Nurse strike in NYC

 

 UKGuardian article:

Close to 15,000 nurses are participating, making it the biggest nurses strike the city has ever seen. Most union members voted last month to authorize the walkout. Anticipating the possibility of a strike,

New York’s governor, Kathy Hochul, declared a state of emergency on Friday and urged hospital administrators and union leaders to reach a last-minute agreement. She warned that a strike “could jeopardize the lives of thousands of New Yorkers and patients”. “I’m strongly encouraging everyone to stay at the table, both sides, management and the nurses, until this is resolved,” Hochul said. 

 

 As in the 2023 labor dispute, the current conflict centers on a complex mix of grievances, rebuttals and hospital-specific concerns. Staffing remains a key source of contention, with nurses arguing that well-funded hospitals are unwilling to commit to standards that ensure safe and manageable workloads....

and the socialist Mayor is backing the nurses.

Here in the Philippines, people study nursing so they can get a job overseas. If they can't pass the test to work in the US UK or Australia, they can still work in Saudi or the middle east, or get a job working as a caregiver, as our relatives do in the UK>

The nursing shortage is constant, and with the aging population and with the increase in paperwork required in hospitals, you can see that this is a good profession.

But does the influx of overseas nurses depress wages for US Nurses? well, it's more complicated than that. For example, not just requiring nurses doing paper work instead of caring for patients leads many nurses to quit, but a similar emphasis on adminstration and paperwork leads to more jobs in administration in hospitals, which means using money that would be better spent on nurses.

but is this partly due to cheap imported nurses enabling hospitals to hire cheaper outsiders? (if you read the Guardian article you note they will staff using temporary nurses: There are entire companies that supply nurses and doctors to where they are needed but it will cost the hospitals more money... so the hospital management is willing to spend money for expensive temps, but not for regular nurses?)

This 2012 article examines the possibility of imported nurses lowering nurse salaries......

however,Grok says it can but it is more complicated than that.

The impact of imported (foreign-educated or internationally recruited) nurses on salaries for nurses in the USA is a debated topic, with mixed evidence from academic studies, labor market analyses, and policy discussions.

 

Key Evidence from StudiesResearch generally shows that large-scale immigration of foreign-trained registered nurses (RNs) increases the overall supply of nurses in certain areas (e.g., states or cities with high concentrations). This can lead to some downward pressure on wages or earnings, but the effects are often limited, inconsistent, or offset by other factors like persistent nurse shortages, institutional wage rigidity in healthcare (e.g., union contracts, hospital budgeting), and strong demand driven by an aging population.

Several studies find evidence of modest negative effects:

Immigration increases nurse supply and is associated with a decrease in annual earnings for U.S.-trained nurses (though hourly wages show less consistent or no decline). For example, a 10% increase in immigrant supply might reduce salaries by roughly 1–4% in some models. This is often linked to foreign nurses filling gaps in less desirable shifts, locations, or facilities, which can indirectly affect overall compensation packages.

Other research finds little to no significant negative impact on wages:Hiring foreign-educated nurses does not lower U.S.-educated nurses' wages or lead to widespread unemployment for domestic nurses.

Despite large inflows (e.g., tripling of foreign nurses passing licensing exams in some periods), observed wages for native nurses show little decline, possibly due to market power in healthcare and employers' reluctance to cut pay amid ongoing shortages. Foreign nurses often work longer hours or in specific roles, and their presence may not directly compete in the same segments as many domestic nurses.

Overall, the consensus from peer-reviewed economic analyses is that any wage suppression is small and not universal, especially compared to the broader benefits of addressing shortages (e.g., maintaining patient care quality and avoiding even worse staffing crises).

Periods of heavy recruitment (like post-2000 or during/after the COVID-19 pandemic) coincide with wage growth in many cases due to high demand.

Contextual Factors

Prevailing wage rules in immigration programs (e.g., EB-3 for nurses, which is common for permanent residency) require employers to pay foreign nurses at or above the prevailing wage for the role and location, with protections to avoid adversely affecting U.S. workers' wages and conditions.

Nurse unions (e.g., National Nurses United) often express concerns about foreign recruitment potentially undermining domestic wages, working conditions, or incentives for better pay/staffing. They advocate for stronger domestic training and retention over heavy reliance on imports.

The U.S. has faced chronic nurse shortages (projected to worsen with retirements and aging populations), which drive recruitment from countries like the Philippines, India, and Nigeria. This demand often pushes wages upward overall, counteracting potential suppression.

Bottom Line 

Imported nurses do not dramatically lower salaries for U.S. nurses on a widespread basis, according to most evidence. At most, they exert modest downward pressure in specific markets or on annual earnings (e.g., through more supply in high-immigration areas), but this is frequently outweighed by shortage-driven wage increases, regulatory protections, and the need to fill critical gaps.If you're concerned about this in a specific region, state-level data or union perspectives might provide more tailored insights. The bigger picture is that foreign nurses help sustain the healthcare system amid ongoing domestic supply challenges.

Thank you for dying (and lowering the federal budget)

 It's not just those bioethicists who are pointing out that if you kill the sick it saves money.

Apparently a lot of old folks with chronic illness died of covid, so surprise surprise they won't have to spend so much on Medicare.

The origina NYTimes article  is behind a paywall, but theFiscal Times site discusses it.

they start by saying it was those budgetary cuts to hospitals etc from Medicare

Something strange has been happening with Medicare, The New York Times reports: “Instead of growing and growing, as it always had before, spending per Medicare beneficiary has nearly leveled off over more than a decade.” If Medicare’s spending per beneficiary had continued along the trajectory it had been on two decades ago, the program’s spending from 2011 until now would be some $3.9 trillion higher and deficits would have been more than a quarter larger, according to an analysis by The Upshot, part of the Times site.

