COVID-fatigued health workers are mobilizing

• "The pandemic exacerbated a crisis that was already there," Michelle Boyle, a Pittsburgh nurse told Axios. "It went from being a crisis to being a catastrophic freefall in staffing."

Driving the news: About 1,400 resident physicians in public Los Angeles County hospitals have authorized a strike if their demands for pay parity with other local facilities aren't met in contract negotiations this week.

• Nurses demonstrated across Pennsylvania in early May, protesting one state lawmaker's inaction on legislation that would have set nurse-to-patient ratios.
• A fight is brewing in Minnesota as contracts covering 15,000 nurses in several hospital systems are expiring.
• Some 2,000 resident physicians and interns at Stanford University and the University of Vermont Medical Center joined an affiliate of the SEIU for medical workers that claims more than 20,000 members nationwide.
• In North Carolina, where union membership is low, staff at Mission Health in Asheville voted to unionize largely over staffing concerns.

Less than half of the of nearly 12,000 nurses polled by the American Nurses Association last year believe their employer cares about their concerns, and 52% of those surveyed said they intend to leave their jobs or are considering doing so.

The other side: Hospital operators generally oppose unionization efforts, as well as mandated staffing ratios.

• "The last thing we need is requirements set by somebody in Washington as to exactly how many nurses ought to be providing service at any given time," said Chip Kahn, CEO of the Federation of American Hospitals. "That ought to be a local decision based on the need in the hospital at the time."
• The American Organization for Nursing Leadership, an affiliate of the American Hospital Association, also opposes staffing ratios.
• The industry says decisions on staffing and workplace rules are best left to local executives who need to be flexible to meet shifting demand for care.
• "You're basically taking away the flexibility of those on the scene to determine what it takes to provide the needed patient care," Kahn said.

Go deeper: The pandemic drove up labor costs significantly for hospitals that were forced to pay travel nurses to fill workforce gaps during COVID surges.

• April marked the fourth month in a row this year that major hospitals and health care systems reported negative margins, a Kaufman Hall report found. And executives say things could worsen amid inflation and stubborn supply chain woes.

And yet, some big hospital chains like Tenet reported strong earnings in the first quarter.

Between the lines: California is the only state to have set staffing ratios for nurses, but hospital unions in other states have fought for similar requirements in their contracts.

• In California, every nurse on a general hospital floor has no more than five patients to care for at a time; nurses in ICUs should care for no more than two patients.
• Nurses want look-alike standards in states like Pennsylvania, where only some hospitals have staffing ratios, saying short-staffing threatens patients' well-being.

What we're watching: While many legislative proposals failed this year, unions representing health care workers say their message is getting across.

• Unions in Illinois, Pennsylvania and Washington state are redoubling efforts for staffing ratio legislation modeled on California's.
• In New York, nurses passed a law that took effect in January mandating staffing committees at hospitals.

The bottom line: The labor tension is a sobering coda to a health crisis that's stretched health systems and workers alike in unprecedented ways.

"What you're seeing is nurses finally saying enough is enough and this system is broken and we need it to be fixed," said Denelle Korin, a nurse alliance coordinator with Nurses of Pennsylvania.