Thousands of nurses at New York City hospitals went on strike Monday morning. The labor action has already begun to disrupt health care services at Montefiore Medical Center in the Bronx and Mount Sinai Hospital in Harlem, where about 7,100 members of the New York State Nurses Association (NYSNA) could join the picket line.

The nurses are striking as they negotiate for higher pay and increased staffing in their first new contracts since the COVID-19 pandemic began. NYSNA members have reached contract agreements with several other hospitals across the five boroughs in recent days, narrowly avoiding similar strikes.

Which hospitals are affected by the strike?

Nurses walked off the job at Mount Sinai’s main hospital in Harlem and at Montefiore Medical Center in the Bronx. Picket lines ran fromt 7 a.m. Monday morning until 7 p.m, and resumed for the same timeframe on Tuesday. NYSNA members said they plan to continue the action every day until agreements are reached.

The Montefiore facilities include the Children’s Hospital at Montefiore, as well as the Weiler, Moses and Westchester Square campuses.

The New York State Nurses Association first announced a plan to strike at these and other medical centers late last month if the union couldn’t reach an agreement with hospital administrators.

Since then, the union has landed contract deals with Richmond University Medical Center, Flushing Hospital Medical Center, BronxCare Health System, Maimonides Medical Center, New York-Presbyterian and two other hospital locations in the Mount Sinai Health System. Some of these deals have already been ratified by union members while others are still up for a vote.

Read More: “We can’t be in two places at once”: Droves of NYC nurses picket on labor strike’s first day

As of Tuesday morning, negotiations were in progress at Montefiore but were stalled at Mount Sinai, according to NYSNA. Late Sunday, Gov. Kathy Hochul, whose office has been involved with the negotiations, attempted a final maneuver to prevent a strike. She suggested that the hospitals and the union agree to enter a binding arbitration deal, which would have continued bargaining discussions and canceled the strike.

Both Mount Sinai and Montefiore stated that they would agree to an arbitration plan.

NYSNA did not, and, in a statement, called on Hochul to “listen to frontline COVID nurse heroes and respect our federally-protected labor and collective bargaining rights.”

Mount Sinai tweeted NYSNA leaders left the bargaining table early Monday morning, shortly after 1 a.m. In a separate statement, the hospital system described the union’s rejection of the arbitration as “reckless behavior,” though its reps had likewise stepped away from negotiations late last week.

These aren’t the only New York City hospitals that are bargaining over new contracts. Nurses at Wyckoff Heights Medical Center in Brooklyn have issued a strike notice for Jan. 17 if negotiations there continue to stall.

How will patient services be impacted at striking hospitals?

Both Montefiore and Mount Sinai announced plans to postpone elective surgeries at their affected facilities ahead of the strike. Montefiore also began working over the weekend to discharge “as many patients as appropriate,” according to a planning document shared with Gothamist by a hospital spokesperson.

In the days leading up to the strike, Mount Sinai made efforts to transfer some patients to other facilities, including newborn babies.

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

Both hospitals are also seeking to have ambulances diverted to other medical centers. Kate Smart, a spokesperson for City Hall, said ahead of the strikes that the city fire department “has contingency plans in place to reroute ambulances and NYC Health + Hospitals has emergency strategies to handle a surge in patients.”

What patients are saying

Monday morning, Noel Williams had an appointment at Montefiore Medical Center, but he said he didn’t mind if the wait times were a little longer than usual because of the picketing employees.

"After all that they've [the nurses] been through over the last two, three years, they deserve all they're asking for. They really held us down during the pandemic," Williams said.

Mili McCoy's 88-year-old father is a recent amputee and also a patient at Montefiore. She thinks she's seen the impacts of the medical staffing shortages firsthand.

“Sometimes, they show up, and my dad isn't in the condition we expect it to be,” McCoy said. “I think it's because there aren't enough people to come check on him during the night — or even during the day.

Why are the nurses striking?

Nurses are fighting for better health benefits and higher pay, but they say they’re most concerned with staffing levels.

“Our bosses created the understaffing crisis by failing to hire and retain enough nurses … leaving the rest of us to work short staffed,” Nancy Hagans, president of the New York State Nurses Association, said in a virtual press conference on Sunday morning. “The hospital is often so overcrowded that patients are admitted in beds in the hallway instead of hospital rooms.”

At Mount Sinai Hospital, there were more than 600 nurse vacancies as of mid-December, according to a document shared with Gothamist by a nurse at the facility.

Frances Cartwright, the chief nursing officer at Mount Sinai Hospital, said the health system is working to fill open positions — and said administrators should focus on doing that before committing to additional hires. She added that staffing issues are not unique to Mount Sinai. “We are in a national workforce crisis,” she said.

View of Mount Sinai hospital, one of the private hospitals where nurses may go on strike in New York City.

Hagans said at Sunday’s press conference that Montefiore currently has more than 700 nursing vacancies — at times leaving one nurse in the emergency department to care for 20 patients at a time.

“We remain committed to seamless and compassionate care, recognizing that the union leadership’s decision will spark fear and uncertainty across our community,” Montefiore spokesperson Loren Riegelhaupt stated via email, citing that the Bronx hospital had made the same offer as the wealthiest of its peer organizations. “This is a sad day for New York City.”

Montefiore did not respond to a request for comment about staffing issues but said it has offered to create 170 more nursing positions. After the strike started, the hospital added that it made new offers around staffing, such as establishing average nurse-to-patient ratios in emergency departments and allowing an arbitrator to enforce staffing agreements if they are violated.

Nursing strikes were averted at other NYC hospitals in part because new agreements offered 18% pay increases spread over three years: a 7% bump in the first year, 6% in the second year and 5% in the third. Montefiore and Mount Sinai are both making similar offers.

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.

How NYC’s mayor is handling the nurse strike

Ahead of the strike, Mayor Eric Adams released a statement on Sunday saying that the city would be prepared to handle any impact on operations at the two affected hospitals. “We encourage all New Yorkers to call 911 only for emergencies, and be prepared to seek an alternate facility in case their preferred hospital is impacted,” Adams said.

According to Kate Smart, a spokesperson in the mayor’s office, as of Monday morning, the city’s emergency management agency was seeing “minor effects” from the strike at NYC Health + Hospitals medical centers, which were potentially expected to receive some diverted patients. She said that city-run hospitals were “busy, but managing.”

The city’s 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.

Smart did not immediately say how many patients had been redirected so far or how many had been received by NYC Health + Hospitals.

FDNY spokesperson Frank Dwyer told Gothamist that EMS would divert any patients as a “courtesy” if the hospitals made such requests and if EMS could accommodate them.

“Diversion requests and approvals can happen for any number of reasons, including an ER facing a high number of patients at any given time,” he said in an email. He added that this was especially true during the peak of the COVID-19 pandemic.

He described the strike as “very fluid” and did not say how many patients had been redirected on Monday.

Dwyer said the city would also add additional EMS staffing and supplies to units in the Bronx and Manhattan but did not specify the number of ambulances or units.

“These changes are fluid and subject to unit and staff availability,” he said.

How long will the strike last?

It’s still unclear how long the strike will last as negotiations are ongoing. Hospital worker strikes have taken place across the country over the past couple of years – lasting from just 24 hours to nearly 300 days.