“Without a doubt, this is the most important thing that has happened to the federal budget in the last 20 years,” David Cutler, a professor of health policy and medicine at Harvard, told the Times. Cutler helped the Obama White House develop the Affordable Care Act, which appears to be one reason for the shifting trendline.

The Trend downward started in 2010...

But AnnAlthouse's blog notes something else in the NYTimes article:

"Medicare may even wind up saving money because of Covid-19 — because the older Americans who died from the disease tended to have other illnesses that would have been expensive to treat if they had survived...."

that graph is not total spending but per capita spending.

one comment noted that 2010 was the start of Obamacare, but would this impact Medicare?

another commenter noted:

Yahoo Finance article from August 2021: COVID-19 didn't hurt Social Security or Medicare as much as experts feared, report finds Money quote from the article: "On the other side, a senior administration official described increased deaths from the pandemic as helping the program's bottom line. It had a "small effect in the other direction" compared to the drop in revenue from fewer workers paying into the system. The sad result of the hundreds of thousands of additional deaths meant that fewer older Americans were available to receive Social Security and Medicare benefits."

another comment noted the decision to put covid patients into nursing homes might have had something to do with this, as do DNR orders/living wills

economics is not my strong point but I might point out that the budget cuts stopped a lot of defensive mediicne and excess testing so we didn't get sued.

But I have been living in the Philippines for 18 years so am not up to date with all this.

defunding medical needs, or a way to cut the bloated system?

Instapundit linked to a NYPost article on 7 ways to stop a plague.

don't bother to read it: it is a WAGD (we're all gonna die) post with an agenda:

Sadly, epidemic prevention doesn’t currently seem to be a priority for the US government. In February, the CDC announced they would need to cut their global disease-prevention efforts by 80 percent due to lack of funding.

all over the internet: WAPO here.

one wonders if this is true, or similar to the "Banned words" kerfuffle a couple months ago that turned out to be fake news.

what was cut was an Obamacare part of the funding.

and it seems to be do gooder stuff for bureaucrats to implement programs to investigate stuff that affect people.

as in bloated bureaucracy where most of the funding goes to pencil pushers, and good folks spend a lot of time in meetings and in "documentation" or "writing proposals".

reminds me of the IHS: We had two docs, six nurses, two in lab and one in x ray, eight in medical records, and an office full of a dozen bureaucrats to process paperwork so our people could get care.

and I saw the same number of people a day (about 20) that I saw in private practice, where I had a secretary and a nurse (and later, a part time typist).

to hire someone took months of paperwork, as if people could sit around that long and not get other job offers.

I would apply for Educational grants, and find that they would pay for it two days before the conference was scheduled, and in one conference, sponsored by a government office, I didn't find I had been accepted until the week afterward, because of the delay in processing my paperwork. (I learned quickly to go to regular CME meetings and pay for it myself and hope I would be reimbursed, and then put up with the lecture by the bureaucrat why this was wrong).

The months to find replacements of medical personnel meant msot of these clinics were short on people who actually worked with patients, so we were always overworked.

as for prevention programs: Yup. we had them.

So, for example, to get money to set up a diabetic teaching program, you had to write a complicated proposal and send it upstream and wait...and wait... and finally you got funding, maybe, for a dietician to come and give a couple of talks.

Then you had to do paperwork to get the dietician hired, taking into consideration if they had dibs on the job because they worked for the government or if they had a CDIB card.

Ditto for equipment and repairing stuff...the clinic took 3 years to get a new badly needed extension, and we couldn't use the defribrillator when we got it because it hadn't been okayed by the electrical expert (a good idea, but why so long?).

To Know A Fly is a humorous novel about scientific research, and shows that even 50 years ago, how much time was wasted in getting money:

It is believed in some quarters that to become a successful modern biologist requires a college education and a substantial grant from the Federal Government. The college education not infrequently is as useful for acquiring proficiency in the game of Grantsmanship as it is for understanding biology.

No self-respecting modern biologist can go to work without money for a secretary, a research associate, two laboratory assistants, permanent equipment, consumable supplies, travel, a station wagon for field collecting, photographic supplies, books, animals, animal cages, somebody to care for the animals, postage, telephone calls, reprints, and last, but by no means least, a substantial sum (called overhead) to the university to pay for all the stenographers hired to handle all the papers and money transactions that so big a grant requires.

as to how to handle an epidemic:

Here is an article on SARS, which was stopped by old fashioned ways.

I am not in favor of cutting funding needed to prevent disease, and am worried that the bureaucrats will decide to cut needed personel instead of cutting all those paper pushers and excessive regulations that cost a lot of money and cut productivity.

and don't tell me that good people in the government bureaurocracy wouldn't do that to poor people.

I was told that one reason we were so understaffed and underequipped on one New Mexico reservation was because the government decided it was only 30 miles to a civilian hospital, so there was no reason we needed a hospital instead of a clinic (the fact that the civilian hospital was over a 7000 foot mountain pass didn't matter, nor that often our patients had to drive 30 miles to get to us because they weren't allowed to go there by themselves for care, without our okay.)

So for three months, we had to send every x ray over that mountain pass because our x ray tech quit (you couldn't put out an ad for a new tech before the final day of work, you know: then it took a lot of paperwork to find someone... yes, they could have hired a temporary replacement but no money).

oh yes: And we had to close the place for two weeks after our boiler exploded, which meant no heat. In the wintertime.

Casinos and tribal take over have helped all of this a bit, but anyone who is in love with single payment medicine should just ask their local Native American about it.

so ignore the kerfuffle and wait and see what happens.

But I worry, not that there will not be funding, but that the entrenched bureaucrats will deliberately do something to make a disaster.

But the, after working for the government, I am cynical in this.