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A patient waved toward nurses during the nurses’ strike outside Brigham and Women’s Hospital Wednesday.Christian Kantosky for The Boston Globe<\/p>\n\u201cIt was a little insensitive,\u201d Ruffin said, then added: \u201cA lot insensitive.\u201d <\/p>\n
During the largest nursing strike in Massachusetts history, Brigham has been able to stay open through contracting with US Nursing, a Colorado-based company whose business model is all about providing nurses to hospitals amid strikes. <\/p>\n
Brigham\u2019s use of the replacement nurses caused what was a one-day work stoppage to extend beyond what the 4,000 striking Brigham nurses intended. Hospital officials said they were obligated to provide at least five days of work for the replacements, prompting the Brigham to lock nurses out through at least Monday.<\/p>\n
While union membership and power have shrunk in many industries in recent decades, the health care industry has remained a labor stronghold; indeed, some parts of the profession that traditionally would have been less likely to unionize, such as primary care physicians, are now agitating to organize amid disputes over working conditions.<\/p>\n
And because hospitals can\u2019t simply close down during a strike in the way that, for example, a factory might, there is a need on the part of employers for firms such as US Nursing.<\/p>\n
The Brigham strike and subsequent lockout have heated up an already contentious battle between the state\u2019s largest health system, Mass General Brigham, and the nurses union, which have been unsuccessfully negotiating a new contract for months. <\/p>\n
In the middle are nearly 1,300 replacement nurses, many from out of state, who drove or flew into Boston to keep the nationally-renowned hospital operating at normal capacity for the duration of the labor action.<\/p>\n
To the picketers, their replacements can be seen as something of a stand-in for MGB itself, a multibillion-dollar corporation with deep pockets. Union members called them out on their picket signs: \u201cDon\u2019t Pick a Scab. It Leads to Infection.\u201d<\/p>\n
It is a unique and controversial business: Hospitals say they have to maintain patient care when staff nurses walk off the job, while labor unions say the practice introduces clinicians unfamiliar with patients and hospital workflows.<\/p>\n
\u201cStrike nurses are like a defibrillator for the healthcare system,\u201d a group of temporary nurses said in a legal document unrelated to the Brigham strike. \u201cWhen staff workers \u2014 the heart of the company \u2014 stop working, strike nurses step in to resuscitate the facility\u2019s vital functioning until internal issues are resolved.\u201d<\/p>\n
It\u2019s also a lucrative one. <\/p>\n
Companies that specialize in supplying replacement nurses during labor disputes, known as \u201cstrike nurses\u201d or \u201ccrisis contracts,\u201d have long operated behind the scenes.<\/p>\n
The job of a strike nurse, one replacement nurse wrote on Facebook this week, is to put your head down and take care of patients. <\/p>\n
A patient waved toward nurses during the nurses’ strike outside Brigham and Women’s Hospital Wednesday.Christian Kantosky for The Boston Globe<\/p>\n
\u201cIt is not our fight,\u201d the nurse, who is not filling in at the Brigham, wrote. \u201cWe are just there to take care of patients so that they can go out and get all the things that they deserve. I stand behind every nurse that strikes. But I also don\u2019t feel one bit bad about going in and taking care of those patients and making good money doing it.\u201d<\/p>\n
Amid the Brigham strike, US Nursing, or USN, is recruiting registered nurses for 10-day assignments that pay roughly $100 an hour, for specialties including emergency care, intensive care, behavioral health, dialysis, and case management. It\u2019s roughly the same as what the hospital\u2019s most experienced nurses make hourly<\/a>, although that rate does not include other benefits, like health care, overtime pay, and educational stipends. <\/p>\n USN\u2019s website has a \u201cstrike alert\u201d system that posts positions for nurses to sign up ahead of potential labor actions. The website says the company has recruited more than 50,000 replacement personnel, who typically expect to be away from home for at least 10 days. It advertises the potential to earn $100,000 a year, freedom to travel, and $500 referral bonuses. <\/p>\n In March, USN posted positions on Facebook in anticipation of a potential strike in Massachusetts. The ads even tout local historical sites.<\/p>\n At the top of USN\u2019s website is a banner that reads: \u201cStand up. Stand in. Be ready when opportunity strikes.