The strike has led many of the nurses to discuss the ways that understaffing, paperwork, and the bottom-line efficiency fixation that are inherent in capitalist organizations eat into the quality of care they can give.
Since the nurses of RWJBarnabas hospital in New Brunswick, New Jersey, first struck early in August, I have had many conversations with them while visiting their picket lines. From the beginning, I have been struck by the extent to which they miss their work and their patients, and by their desire to increase the ratio of nurses to patients so the patients can get the care they need.
This obviously does not fit the stereotype that people only work for the paycheck. It also raises questions about the meaning of work, and about why capitalism creates pressures that operate to destroy the worthwhile and even fun parts of jobs.
Marxist and other theories of alienation often seem to say that workers hate their jobs because capitalism has created alienated work. In its narrowest sense, “alienation” simply means that much of the value of the work that workers do is taken away from the worker and becomes profit for the employers. More broadly, alienation means that employers control what workers do, the conditions in which they do it, and the product of the labor, and that the result is to remove control, creativity, and joy from the job.
The pleasure they should get from taking care of the patients is whittled away day by day as paperwork and understaffing mean they cannot give the patients the care they need.
Yet this is not what I am hearing from the nurses. And, I might add, it is not what I heard from truck drivers when I studied one of their Los Angeles local unions 50 years ago. (See Teamsters Rank and File, Columbia University Press, 1982.) Drivers saw what they were doing as useful, enjoyed “building up their routes” and pleasing the people to whom they made deliveries, and resented it when employers took action that might have increased their profits, but hurt their customers and the drivers’ relationships with the customers.
What does all this mean? To me, it means that people get joy and pleasure out of helping other people. This is particularly evident with the nurses: The ways they help their patients are very meaningful to them, and, when they are striking, they miss those patients who have recurrent need for care and who they have come to know. As they tell me, the replacement (scab) nurses do not know these patients and will not take as good care of them.
I think this goes very deep into who people are and what society is like. In Marx’s terms, I think helping other people is part of our “species-being,” built into our history and our cultures by many centuries of experience. We like to produce use values for other people, whether this is by taking care of them when they are sick or by delivering goods to them. Undoubtedly, nurses feel this more that truck drivers, since their involvement with other people is more intense and concrete.
Unfortunately, capitalism is a system built to produce and increase profits by focusing on exchange value rather than use value. In terms of the nurses, even though they work for what is ostensibly a nonprofit hospital, they are under constant pressure to work harder, and to serve more patients, and sicker patients, with fewer nurses, while the chief executive officer and other higher-ups make $10 million and even more each year. As one nurse phrased it to me, what they care about is the records we enter into our computers more than the patients. These records, it should be noted, are the basis for the billing that brings the money in. Record-keeping also takes nurses’ time away from the patients.
One nurse told me about what the pressure to do more with fewer people means in practice. She is one of a few workers assigned to an intensive care unit for children. One day, another unit had a staff shortage, so the employer moved all the nurses from her unit to another floor to work with other patients. Her primary assignment that day had been intake—to admit children who needed intensive care to the unit, including filling out the relevant paperwork on the computer. On this particular day, she was admitting a child to the unit when alarms went off for two other children on the unit. In human terms: One child needed to be admitted, and two others had potentially life-threatening emergencies at the same time. Although a particularly bad instance of how understaffing works, this ethical dilemma and associated pain and trauma to the nurses occurs in less acute forms every few days. Yet the paperwork gets filled out, the money comes in, and, in spite of the understaffing, some of the children do get good care even if others end up dead or seriously harmed by inadequate care.
What does this mean for the nurses? They feel guilt and conflict over the decisions their employers force them to make about who does and who does not get seen when. They see their dignity attacked, and their professional knowledge debased, when their supervisors ignore their warnings and their concerns. And the pleasure they should get from taking care of the patients is whittled away day by day as paperwork and understaffing mean they cannot give the patients the care they need.
One of the potential ways in which this strike can help is by forcing safe staffing legislation through the state legislature—although so far, the governor and legislature seem cool to this idea, perhaps because of their economic and personal ties to RWJBarnabas management and to the “healthcare” industry more generally. Another is that they may win contractual provisions that help them defend safe staffing levels. A third is that the heightened solidarity they have built up with each other will let them resist managers’ bad decisions more effectively on a day-to-day basis.
In addition, the strike has led many of the nurses to think and discuss the meaning of their jobs and the ways that understaffing, paperwork, and the bottom-line efficiency fixation that are inherent in capitalist organizations eat into the quality of care they can give, their sense of dignity, and the joy they should get from taking care of the sick. In my view, the only way to solve these problems for them and for future generations is to replace capitalism with a new system that some of us call “socialism,” with the understanding that we will only come to understand this new system as we build it. I hope some of these nurses, and billions of other people in addition, will come to agree with me on that before capitalism creates an unlivable environment for humanity.