NYC nurses strike nears partial end as Montefiore, Mount Sinai reach tentative deals; NewYork-Presbyterian walkout continues

On a gray February morning outside Montefiore Medical Center in the Bronx, the picket signs were still stacked by the curb when a cheer rippled through the crowd of bundled-up nurses. After nearly five weeks on strike, word spread that negotiators had reached a tentative deal. For thousands of nurses at Montefiore and Manhattan’s Mount Sinai hospitals, the walkout that had upended New York City’s private health care system was finally nearing an end.

For thousands of others, it was not. Across the city at NewYork-Presbyterian Hospital’s Columbia University Irving Medical Center campus, nurses in red union hats kept circling the block, chanting for “safe staffing now.” As of Tuesday, roughly 4,200 nurses at the Columbia campus remained on strike, even as about 10,500 colleagues at Montefiore and Mount Sinai prepared to vote on contracts and return to work.

Tentative agreements at two systems

The partial settlement, announced Feb. 9 by the New York State Nurses Association (NYSNA), would conclude what the union and local officials say is the largest and longest nurses’ strike in New York City history for two of the three major hospital systems involved. The walkout began Jan. 12, when close to 15,000 nurses left their posts at three private networks after contract talks broke down over wages, staffing and safety.

The tentative three-year agreements with Montefiore and the Mount Sinai system call for:

• Wage increases totaling slightly more than 12% over the life of the contracts
• Preservation of existing health benefits, with no new out-of-pocket costs
• Renewed language requiring enforceable nurse-to-patient staffing ratios
• Expanded workplace-violence protections, explicitly naming transgender and immigrant nurses and patients
• New limits on artificial intelligence and electronic monitoring technologies in hospitals

“Nurses held the line for weeks for safe patient care,” NYSNA President Nancy Hagans said in a statement announcing the tentative agreements. “We are heading back to the bedside with our heads held high, having secured contracts that maintain enforceable staffing standards, improve protections from workplace violence and maintain our health benefits with no additional costs.”

Nurses at Montefiore and Mount Sinai began voting on the agreements Monday, with ballots due by Wednesday. If ratified, they are expected to return to work Saturday.

NewYork-Presbyterian dispute remains unresolved

The strike’s end at two systems follows nearly a month of tense bargaining, high-profile political attention and contingency planning by hospitals that remained open by relying heavily on temporary travel nurses and redeployed staff. It also highlights a deepening rift at NewYork-Presbyterian, where the union says the hospital has not yet matched the staffing commitments agreed to by its peers.

NewYork-Presbyterian officials say they have accepted a mediator’s proposal that largely mirrors the economic terms at Montefiore and Mount Sinai, including wage increases, preserved pensions and health benefits, and what they describe as higher staffing levels. In public statements, the hospital has said it is committed to patient safety and has called on the union to end the strike.

Union leaders counter that without clear, enforceable nurse-to-patient ratios and strong penalties when hospitals fall short, promises to “increase staffing” can remain largely aspirational.

“We’ve seen what happens when staffing is just a goal on paper,” said Kelly Gibney, a NewYork-Presbyterian nurse who has joined the picket line at the Columbia campus. “We are constantly caring for too many patients at once. We just want to go back to work with guarantees that our patients will be safe.”

The fight over staffing ratios

At the heart of the dispute is a years-long fight over how many patients each nurse can safely care for, and who decides. New York state law requires hospitals to set staffing plans through committees that include nurses and managers, but bedside nurses say those plans are frequently ignored in practice.

In 2023, a three-day strike by about 7,000 nurses at Montefiore and Mount Sinai produced what the union called “historic” contract language: the first enforceable nurse-to-patient ratios in those hospitals, backed by expedited arbitration and financial penalties when units were chronically understaffed.

Nurses contend that, three years later, chronic violations persisted. Hospital executives have acknowledged staffing challenges but say they face nationwide shortages and financial constraints.

Pressure on hospitals during flu season

During this winter’s strike, those tensions played out against a backdrop of a heavy flu season and lingering COVID-19 cases. The governor declared a state of emergency before nurses walked out, warning the dispute could jeopardize patient care if not quickly resolved. Hospitals postponed some elective surgeries, diverted ambulances and transferred patients to other facilities to keep emergency departments functioning.

Hospital officials maintain that facilities remained safe and that no major incidents were linked to the strike. But reports of emergency departments treating up to 300 patients at a time, and of patients lining hallways awaiting beds, bolstered nurses’ arguments that routine staffing was already stretched thin even before the walkout.

New contract frontiers: AI limits and safety language

Alongside staffing and pay, the tentative contracts at Montefiore and Mount Sinai break new ground by explicitly addressing artificial intelligence and electronic surveillance tools, an emerging flashpoint in hospitals nationwide.

While full contract language has not been publicly released, the union says the agreements place limits on how AI-driven systems can be used in areas such as scheduling, productivity tracking and clinical decision support. Nurses sought guarantees that algorithms would not override their professional judgment or be used as the sole basis for discipline and evaluation, and that they would have a voice in how new technologies are deployed on hospital floors.

Workplace safety language is also expanded. The contracts strengthen procedures for reporting and responding to incidents of violence against staff and patients and, for the first time, specify protections for transgender and immigrant nurses and patients. That reflects concerns about bias-motivated attacks and harassment that have surfaced amid broader national debates over immigration and gender identity.

Hospitals have not publicly objected to the anti-violence provisions. But on wages and staffing, they have argued they already offer some of the highest nurse pay in the country and face limits on how much more they can commit.

Costs, pay and the broader impact

Executives and industry groups say average salaries for full-time registered nurses in major New York City hospital systems now exceed $160,000 a year when overtime and differentials are included. They warn that additional raises and rigid ratios could strain budgets, particularly for inpatient units that are still recovering from pandemic-era disruptions and shifts in how care is delivered.

Nurses and their allies note that the hospitals spent tens of millions of dollars on temporary replacement staff during the strike, often at premium travel-nurse rates, and continue to invest in large building projects and executive compensation. They argue that focusing on base salaries ignores the cost of constant turnover and burnout.

“This is not about whether nurses are paid more than in other parts of the country,” Hagans said earlier in the strike. “It is about whether hospitals will staff units safely so nurses can stay at the bedside instead of leaving the profession.”

The outcome of the NewYork-Presbyterian standoff will help determine how far those arguments resonate beyond New York City. The three systems involved in the strike are among the largest private employers in the state and anchor institutions in national academic medicine. Their contracts often serve as benchmarks for smaller hospitals and for future bargaining rounds at other systems.

If nurses at Montefiore and Mount Sinai ratify agreements that pair enforceable staffing ratios with AI and safety protections, those provisions could become standard demands in upcoming negotiations across the region. If NewYork-Presbyterian ultimately accepts similar terms after a longer fight, it could signal a broader shift in how hospitals balance labor costs, technology and patient-care standards.

For now, the city’s private hospitals sit in limbo. At Montefiore and Mount Sinai, managers are drafting schedules for nurses they expect to see back on the floors this weekend, assuming ratification votes go through. At NewYork-Presbyterian’s Columbia campus, nurses continue to march past the main entrance, pausing as ambulances pull up.

“We’ll be back at the bedside as soon as we can,” Gibney said. “But we need to know that when we walk through those doors, we’re not walking into the same unsafe situation we left.”