Why Are Nursing Workforces Going on Strike?
By Jordan C Kabins, Ph.D., MBA
Introduction
Over the past year, nursing strikes and workforce stoppages have occurred across major U.S. healthcare markets, including New York, California, Pacific Northwest, and New Orleans. These actions have involved thousands of nurses walking out of hospitals operated by massive and major health systems, including urban academic medical centers.
Although these strikes are frequently attributed to disputes over wages or staffing ratios, such explanations are superficial. The underlying issue is a systemic breakdown in the psychological contract between nurses and their employers, a process that has developed over several years and was significantly exacerbated during the COVID-19 pandemic.
Strikes do not occur impulsively; rather, they signal that the relationship between the workforce and the organization is no longer considered viable.
Why Is This Occurring?
"A Fractured Psychological Contract”
The psychological contract refers to the unspoken expectations between employees and employers: safety, support, fairness, respect, and mutual obligation. In nursing, this contract historically included professional autonomy, adequate staffing, ethical care delivery, and organizational backing during crises.
Across healthcare markets, nurses increasingly perceive that this contract has been neglected, violated, or abandoned.
Core Drivers Behind Nursing Strikes
1. Novice Nurses Are Not Being Prepared or Supported
Nursing education prepares individuals to pass licensure exams, not to navigate the emotional, cognitive, ethical and behavioral demands of real-world clinical practice.
New nurses often enter environments characterized by:
High patient acuity
Chronic understaffing
Limited mentorship
Minimal psychological support
This gap leads to transition shock, which is the sudden realization that the realities of the nursing role far exceed initial expectations. In the absence of structured support, novice nurses experience:
Moral distress
Emotional exhaustion
Anxiety and self-doubt
Early disengagement or exit from the profession
Hospitals often expect resilience from nurses without providing the psychological support necessary for its development. When nurses lack support during their most vulnerable professional phase, trust deteriorates rapidly.
2. COVID-19 Created Deep and Lasting Contract Violations
For many nurses, the COVID-19 pandemic represented a fundamental rupture in trust.
Frontline nurses were exposed to:
Severe PPE shortages (including mask reuse and rationing)
Unsafe staffing levels
Increased floating and role overload
Repeated exposure to death, suffering, and ethical dilemmas
Nurses were required to “do more with less” under life-threatening conditions, frequently while feeling unprotected by leadership or organizational systems.
Critically, many of these conditions never fully recovered.
Instead, the pandemic left behind:
Institutional distrust
Psychological rigidity
Chronic fatigue
A belief that organizations will again fail them in future crises
When crisis behaviors become standard operational practices, the psychological contract does not recover; instead, it becomes more rigid and resistant to repair.
3. A Workforce That Is Tired, Aging, and Cognitively Depleted
National Nursing survey(2025) consistently describes a workforce that is:
Older
More fatigued
Experiencing sustained burnout
Lacking sufficient cognitive and emotional resources to continue at current intensity
This depletion directly contributes to:
Absenteeism
Presenteeism
Reduced engagement
Increased turnover
As nurses leave the profession, the remaining staff must absorb additional workload, which intensifies staffing shortages and accelerates the cycle of burnout. This self-reinforcing dynamic brings healthcare systems closer to workforce collapse, making strikes one of the few remaining mechanisms for collective expression.
Why Strikes Become Inevitable
When nurses feel:
Unheard
Unsupported
Ethically compromised
Psychologically unsafe
Traditional feedback channels lose credibility, and strikes emerge not as initial choices but as last-resort efforts to restore balance, dignity, and safety within the employment relationship.
Solutions
Repairing the Psychological Contract
Sustainable solutions necessitate more than temporary pay increases or crisis staffing plans; they require deliberate efforts to repair the psychological contract.
1. A Stronger Humanities-Focused Approach
Healthcare organizations should reframe nursing as fundamentally human work rather than solely operational labor. This approach involves recognizing emotional labor, ethical strain, and cognitive load as legitimate organizational responsibilities.
2. Meaningful Nurse Voice
Nurse input should be continuous, rather than limited to contract negotiations. Nurses require formal, protected mechanisms to influence staffing models, workflow design, and patient care policies.
3. Leadership Development
Public health and nursing leaders require training in:
Psychological safety
Emotional intelligence
Leadership style training
Change management
Leadership quality is one of the strongest predictors of nurse retention.
4. Transition and Resilience Training
Hospitals should invest in structured onboarding, mentorship, and ongoing psychological skills development, particularly for novice nurses who are navigating transition shock and moral distress.
5. Psychological Contract Reinforcement
Organizations should explicitly rebuild trust by aligning their commitments with actual practices, especially regarding retraining, safety, staffing, and crisis preparedness.
Why This Matters for Nurses and Employers
When psychological resources are restored, organizations see:
Reduced absenteeism and presenteeism
Higher retention
Improved patient outcomes
Lower long-term labor and replacement costs
Repairing the psychological contract is both an ethical imperative and an economically rational strategy!
References:
Kabins, J. (2026). The Challenges and Experiences of Mask Compliance among Nurses in Southern Nevada during COVID-19.
National Nurses United. (2025, October 30). New Orleans nurses deliver notice for three-day strike for nurse retention. https://www.nationalnursesunited.org/press/new-orleans-nurses-deliver-notice-for-three-day-strike-for-nurse-retention
Nurse.org Staff. (2026, January 9). 2026 nurse strikes: Complete list of active and planned strikes. Nurse.org. https://nurse.org/articles/nurse-strikes-list
Smiley, R. A., Kaminski-Ozturk, N., Reid, M., Burwell, P., Oliveira, C. M., Shobo, Y., ... & Martin, B. (2025). The 2024 National Nursing Workforce Survey. Journal of Nursing Regulation, 16(1), S1-S88.
Tsvetkova, M., & Michalska, A. (2026, January 13). Severe staffing shortages expected at New York hospitals as 15,000 nurses go on strike. Reuters. https://www.reuters.com/business/healthcare-pharmaceuticals/severe-staffing-shortages-expected-new-york-hospitals-15000-nurses-go-strike-2026-01-12/
