as negotiations between their union and management stalled.

Around 7,000 nurses based at multiple campuses across Montefiore Medical Center in the Bronx and at Mount Sinai Hospital in Manhattan are participating in the strike, according to union officials from the New York State Nurses Association (NYSNA).

Outside Montefiore’s Moses campus in Norwood, hundreds of nurses wearing red beanies chanted “safe staffing saves lives,” and “every patient is a VIP,” as they marched around the perimeter of the hospital.

“We try to provide the care we can, but the reality is we can’t be in two places at once,” said nurse Nicola Nichol, 31. “We’re walking today, not for the money but for adequate nursing staff — and that comes right back to taking care of our patients.”

Emergency room nurse Ana Villeda said sometimes nurses there take on as many as 20 patients at a time. As Gothamist previously reported, significant research shows that low nurse staffing levels in hospitals can negatively impact patient outcomes, including mortality rates.

“We have patients in the hallways, and we don’t have enough monitors to put them on, putting their life at risk,” Villeda said. “We’re out here fighting for change, so our patients can receive better care. The nurses don’t want to be out here striking. We want to be inside with our patients.”

At Mount Sinai Hospital, nurses began lining up to picket just before 6 a.m. Throughout the day, nurses cheered and waved signs, but those who spoke to Gothamist said they wished it had not come to this moment.

“It’s very sad for us,” said Carol Rankin McGowan, a nurse at Mount Sinai’s neurosurgical intensive care unit. “I don’t want to be on strike. I don’t want to leave my patients up in the unit. But management has forced us to this.”

Nurses described strained operations inside the NICU and ICU at Mount Sinai as nurses protested outside the hospital.

Last-minute negotiations Sunday staved off strikes at two other Mount Sinai campuses, union officials said — with parties agreeing upon an 18% wage increase over three years and improved staffing ratios.

Mount Sinai Hospital and Montefiore are offering similar wage increases, but NYSNA said the medical centers so far have not committed to the nurse-to-patient staffing ratios the union is requesting.

Montefiore said it offered to create 170 new nursing positions. But NYSNA President Nancy Hagans noted at a press conference Monday that both Mount Sinai and Montefiore currently have hundreds of nursing positions open for hire — so creating more won’t solve the problem. She said NYSNA is pushing for provisions in the contracts that will make it possible to enforce the hospitals’ staffing promises.

Read More: What New Yorkers need to know as thousands of NYC nurses begin strike

Gov. Kathy Hochul made a bid to avoid a strike at these hospitals Sunday evening by asking the hospitals and nurses union to agree to binding arbitration. Doing so would have allowed talks to continue but nullified the strike. NYSNA declined.

Hagans chided the governor for trying to curtail the union’s right to strike. And other elected officials came out to NYSNA’s press conference in front of Mount Sinai Hospital Monday to show their support – including New York Attorney General Letitia James, Public Advocate Jumaane Williams, Manhattan Borough President Mark Levine and Councilmember Mercedes Narcisse, who is also a nurse and chairs the council’s hospitals committee.

An advertisement supporting NYC nurses at the 59th street/Columbus circle subway station, Jan. 9, 2023.

Several other hospitals facing the potential of a strike have reached contract deals since the new year began, including at NewYork-Presbyterian, Maimonides Medical Center, and BronxCare Health System, among others. Thousands of NYSNA members first threatened the strike ahead of Christmas and then gave 10-day notice on Dec. 30 of their plans to demonstrate.

But negotiations at Montefiore and Mount Sinai Hospital are ongoing. As of midday Monday, talks were in progress at Montefiore but had stalled at Mount Sinai, Hagans said.

“Despite Montefiore’s offer of a 19.1% compounded wage increase—the same offer agreed to at the wealthiest of our peer institutions—and a commitment to create over 170 new nursing positions, and despite a call from Governor Hochul for arbitration, The New York State Nurses Association (NYSNA) leadership has decided to walk away from their patients,” Montefiore wrote in a statement on their website.

The contrasting numbers – 18% versus 19.1% — cited by the union and Mount Sinai come from how they’re expressing the terms of the deal. The agreement would call for a 7% bump in the first year, 6% in the second year and 5% in the third. In total, that’s 18%, but after these terms are applied, nurses will technically make 19.1% more three years from now, due to the math associated with compounding percentages.

Registered nurses make an average annual salary of $98,460 in the New York City-metro area, while nurse practitioners earn $141,010, according to data released last year by the U.S. Bureau of Labor Statistics.

Both Mount Sinai and Montefiore have postponed elective surgeries and procedures at the impacted campuses. Montefiore is also rescheduling outpatient visits. “We deeply apologize for any inconvenience to our patients,” Montefiore’s statement read.

The mayor’s office stated that emergency management officials have set up a virtual situation room that includes hospital officials as well as fire and police personnel. FDNY is monitoring the system to redirect ambulances from impacted hospitals to others in the area.

The New York State Department of Health said Monday afternoon that it was sending surveyors to the affected facilities to ensure they have adequate resources for patient care.

In a statement from Mount Sinai, hospital officials called the nurses union “reckless,” and said they’d offered the same 19.1% percent raise as Montefiore. Ahead of the strike at its Harlem location, the hospital had begun transferring babies out of its neonatal intensive care units.

“Our first priority is the safety of our patients. We’re prepared to minimize disruption, and we encourage Mount Sinai nurses to continue providing the world-class care they’re known for, in spite of NYSNA’s strike,” the statement read.

Ahead of the strike, the Greater New York Hospital Association said the hospitals were prepared to hire temporary staff to help fill in for the nurses leaving their posts. But nurses at Mount Sinai Monday acknowledged the strike’s impact on patient care.

At the Moses campus of Montefiore Medical Center, about 150 nurses began a strike the morning of Jan. 9, 2023.

Amanda Wilkinson is a nurse in an outpatient oncology unit at Mount Sinai. “We have many patients who are on trial drugs, including one that was just approved, for their last resort. This is something they’ve been waiting on for many months…and they have to be inpatient for this for several weeks,” Wilkinson said. But she said some patients are being told not to come in because of the strike.

Wilkinson said that it was difficult to make those calls but that she believed the strike was necessary to improve patient care in the long term.

Outside Montefiore Hospital, MTA bus drivers and passing cars honked in support of the striking nurses. Some people visiting patients there also expressed tentative support. Mili McCoy was in the lobby waiting to visit her 88-year-old father who recently had his leg amputated. She said she was nervous about what the strike might mean for his care, but said she agrees with what the nurses are asking for.

“Sometimes we show up and my dad isn’t in the condition we expect him to be. I think it’s because there aren’t enough people to come check on him,” she said, describing a recent visit where her father was covered in blood after his IV came unconnected. “You have to be able to come in here and give it your all. Some can’t. They’re tired. They’re short-tempered and I think a lot of it has to do with their being short-staffed.”

“The nurses are so vital,” she added.

New Yorkers can file complaints about services at impacted hospitals – or any hospital – by calling 1-800-804-5447 or completing an online form, according to the state health department.

This story was updated. Liz Kim contributed reporting.