Building a Statewide Movement in Ohio

At the Ohio State University (OSU) Wexner Medical Center, we’ve had some of the strongest staffing provisions in the country, with specified ratios for each unit, since 2019. But those provisions alone can’t solve the staffing crisis. We have more than 1,100 full-time nursing vacancies in the hospital. Most days, the hospital has to close more than 100 beds, which has a bottleneck effect in the emergency department. That translates to 30 or 40 boarders and 60 people waiting in the emergency room for care. Administrators don’t want to take meaningful action on staffing—but they’re opening a new $2 billion inpatient hospital tower early in 2026. Who’s going to staff it? It feels like they’re trying to normalize these conditions to save money rather than investing in safe, sustainable patient care.

Most hospitals in Ohio don’t even have the protections we’ve bargained with OSU. So one of the major goals of the Ohio Nurses Association’s (ONA’s) Code Red campaign is to establish greater consistency across the state through legislation, collective bargaining, and organizing as we work toward safe staffing for all Ohio nurses and health professionals.

ONA started our campaign by surveying registered nurses statewide about staffing and workplace safety—and we got more than 11,000 responses from every county in the state. We developed a white paper based on the results (available at ohnurses.org later this year), and we’re using it to support other elements of our campaign, including our legislation that was introduced in fall 2023. The bill addresses safe staffing and mandatory overtime, protects whistleblowers, and establishes recruitment and retention initiatives like a student debt forgiveness program. Our goal is to pass it by the end of 2026.

In the meantime, we’re focusing on coordinating messaging and strategy across the state, using the Ohio State University Nurses Organization’s (OSUNO’s) staffing contract language as a model. Throughout the pandemic, we were able to maintain safe ratios at OSU. Our critical care units didn’t flex above two patients per nurse. In some instances, acute care and other lower acuity areas had to flex up more, but we were able to hold the hospital to not flexing above five patients per nurse in the med-surg unit.

ONA’s goal is to take that from precedent to standard, helping locals build the OSUNO language into collective bargaining campaigns that connect with larger statewide initiatives. That way, when the Ohio Hospital Association claims that ratios are dangerous for patients or will bankrupt them and harm our community, we can point to the 20 hospitals that have this structure in place and the patient care outcomes that prove it works.

We’re also helping locals develop their own Code Red campaigns, following OSUNO’s lead. OSUNO is pushing for some mid-contract improvements, including enhanced incentives to fill open shifts, reopen beds, and safely care for patients. We’re also looking for additional protections from workplace violence, like metal detectors, more security personnel, and better training and post-incident support.

To support those goals, we’re working to build sustained public awareness of and support for safe staffing. We started with a small group of nurses standing in front of the hospital for an hour every morning with a banner that read “Understaffing = patient care crisis.” We’re also collecting member testimonials to share on social media and use in paid advertisements. We want our community and legislators to understand what understaffing conditions mean in our hospital and how tired and burned out nurses are—and we hope what we’re doing at OSU will help tell the story statewide.

Instead of reinventing the wheel at each local, we’ll adjust the OSUNO model for each ONA hospital’s needs. We’re putting together a toolkit for pictures and quotes, graphics, button templates, and more that locals can use.

We’ve been sounding the alarm for a long time, especially during COVID-19, and healthcare workers in Ohio have taken notice. We’ve had a lot of interest in new organizing because people can see what we stand for: we’re responsive to what’s happening with our members, we want to protect patients, and we have our priorities in the right place. Code Red is a continuation of that, and it’s especially important right now as ONA is in a period of transition. We’ve ended our affiliation with the American Nurses Association and are revamping our constitution and bylaws to become a fully fledged union. Our Code Red campaign will help us continue to grow union density and healthcare worker power in our facilities and across the state. We plan to keep sounding the alarm louder and louder until we get the results we need to safely care for our patients.

Rick Lucas, RN, has been a critical care nurse for 20 years and a rapid response nurse at the Ohio State University Wexner Medical Center for 10 years. He is the president of the Ohio State University Nurses Organization and first vice president of the Ohio Nurses Association.

[photo: courtesy of ONA]