‘Channel your anger’: what can we learn from Germany’s nursing strike success?

The same situation played out in hospitals around the world: when the COVID-19 pandemic struck, health care workers were plunged into chaos. As the virus raged, causing an influx of patients and widespread staff sickness, the remaining workers were stretched to breaking point. But these weren’t new issues.

In Berlin, the pandemic was the final straw. “I realised I won’t be able to work in this job for the rest of my life if there’s nothing changing,” says ICU nurse Lisa Schandl, a trainee at the time. “Some people were too burned out to stay in the job. The rest of us joined the union and joined the fight because we saw this was the last chance of changing something.”

Workers formed the Berlin Hospital Movement to fight for better conditions. Lisa became an elected spokesperson for the movement and the public sector workers union Ver.di.

At Berlin’s two main public hospitals Vivantes and Charité, workers had been feeling the pressure for years. Hospitals maximised profit by reducing staff numbers. Staff were overworked, left without time to give patients their full attention or complete professional training.

It was a chance to channel the anger

The pandemic just highlighted what had already gone wrong. “New colleagues were overwhelmed. The colleagues that had been there for a long time were depressed because they have seen the downward spiral. There was burnout in every single ward, no recognition and a huge lack of nurses,” Lisa says.

Building a movement

In late 2020, workers began to lay the groundwork for the Berlin Hospital Movement. “It was a chance to channel the anger,” says nurse David Wetzel, Ver.di union rep and spokesperson for the Berlin Hospital Movement. “If there’s a specific plan of how to change things, you can make your anger productive.”

David joined Ver.di in 2017, inspired by strike action taken by colleagues at Charité. Lisa joined as the Berlin Hospital Movement was forming. “There are more people, younger people, it’s more modern. It’s a feeling now of us being the union, not us taking part in it,” Lisa says.

In Germany, strike action has to be organised through a union and can only be called as part of collective bargaining efforts. Most unions ballot members on strike action, proceeding if a majority vote in favour. There was little precedent for hospital workers going on strike says David, but in other industries in Germany, “it's not that unusual for a union to go on an indefinite strike”.

Before any of this, the Berlin Hospital Movement had to create a clear vision. “To convince people to join the campaign, you have to have a plan to win,” says David. “Then the main goal was to get a majority [of hospital staff] involved. We wanted us nurses representing ourselves on all levels – at negotiations, talking to politicians and to the press.”

The best way to achieve this, says Lisa, was “one-to-one conversations”. Union members spoke to colleagues on every team in the two hospitals. “We were asking them what were their demands, what were their issues? Letting them complain a bit. Then during that process, finding an organic leader on each ward, one person that the rest of the team trusts enough to lead them into the striking process.”

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Via this network, each team decided what they needed to improve conditions in their ward or service. They conducted surveys of colleagues to test the appetite for action. They also elected delegates who could act as intermediaries between the workers and the negotiating committee, which itself was made up mostly of hospital workers.

Four demands

The Berlin Hospital Movement had “four core demands”, says David: nurse-to-patient ratios to ensure safe staffing levels, sanctions for the hospitals if these ratios aren’t met, better conditions for trainees, and finally, better pay for outsourced workers. “Nurses are the experts on their working conditions,” says David. “So every ward came up with a specific nurse-to-patient ratio. Then an important part is the sanctions, so if the ratios aren’t met, we’re getting paid days off. This is putting management under pressure to meet those ratios.”

In 2021, the workers delivered a petition laying out these four demands to hospital bosses and Berlin mayoral candidates. “We told them, there's 100 days to fulfil these demands, then we will go on indefinite strike,” David says.

Get together with colleagues, stand up for your demands and realise that no one will do it for you

Contacting politicians directly was crucial. Lisa and others asked for the personal numbers of each politician so they could keep in touch throughout the campaign. “Politicians know about short staffing in hospitals and bad working conditions, but some of them have never spoken to one nurse directly,” she says. “As nurses, we all know about these situations where patients are in real danger. To hear this from a nurse directly is something completely different than when union officials approach them, then they really have the urge to change something.”

After a three-day warning strike, hospital bosses refused to agree to the four demands. Workers began an indefinite strike. “It was super important to have these two rails: the indefinite strike on the one hand and negotiations on the other, and have this as a simultaneous process,” David says.

The hospital workers took care to plan a safe strike. “It’s not like for railway workers where you can strike down the whole train system in Germany, you need to maintain safe patient care,” Lisa says. “It was possible for us to use the time during strikes to approach politicians, spread out into the clinics, and show our colleagues that it was possible to go on strike. Some of them took their time to be brave enough. What was key to the success of the strike was it was strong during the whole time. It didn’t just start with a bang, there were waves.”

Workers united

After four weeks, their demands were met. It has transformed Lisa and David’s working lives for the better. “Now, after having the contract running for one year, we realise what effect it has had. It's life-changing because you're not that overworked. You're not that stressed out. You can finish one thing and not get interrupted. It is a huge improvement,” David says. “To come to a shift and know today we’re meeting our ratio, that’s what we fought for. It’s a special feeling with your colleagues. For me, this is the ultimate success of this whole movement.”

Lisa agrees: “You don’t see your team members when you’re understaffed. Now we know all of our colleagues. The team prospers. And we know we can reactivate those colleagues as soon as there is a struggle. It was a historic movement in Germany. We didn’t think it was possible before.”

For nursing staff in the UK, many taking part in strike action for the first time, Lisa and David have words of encouragement. “The more nurses joining the struggle the better,” Lisa says. “Be brave enough to try it out. Even if it’s one day at the picket line. Look at all those other people fighting for themselves. It’s empowering. It gives me so much hope for the job.”

“You have to get together with your colleagues. Bring in as many colleagues as possible, keep everything as democratic as possible, and build up real power,” says David. “Stand up for your demands and realise that no one will do it for you. You have to do it for yourself.”