Inside the Month-Long NYC Nurses Strike: How NYSNA Maintained Momentum

Nearly 10,500 nurses at Mount Sinai and Montefiore hospital systems ended their strike on February 10 after approximately four weeks on picket lines—but the story didn’t end there. While those nurses headed back to work with new contracts in hand, roughly 5,500 of their colleagues at NewYork-Presbyterian Hospital voted to keep striking, rejecting management’s offer by a decisive 73 percent. The largest coordinated nursing strike in New York City history had become something more complicated: a test of how long nurses could sustain momentum against the city’s wealthiest hospital system.

The strike, organized by the New York State Nurses Association (NYSNA), began January 12 with nurses walking off the job across three major hospital systems. They maintained 24-hour picket lines through some of the coldest weather New York had seen in years. The settled contracts delivered twelve percent salary increases over three years, maintained enforceable staffing ratios with financial penalties for violations, and included language allowing nurses to override artificial intelligence-generated patient care recommendations using their clinical judgment.

That AI provision represents the first contract language about AI systems in patient care anywhere in the country. The different results at different hospitals—wealthier NewYork-Presbyterian refusing demands that community hospitals accepted—revealed the relationship between hospital profitability and management willingness to resist labor demands.

How the Strike Unfolded

The action emerged from years of deteriorating conditions following the COVID-19 pandemic. Nurses across New York’s private hospitals had experienced understaffing, increased workplace violence, and attempts to erode benefits they’d won in previous contracts. NYSNA began contract talks in September 2025, representing nurses across twelve hospital systems. When talks stalled over enforceable staffing ratios and workplace protections, Governor Kathy Hochul issued Executive Order 56 on January 9, declaring an emergency that let hospitals hire nurses from other states without New York licenses.

The union responded three days later by calling nurses to strike at NewYork-Presbyterian, Mount Sinai Health System (including Mount Sinai Hospital, Mount Sinai Morningside, and Mount Sinai West), and Montefiore Medical Center in the Bronx.

NYSNA provided warming buses, distributed hot chocolate and pizza, and organized daily scheduling to prevent burnout. The Teamsters, carpenters’ unions, and other labor organizations joined picket lines in solidarity. Fire engines blared horns in support as they passed striking nurses.

Hospital management responded by accelerating replacement staffing. The three systems collectively hired temporary nurses at rates reaching $9,000 to $10,000 per week, eventually spending a combined $100 million on temporary replacement labor by the strike’s end. Mount Sinai and Montefiore brought in public relations firms to counter union messaging. NewYork-Presbyterian—the wealthiest of the struck systems, with CEO Steve Corwin receiving $26.3 million in compensation during 2024—proved the most aggressive in resisting union demands.

Political Pressure Builds

The strike gained visibility during its second week when New York City Mayor Zohran Mamdani joined picket lines on January 21, marking his second appearance in solidarity with striking workers. On the same day, U.S. Senator Bernie Sanders appeared at Mount Sinai West, telling gathered nurses: “The people of New York City, the people of Vermont, the people of America, love and appreciate our nurses. And today we say to those hospitals: Sit down and negotiate a decent contract.”

Public Advocate Jumaane Williams and other elected officials joined picket lines over subsequent days. By late January, NYSNA President Nancy Hagans reported that nurses had maintained disciplined picketing while hospitals refused to make meaningful counterproposals.

The settlement dynamic shifted over the weekend of February 8-9, when NYSNA leadership negotiated preliminary deals with Montefiore and Mount Sinai. The union’s decision to force votes at all three hospitals—going against the clear advice of the NewYork-Presbyterian bargaining committee—generated internal conflict that would define the strike’s final phase.

The NewYork-Presbyterian negotiating committee had determined that the proposed contract, while providing the same twelve percent wage increases, lacked enforcement mechanisms and job protections that committee members considered important. Committee member Sophie Boland stated: “We have already seen what happens when protections are weak,” citing experiences at other hospitals where management repeatedly violated understaffing provisions. Despite the committee’s recommendation to reject, NYSNA’s executive director and president proceeded with votes at all three hospitals.

The Vote That Split the Strike

The results revealed stark divisions. Montefiore nurses ratified the contract 86 percent in favor. Mount Sinai nurses voted 87 percent to accept. Mount Sinai Morningside and West nurses approved with 96 percent support.

