What would happen if you didn’t show up to work, if you walked out of work, if you went on strike? Would anyone notice? Would anyone suffer? Besides earning a (hopefully ‘living wage’) paycheck and (hopefully) decent benefits including heath insurance, how essential is the work we do? And just how expendable are we?

These questions have been on my mind over the past several weeks as a labor dispute rumbles along at the University of Washington in Seattle where I teach. Our faculty members are not unionized, but our teaching assistants are part of the labor union UAW Local 4121. They just voted (90% in favor) to strike if their union representatives can’t negotiate a new work contract with the university by April 30th. Among the union’s terms is one calling on the university to adhere to the City of Seattle’s new minimum wage ordinance that went into effect at the beginning of this month. They are also asking for better health insurance benefits. Their most recent (and first ever) strike was for fifteen days at the end of the academic year in June 2001. Fortunately, I was not teaching at the time, but I understand that the strike created a problem for final exams and grades. (See Columns: University of Washington Alumni Magazine article “Briefing: First Ever TA Strike Hits UW Campus.”)

By now we are all aware of the escalating cost of a college education. An increasing body of research indicates that the largest contributors to this tuition increase are the expansion of the number of university administrators and their inflated (six and seven digit) salaries. The increase in tuition certainly is not going to increased salaries/benefits for most faculty members or to graduate student employees (nor to improved teaching facilities/see paragraph below). An April 5, 2015 NYT op-ed article by Paul F. Campos, “The Real Reason College Tuition Costs So Much,” is refreshingly direct and clear on these issues.

There are approximately 4,500 teaching and research assistant graduate students who work for the University of Washington. My son is one of them, as is my current and best ever teaching assistant. She helps me keep track of and grade all the weekly writing assignments for the close to 150 senior nursing students in a writing-intensive health policy course. She also helps me do battle with the antiquated A-V classroom equipment. Just last week she helped me avoid being electrocuted by a malevolent, malfunctioning microphone that they had jury-rigged to a large boombox on the podium (because the A-V equipment had completely died). I am (still) here to attest to the fact that teaching assistants are indispensable.

And while union membership has been declining in the U.S. over the past several decades, it has been increasing for healthcare workers, and especially for nurses employed by hospitals. That hospitals, including the supposedly not-for-profit hospitals, are big businesses that run like factories, is a well-established fact. Healthcare reform efforts have placed increasing financial pressures on hospital administrators who typically turn these into ‘lean work’ initiatives for the hospital employees below them. ‘Lean work’ probably has some fancy management-speak definition, but it really means that those lower in the food-chain (such as nurses) run their butts off trying to do more work with far less resources.

As Alana Semuels writes in The Atlantic (“The Little Union that Could” November 3, 2014), the small but growing union National Nurses United (NNU) has been especially effective at battling the Goliaths of healthcare power and at winning many of these battles. NNU has pioneered the use of one-day strikes to pressure hospital administrators to provide nurses with the resources they need, such as safe nurse-to-patient ratios and adequate Ebola safety equipment. When Arnold Schwarzenegger was Governor of California and tried to block a state law that would provide safe nurse staffing levels, the nurses of NNU helped to block the Terminator’s block: California remains the only state to mandate safe nurse (RN)-to-patient ratios in hospitals. Yes! Power to the people/nurses!

Here’s some interesting food for thought: When physicians strike, patient mortality goes down; when nurses strike, patient mortality goes up. A physician colleague of mine always tells my students this when he gives a guest lecture in my health policy course. It always grabs students’ attention and it’s not just a random, sensationalized statement. It is backed by a growing number of studies from the U.S. and from other countries (see below). In healthcare, the work of nurses matters. In higher education, the work of graduate student teaching assistants matters.

****** References:

“Evidence of the Effects of Nurses’ Strikes”  by Jonathan Gruber and Samuel A. Kleiner, National Bureau of Economic Research, March 2010.

“Doctors’ Strikes and Mortality: A Review” by Solveig Cunningham, Kristina Mitechell, KM Venkat Narayan, Salim Yusuf. Social Science and Medicine. 2008. 67:1784-1788.

Seattle Times article “Grad students employed by UW vote to strike if contract talks fail” by Katherine Long, April 22, 2015.)

“UW regents flee as student activists speak up” by Katherine Long, April 8, 2015, Seattle Times.