\u201d<\/p>\n USN has drawn some fire, not only from those whose strikes are being undermined, but also from its own workers. <\/p>\n About 40 temporary nurses hired by the agency to cross picket lines during a three-day strike in October 2023 at Kaiser Permanente hospitals in California accused USN in a federal lawsuit of failing to properly pay them. <\/p>\n USN did not respond to multiple comment requests. <\/p>\n The suit was settled out of court in January 2025.<\/p>\n Strike nurses are among the highest paid nurses in the industry, some earning up to $120 an hour, said the complaint, with bonuses of $1,400.<\/p>\n \u201cThe ethical aspects of strike nursing are open to debate, with a diverse range of opinions,\u201d said the lawsuit. \u201cThe question of whether replacing staff nurses during strikes is acceptable depends on personal values.\u201d<\/p>\n There have been several strikes by nurses in Massachusetts in recent years, including a nearly 10-month one at Saint Vincent Hospital<\/a> in Worcester beginning in 2021, the state\u2019s longest-running strike in history. Earlier this year, a strike by more than 4,000 nurses in New York lasted one month before an agreement was reached.<\/p>\n As the number of walkouts by nurses over pay and workplace safety increases in the United States, hospitals have expanded contingency plans that include contracts with these strike staffing agencies. <\/p>\n In addition to USN, there are Strike Nurse USA<\/a> and Healthcare Staffing Solutions Inc.<\/a> that advertise filling in nurses during labor disputes. There are more than 42,000 members of a Strike Nursing Network Facebook group. <\/p>\n MGB is contracting with Healthcare Staffing Solutions for temporary help involving a separate seven-day strike this week by about 450 of its home care clinicians. <\/p>\n In hiring the temporary nurses, MGB is not only paying for their shifts, but also for their training, flights, meals, and hotels. <\/p>\n Replacement workers typically cost hospitals as much as three times what the striking nurses get paid, said Patricia Pittman, a recently retired health management professor at the Milken Institute School of Public Health at George Washington University. That math doesn\u2019t always sit well with nurses, other workers \u2014 and patients.<\/p>\n \u201cWhen the nurses who have walked out make this argument to the public, the public tends to sympathize with the nurses,\u201d she said. \u201cThere are many strikes where it sort of damages [hospitals\u2019] reputation and damages their argument.\u201d<\/p>\n MGB would not provide an estimate of its replacement expenses for the work stoppage. <\/p>\n \u201cThose costs are real, but they are temporary and directly tied to a defined work stoppage period,\u201d said Jessica Pastore, a Brigham spokesperson. \u201cThat is very different from agreeing to an above-market wage adjustment that becomes part of the permanent cost structure and compounds year after year.\u201d<\/p>\n MGB said across-the-board raises the union wants would cost Brigham $128 million over 18 months. <\/p>\n MGB notes it already provides 5-percent annual raises to all nurses until they reach 20 years of service. One-third of Brigham nurses have reached that tier, which corresponds with an annual salary of at least $220,000.<\/p>\n MGB said all replacement nurses are licensed, trained, and many have served in the nation\u2019s top hospitals. <\/p>\n But some patients said they still felt nervous. <\/p>\n \u201cYou can\u2019t just provide a manual to these nurses and say, \u2018Make sure we\u2019re following all the procedures,\u2019\u201d said Vasili Mallios, 37, a teacher from Winthrop, who is in the NICU with his newborn son. \u201cThe Brigham nurses bring both the science and the art, and they have an understanding of who our child is from day one.\u201d<\/p>\n On social media, replacement nurses have said they\u2019re just trying to support patients and earn premium wages, but they\u2019ve faced backlash. <\/p>\n None responded to requests for comment. <\/p>\n \u201cI am very concerned about this [Massachusetts] strike,\u201d one replacement nurse wrote on Facebook Tuesday. \u201cWhy are these [Brigham] nurses running around the city manipulating patients and families into believing nurses that are filling in are not competent?\u201d<\/p>\n Another post on Wednesday by a fill-in nurse said unionized nurses in Massachusetts have the benefit of striking for what they need. <\/p>\n \u201cI\u2019m from Texas where if we don\u2019t like something, the hospital will quickly show us the door,\u201d she wrote. \u201cThese Boston nurses hate us already!\u201d<\/p>\n Marin Wolf can be reached at marin.wolf@globe.com<\/a>. Sarah Rahal can be reached at sarah.rahal@globe.com<\/a>. Follow her on X @SarahRahal_<\/a> or Instagram @sarah.rahal<\/a>. Jonathan Saltzman can be reached at jonathan.saltzman@globe.com<\/a>.<\/p>\n