NewYork-Presbyterian nurses rejected the same pay offer 73 percent—3,099 to 867.

After the rejection, 2,500 nurses attended an emergency online meeting called by the bargaining committee to discuss continuing the strike. Fifty nurses marched to NYSNA headquarters on February 12 with a petition bearing 1,500 signatures demanding investigation and possible punishment of union leadership for overriding the bargaining committee’s recommendation. Committee member Tonya Fisher stated: “Nurses feel deeply betrayed by the way this was pushed through.”

Montefiore and Mount Sinai nurses returned to work beginning February 14. Mount Sinai CEO Brendan Carr issued a letter to employees acknowledging the emotional toll and expressing relief that “our patients always come first.” But approximately 4,200 NewYork-Presbyterian nurses continued picketing while union leadership pursued continued negotiations with hospital management.

The Organization Behind the Action

The New York State Nurses Association represents more than 42,000 registered nurses across New York State. NYSNA had affiliated with National Nurses United—the country’s largest nurses union representing more than 225,000 members nationwide—in October 2022.

Nancy Hagans, serving as NYSNA president since 2021 and as co-president of National Nurses United since 2022, emerged as the public face and strategic leader of the strike. Hagans is a critical care expert with more than thirty years of experience at Maimonides Medical Center in Brooklyn.

At Mount Sinai Health System, nurses represented approximately 4,300 members spread across multiple Manhattan campuses. Montefiore represented a comparable number of nurses in the Bronx, while NewYork-Presbyterian contained roughly 4,200 nurses across its three major campuses.

The nursing workforce at these institutions reflects New York City’s multicultural population. NYSNA union member profiles documented representation of immigrant nurses, nurses of color, and nurses of varying ages and experience levels, from recent graduates to veteran nurses nearing retirement. Many expressed that they’d worked through the COVID-19 pandemic while hospital management attempted to reduce health insurance benefits during the crisis—a combination that had made many nurses angry enough to fight back.

Coalition Support

The strike drew coalition support that increased visibility and political leverage. Union solidarity extended across the labor movement, with Teamsters and carpenters’ unions joining picket lines, while the NAACP and public advocates joined demonstrations. Political allies included Mayor Mamdani and Senator Sanders. Community organizations, patient advocacy groups, and faith-based institutions provided support through meals, supplies, and spreading the word.

This coalition structure reflected a strategy of framing the nurses’ strike not as a narrow economic dispute but as a public health and social justice issue affecting the entire New York City community.

What the Strike Achieved

The settled contracts provided nurses with salary increases of approximately four percent annually over three years, totaling twelve percent over the contract period. For nurses earning in the mid-$70,000 to $100,000 range, a four percent annual increase represented approximately $3,000-$4,000 in additional annual compensation.

The contracts maintained enforceable safe staffing ratios with faster dispute resolution and financial penalties for violations. This was the central issue around which the strike was called, and its significance becomes apparent through comparison to the 2023 precedent.

Three years earlier, Mount Sinai and Montefiore nurses had won enforceable staffing ratios through a three-day strike, establishing expedited arbitration language requiring hospitals to pay financial penalties to nurses working in understaffed units. By 2026, hospital management attempted to roll back these provisions, treating them as optional rather than contractual guarantees. The union’s defense of these staffing protections prevented a major step backward.

The enforcement mechanisms worked. Mount Sinai faced at least $2 million in arbitration-awarded penalties during 2024 alone for understaffing violations in labor and delivery, oncology, and emergency departments. The public hospital system NYC Health + Hospitals, which had adopted similar staffing enforcement provisions in 2023, hired 600 additional nurses to comply with contractual staffing ratios.

The AI Breakthrough

The artificial intelligence provisions deserve attention as a tactical innovation in labor negotiations. The settled contracts at Montefiore and Mount Sinai included language addressing AI in patient care—Montefiore’s language states that nurses can use their clinical judgment to override AI-generated patient care decisions, while Mount Sinai committed to notifying the union before implementing new technologies affecting nursing practice.

This language appears to represent the first union contract provision about AI in patient care anywhere in the country. The provision responds to concerns that as hospitals increasingly implement AI diagnostic and treatment recommendation systems, nurses might lose the ability to exercise clinical judgment and might face disciplinary action for deviating from algorithmic recommendations.

