Update: On Monday, May 2, the Committee for Recognition of Nursing Achievement, which represents nurses at Stanford and Lucile Packard Children's hospitals, announced that its members voted to ratify a new agreement. Read our latest story.

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Thousands of nurses from Stanford and Lucile Packard Children's hospitals staged a raucous protest on the hospital campus on Monday during the opening salvo of their strike.

The nurses, wearing the blue T-shirts with the name of their union, the Committee for Recognition of Nursing Achievement (CRONA), set up picket lines along Welch Road near Stanford's new hospital at 500 Pasteur Drive and along the street to Packard Hospital. Frustrated by failed negotiations to renew their contract, which ended March 31, the nurses said they are tired of being ignored, particularly after more than two years of being on the front lines of COVID-19 care. Their demands include greater staffing, mental health and wellness support, increased wages and benefits.

Jackie Campbell, a strike leader who is on the union's negotiating team, said she worked at Stanford during the last strike 20 years ago.

"We seem to be fighting for the same sort of things, including safe patient staffing," she said. "We have some of the sickest patients in the country and in the world. The nurses here are highly specialized. Every time we lose them, we lose the ability to care for patients. Each time, we have to take more time out to train new staff and then they leave for somewhere else. If the hospitals can't recruit and retain people, we are training them for nothing. It all affects patient care," she said.

Colleen Borges, CRONA's president, said the nurses are also demanding for appropriate staffing levels based on acuity care, which is higher levels of care for sicker patients. Nurses want more flexible staffing and better pay to accommodate times of higher patient acuity. Staffing ratios are set by the state, but they are minimum staffing ratios, she said.

Borges questioned the hospitals' claim that they have hired enough replacement staff for the strike to maintain patient care levels.

"We can't even fill the holes that we have now. I don't know how they are having enough staffing. They don't need to staff with traveling nurses who are getting paid twice what we get paid. Instead, invest in your nurses. We are the biggest return on their investment," she said.

Campbell said that mental health and well-being support are also "a big deal" — especially for nurses working in the intensive care unit. The last two years of COVID-19 pandemic and patient deaths have made the emotional strain on nurses even more acute.

"Losing a patient takes an emotional toll and then the nurses are expected to turn around and take care of another (critically ill) patient the next day," Campbell said.

The nurses want a program that is "not just a facade of mental health care. Right now, it is just a facade. If somebody is in crisis, you don't want to be calling 14 or 15 phone numbers. You want to be able to get someone on the phone right away," she said.

Borges said the nurses want mental health counseling that is more than the six sessions the hospital currently offers and for the hospitals to defray the cost of private counseling. The nurses also want access to their accrued time off when they need it so they can rest and recharge. Instead, the hospitals want the nurses to be even more available, she said.

While hospital leaders claim the nurses are among the highest paid in the country, Borges said if that is so, it's a spurious argument given the Bay Area's stratospheric cost of housing and cost of living. The overworked nurses put in 12- to 15-hour shifts at times and many must travel an hour or more to get to work, she said.

Although the union did win safer conditions a couple of years ago with dedicated sleeping rooms for on-call nurses who were previously sleeping in their cars, Borges said the nurses are still driving long distances from communities outside of the area where they can afford to live and the hospital doesn't have to provide a wage that could allow them to live near where they work.

As a pediatric oncology nurse who has worked at the hospitals for 27 years, Borges said at some point she will be retiring, but she and the other nurses are fighting for young people who want to enter the profession, such as her daughter, who will come after them. What the nurses gain now will influence the future of patient care, she said.

"Nursing in this country is in trouble. Nurses are leaving the profession faster than we can replace them," Borges said.

"The nurses are tired," said Campbell, as the nurses around her waved signs that read, "From heroes to zeros," in reference to the initial wave of thanks and support they received during the start of the pandemic. They also want medical health care coverage after retirement.

"We spend our whole lives taking care of people and when we retire we want to be able to be taken care of," she said.

The nurses said they will stay on strike for as long as it takes. The union's next bargaining session is scheduled for Tuesday, April 26.

Stanford released a statement on Monday from Dale E. Beatty, chief nurse executive and vice president of patient care services for Stanford Health Care, and Jesus Ceperos, senior vice president of patient care and chief nursing officer for Stanford Children’s Health. They referred to a website, StanfordPackardVoice.com, which discusses the hospitals' latest proposal to CRONA.

"Both hospitals remain open, and we have secured the services of qualified, experienced replacement nurses to work alongside other members of our patient care team to continue providing the safest, highest quality care to our patients," they said.

The strike has caused the hospitals to reduce their volume of services in some areas and to reschedule elective procedures, however.

"We respect our nurses' legal right to take part in a work stoppage but are deeply disappointed that the union chose this path. A union work stoppage is a serious event that is disruptive to our patients, families, and colleagues. The impact can be deep, long lasting, and costly.

"The wellbeing of our nurses and all our staff is a core priority for our hospitals. One of the ways we do this is by ensuring that our nurse-to-patient staffing ratios remain above California standards and are adjusted to patient acuity, which we have done throughout the pandemic. Overtime is entirely voluntary and our overtime utilization is consistently lower than other hospitals nationally," they said.

"We have worked diligently to reach a mutually acceptable contract agreement and have made meaningful progress at the bargaining table so far. We've offered an enriched comprehensive proposal that features only enhancements for our nurses, including wage increases that will keep our nurses among the highest paid nurses in the nation, greater retention bonuses in the first year, funds to help repay loans incurred while seeking a nursing degree, increased access to paid time off for new nurses, and a new program for retention-incentive payments for our nurses working in units with higher vacancy rates and hard-to-fill positions. We want to reach (an) agreement with CRONA, and we believe we demonstrated that with our latest offer."

The hospitals defended their decision to cut pay and health coverage to any striking nurses.

"Standard national practice is that employer-paid benefits are only provided to employees who are actively working. During this work stoppage, we've made it clear that nurses who choose to strike may continue their health coverage through COBRA (Consolidated Omnibus Budget Reconciliation Act), a federal program that allows employees to temporarily extend their group health benefits. This standard practice is not unique to our hospitals and applies to any of our employees who are not working, are on unpaid status, and are not on an approved leave."