Since nursing contract negotiations heated up in January 2026 at UPMC Magee-Womens Hospital in Pittsburgh and at UPMC Altoona, the debate shifted from standard wage disputes to a more fundamental question of patient safety: the nurse-to-patient ratio.
The New York State Nurses Association’s approach has become a primary blueprint for nursing labor strategy nationwide. By framing staffing ratios as a nonnegotiable safety standard, NYSNA shifted the focus of contract negotiations from simple wage increases to enforceable clinical mandates. In January, the new union held its first meeting with UPMC management to negotiate a contract. At the time of publication of this article, the NYSNA and the New York-Presbyterian/Columbia hospital had reached a tentative deal, though the provisions of the agreement have not been made public.
In fall 2025, 900 nurses at UPMC’s main hospitals in Pittsburgh voted to be represented by the Service Employees International Union, or SEIU.
Anna Mayo, assistant professor of organizational behavior at Carnegie Mellon University, explains the workload and staffing concerns that nurses face both in Pittsburgh hospitals and nationwide.
What are the key concerns in the nursing contract negotiations at Magee?
One big concern relates to nurse staffing, and specifically the nurse-to-patient ratio. Other issues include wages, health benefits, parental and sick leave, work hours and workplace violence mitigation measures. Magee is one of Pittsburgh’s biggest labor and delivery and neonatal centers, and nurses there say they’ve been working with what they describe as “unsafe patient loads.”
Magee nurses held a news conference in January 2026 advocating for more time with their patients by establishing minimum nurse-to-patient ratios. The main issue the nurses want resolved in their first collective bargaining agreement is a cap on how many patients a nurse can be assigned per shift. If Magee were to follow recommended industry standards set by the Association of Women’s Health, Obstetric and Neonatal Nurses, that would be one nurse assigned for every patient in active labor.
Is there evidence linking nursing staffing levels to patient outcomes like mortality, infections or readmissions?
The short answer is yes. There is general agreement that having “safe” nursing staffing levels is related to better patient outcomes, but what exactly constitutes safe staffing is less clear.
These ratios commonly account for a nurse’s workload based on both numbers of patients and patient acuity – a measure of how much time a nurse needs to spend with a patient. Relevant patient factors include the severity of the case and need for medication or other interventions, patient mobility and status as a new admission or being close to discharge. Factors like a nurse’s experience level and the floor layout might also be considered in a measure of acuity. For example, patients who are farther away from each other can require more time for one nurse to monitor.
Even with advances in the use of artificial intelligence and electronic health record data to generate real-time predictions of acuity, current modeling is imperfect.
A 2025 study shows that how busy a nurse feels is often more important than the number of patients they have or current estimates of how much care those patients require. Even if the official numbers look OK, a nurse’s personal experience of the workload is a better predictor of whether they will miss a care task. Because there is not yet a clear and agreed-upon way to measure this, nurses and hospital leadership – who view the problem from their distinct positions – often disagree on what safe staffing actually looks like, which can lead to conflict.
As someone who studies the coordination of health care teams, I see a missing piece in the conversation about nurse staffing: the rest of the team. This could include other medical providers, therapists, dietitians, social workers and diagnostic staff.
In reality, you could have two nurses in the same unit with the same number of patients who appear to need the same amount of care. But one might be overtaxed while the other is doing fine, at least in part because of how the broader patient care teams are structured and working together.
When nursing units are understaffed, what happens to other health care workers on their team?
Evidence about understaffing and use of replacement workers is largely focused on patient outcomes, and it is mixed. One 2022 meta-analysis found no difference in patient outcomes during or outside of health care worker strikes. However, a research study using data from New York that focused on nursing strikes specifically suggests an increased risk of both mortality and readmission.
Research on health care teams, though, suggests there is also risk for teamwork breakdowns. Having replacement workers during a strike inherently creates patient care teams where team members haven’t worked together before. This lack of shared experience can negatively affect teamwork.
Are there any solutions?
Negotiations research suggests the key to conflict management is to understand the other party’s underlying interests. Nurses are clearly burnt out, and that should be taken seriously. However, accounting for the bigger picture – staffing decisions at the team level – could reduce the stress on nurses.
For instance, how care teams are grouped can have serious implications as well. A nurse’s experience will depend on how difficult and time-consuming it is to coordinate and care for each patient. If a nurse has three patients and three different care teams instead of the same care team for all patients, the coordination costs are more burdensome.
There is some evidence of the benefits of team-based staffing in primary care and emergency departments. It could mitigate how drastic the difference in a nurse’s workload feels when comparing a load of one patient to two, three, and so on. Additionally, my research suggests low-cost interventions that spark increased nurse involvement can improve team coordination and patient outcomes, and so might also be a useful lever for affecting a nurse’s felt workload.
Looking at how patient care teams work together – instead of just focusing on nurses – might reveal new ways to help patients and staff. Solving these problems could reduce the need for strikes or protests in the first place and help hospital leaders better support their employees, their patients and the organization as a whole.
This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Anna Mayo, Carnegie Mellon University
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Anna Mayo does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