The AI provision represents not merely an economic or working condition gain but a claim to professional independence in an industry increasingly shaped by computer systems.

Where the Strategy Hit Limits

The strike’s partial resolution—with NewYork-Presbyterian nurses continuing their action—revealed limitations on nursing union leverage and suggested that hospital finances were a key factor in management resistance.

NewYork-Presbyterian, as the city’s wealthiest hospital system with a $2.7 billion revenue base and reported $97 million surplus in early 2025, could more easily handle economic pressure from the strike compared to Mount Sinai and Montefiore. While the three hospital systems collectively spent $100 million on travel nurse replacement staffing, this was affordable for NewYork-Presbyterian because of its financial scale.

The decision by NYSNA leadership to force votes despite the NewYork-Presbyterian bargaining committee’s recommendation to reject raised questions about union decision-making. The committee’s objection was based on analysis—NewYork-Presbyterian’s proposed staffing language included commitment to hire only 60 new full-time employees compared to the union’s demand for 120, lacked enforcement mechanisms beyond numerical hiring targets, and offered no job protection for existing staff if the hospital chose to reduce positions later.

The 73 percent rejection vote at NewYork-Presbyterian validated the bargaining committee’s assessment that the proposal represented a different agreement than what Mount Sinai and Montefiore secured.

Learning from Healthcare Strike History

The 2026 strike followed a path set by recent healthcare labor activism, particularly the precedent set by the three-day Mount Sinai and Montefiore nurses’ strike in January 2023, which had caught hospital management by surprise and resulted in contract language establishing enforceable staffing ratios.

By 2026, hospital management was neither caught off guard nor passive in response to strike threat. The three years between strikes had allowed hospital executives to develop backup plans for replacement staffing, invest in travel nurse recruiting relationships, and develop communication plans to counter union messaging. The deployment of public relations firms by Mount Sinai—a tactic absent in 2023—reflected management’s understanding that public perception was a key battleground.

Healthcare worker strikes are a labor relations category defined by federal law requiring ten days’ notice before work stoppage and notification of federal mediation services. The fact that hospitals provide services creates tension—while unions possess leverage from workers who can’t be replaced, hospitals and the public face pressure not to disrupt patient care.

Research on strike effectiveness indicates that healthcare strikes can achieve gains when union strategy emphasizes patient safety rather than pure economic demands and when the striking workers possess specialized skills that can’t be replaced.

The Broader Labor Context

The makeup of NYSNA’s strike reflects patterns in the American labor movement, where healthcare workers and public service employees increasingly represent the leading edge of union activism. As manufacturing-based industrial unionism has declined, healthcare and public service unions have become more important in the American labor movement.

The Kaiser Permanente healthcare strike of January-February 2026—occurring contemporaneously with the New York nurses’ strike—represented an even larger healthcare labor action, with 31,000 nurses and healthcare workers walking out on January 26 across California and Hawaii, followed by pharmacy and laboratory workers joining the action on February 9. That wave of healthcare organizing in early 2026 suggests underlying causes—post-pandemic workforce militancy, healthcare worker burnout, perceived corporate profiteering during pandemic crisis—driving healthcare labor activism across the country during this period.

The political environment around the 2026 strike differs from earlier healthcare strikes. Mayor Mamdani’s participation in picket lines and Senator Sanders’ appearance represent political sympathy toward labor activism that contrasts with earlier eras when elected officials more commonly stayed neutral in labor disputes or aligned with business interests.

Tactics That Could Amplify Future Actions

The 2026 strike’s mixed outcomes suggest several strategic approaches that could strengthen future healthcare labor actions. These observations draw from historical precedent and movement strategy research.

Building Coalitions with Patient Groups

The 1999-2000 Justice for Janitors campaigns in Los Angeles combined labor organizing with community-based direct action, building coalitions between workers and neighborhood organizations whose members used the service providers’ workplaces. The 1968 Memphis sanitation strike gained national prominence when civil rights leaders framed worker dignity as a civil rights issue, transforming it from a narrow labor dispute into a social justice campaign.

NYSNA could develop partnerships with patient advocacy organizations, disability rights groups, and community health organizations to frame staffing ratios and nurse working conditions as patient safety issues affecting all patients. Rather than positioning the strike as labor-versus-management, this framing could mobilize patient groups to pressure hospital boards and administrators.

Research on hospital staffing demonstrates direct correlations between nurse-to-patient ratios and patient mortality rates. Making this evidence accessible to patient advocacy organizations could amplify pressure on hospitals. Hospitals face damage to their reputation and legal liability if patient outcomes decline—framing the strike as a campaign for patient safety could change the debate from “unions disrupting care” to “advocates demanding safe care standards.”

Timing Strikes to Hit Hospitals Hardest

The 1997 UPS Teamsters strike deliberately targeted the pre-Christmas period when package delivery volume reached maximum levels, maximizing economic damage and pressure on the company during its most profitable season.

NYSNA could strategically time future strikes to coincide with periods when hospitals generate the most revenue and are busiest. Hospitals generate higher revenue during flu season (January-February), post-holiday period when elective surgeries resume, and summer season when emergency department volume increases. Timing strike authorization to threaten action during high-revenue periods creates greater financial pressure than strikes during low-revenue seasons.

Hospitals’ finances depend on continuous revenue generation. Strikes during peak demand periods cost them the most money per day of action, putting more financial pressure on management to settle versus strikes during slower periods when replacement staffing covers operations more easily.

Documenting Problems Before Striking

The 1981 Solidarity movement in Poland documented government oppression systematically for months before calling major actions, creating a narrative foundation when strikes occurred that demonstrated necessity rather than impulse.

Before calling a strike, NYSNA could launch a public project where nurses photograph, document, and publicize instances of dangerous staffing (patient care in hallways, understaffed units, documented harm from inadequate staffing) with patient permission and privacy protections. Creating a visual and narrative documentation campaign over weeks before strike action could establish public understanding of the problem, making the strike appear as a necessary response to documented conditions rather than a union demand emerging suddenly.

Pre-strike documentation establishes the problem in public consciousness before the strike frames it as labor-management dispute. It transforms strike from appearing as sudden action to appearing as necessary next step, and creates visual and narrative evidence difficult for hospitals to dispute.

Reaching Out to Board Members and Donors

The “Mink Brigade” of wealthy women supporters who joined the 1909-1910 Uprising of the 20,000 garment workers’ strike made the action more visible and credible, bringing respectability from wealthy supporters to working-class labor action.

NYSNA could develop targeted campaigns reaching hospital board members and major donors, emphasizing that inadequate staffing endangers patient safety and exposes the hospital to liability and regulatory action. Rather than approaching board members as enemies in a labor-versus-management fight, union could frame contact as protecting institutional reputation and patient outcomes.

Hospital boards often let management handle union issues but respond strongly to concerns about patient safety, reputation, and liability. Board members may exert pressure on executives to settle strikes when they understand patient safety implications. Donors care about institutional reputation and may withhold contributions if they perceive leadership failures.

Following the Public Money

The 2018-2019 Los Angeles teachers’ strike used the argument that public resources flowing to private entities (charter schools) reduced funding for public education, creating a narrative about how public money gets divided.

NYSNA could publish research showing the proportion of each hospital system’s revenue derived from public funding sources (Medicare, Medicaid, public insurance programs), property tax exemptions granted to hospitals, and other public subsidies. If hospitals receive thirty, forty, or fifty percent of their revenue from public funds while paying executives tens of millions annually and claiming insufficient resources for nurse staffing, union could frame the issue as misuse of public money.

Holding hospitals accountable for public money works differently than labor-versus-business framing. Elected officials can justify involvement in hospital management decisions on public resource accountability grounds. It changes the conflict from “union wants higher wages” to “hospital misuses public money.”

Coordinating Strikes Across States

The 1994 UPS strike by Teamsters achieved leverage partly through its national scope, making package delivery impossible across the entire country and preventing employer from shifting operations to non-union regions.

NYSNA could coordinate with nursing unions in other Northeast states to develop regional strike authorization and threat timelines, allowing unions to negotiate regionally rather than facility-by-facility or city-by-city. Large hospital chains with multiple state operations face greater difficulty sustaining replacement staffing and operations across multiple strike locations simultaneously.

Hospital chains operate regionally and nationally. Multi-state strikes prevent workarounds management might develop for single-state strikes, force negotiation with corporate headquarters rather than individual facility bargaining, and increase strike costs across multiple markets.

The Unfinished Strike

As of mid-February 2026, approximately 4,200 nurses at NewYork-Presbyterian remained on strike after overwhelmingly rejecting the hospital’s contract proposal. The hospital stated that it remained “willing to keep offering the rejected proposal for reconsideration,” suggesting management would maintain the same offer while hoping for striking nurses to give up.

NYSNA declared the action an unfair labor practice strike—calling it management’s refusal to negotiate in good faith rather than an economic strike—which legally gives more protections to striking workers, though this determination requires the National Labor Relations Board to agree.

The divergence between settled and striking nurses created tension within the union. Nurses who returned to work at Mount Sinai and Montefiore could claim victory, but union solidarity required supporting NewYork-Presbyterian nurses’ continued action. The fact that the majority of nurses had stopped picketing while a minority continued changed how the strike worked and its political meaning.

The obstacles to NewYork-Presbyterian settlement appeared likely to persist. NewYork-Presbyterian refused enforceable staffing ratio language, offering only commitments to hire additional staff without enforcement mechanisms or job protections—what the bargaining committee identified as insufficient. The hospital continued deploying travel nurses at high cost, suggesting management felt financially confident despite replacement staffing expenses.

The federal Department of Justice investigation into NewYork-Presbyterian’s unfair business practices and abuse of market power created an additional dimension to negotiations. Management might resist settling with the union if doing so appeared to prove that the hospital had insufficient financial constraints to justify resistance.

The continuing strike put NYSNA leadership in position to make choices about escalation, negotiation, and endurance. The union could take more aggressive action—more disruptive picket strategies, picketing at NewYork-Presbyterian board members’ offices or homes, public campaigns against hospital executives, or intensified political pressure through elected officials. Alternatively, leadership could attempt to reach settlement through private negotiations, potentially accepting some middle ground between the hospital’s initial offer and the union’s core demands.

The continuing strike’s significance went beyond the immediate contract issues to questions about union power and hospital finances in today’s healthcare economy. If NewYork-Presbyterian successfully resisted settlement and eventually forced nurses back to work without securing the sought-after staffing enforcement language, this would be a setback for nursing unions’ goals of establishing enforceable staffing protections as an industry standard.

Conversely, if NYSNA eventually won staffing protections from NewYork-Presbyterian after continued strike pressure, it would demonstrate that even wealthy hospital systems could be forced to concede on the main issue. The outcome would send a message throughout the healthcare labor movement about what union leverage could achieve against hospitals’ most resistant management.

The healthcare labor landscape suggested that 2026 represented a moment for hospital workers to organize. The contemporaneous Kaiser Permanente strike involving 35,000 healthcare workers across California and Hawaii, combined with the New York nurses’ actions, indicated that healthcare workers nationally saw an opportunity to win improvements.

The post-pandemic labor market, in which healthcare worker shortages created constraints on management’s ability to replace workers, combined with political support from elected officials and increased public sympathy for healthcare worker issues generated by pandemic visibility, appeared to create conditions favorable for healthcare labor action.

The question facing unions was whether 2026 would be a turning point toward sustained healthcare worker organizing and militancy, or whether the momentum would fade after particular settlements were reached, leaving the problems of understaffing, low compensation, and working conditions unresolved.

The 2026 New York nurses’ strike, through its AI contract provisions and sustained month-long action across multiple hospital systems, set new standards for healthcare labor negotiations and demonstrated that nursing unions could extract meaningful gains through disciplined collective action. The partial success—settlement at two hospital systems while another refused concessions—showed both the power and limits of nursing union leverage against the most resistant employers.

For the labor movement, the strike demonstrated that workers in services requiring specialized training and strong public sympathy could exercise meaningful power through organized strike. But the fact that power wasn’t enough to force settlement everywhere—particularly against the wealthiest employers—suggested that legislation requiring staffing ratios and healthcare worker protections might be necessary in addition to collective bargaining for making lasting improvements in healthcare worker conditions across the entire industry.

This article analyzes protest and activism tactics for educational purposes. We aim to contribute to effective and ethical efforts across the political spectrum, and we present diverse viewpoints and ideas without endorsement.