“People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public…” wrote Adam Smith in 1776. Four new class action suits allege that folks running hospitals are doing just that: conspiring to depress nurses’ wages, even though, as I’ve written before, raising them could help address a nurse shortage which threatens public health.

Filed yesterday in Albany, Chicago, Memphis and San Antonio, the suits allege that hospitals in those cities are exchanging detailed information about nurses’ pay, so that each can keep labor costs low without suffering a competitive disadvantage. A lead lawyer on the suit, Dan Small of Cohen, Milstein, Hausfeld and Toll (a large corporate firm whose deep pockets are backing the sex discrimination suit against Wal-Mart) tells me that the suits are based on interviews with current and former employees of these hospitals, who were privy to meetings and discussions in which pay information was shared.

In each of these markets, raising the wages could have helped to alleviate a nurse shortage. Instead, understaffing and low pay is leading to widespread burnout. Yesterday I spoke with one of the named plaintiffs, Conise Dillard, of Cordova, Tennessee, an RN who worked for Baptist Memorial Hospital in Memphis. Conise painted a disturbing picture of the consequences of a nursing shortage. She worked the night shift, handling thirteen patients at a time all by herself, because “the hospital was not able to send us more nurses.” Conise explained that more patients are admitted during the night, more die during the night, and pain levels are higher, so the understaffing made it almost impossible to adequately care for everyone. “I’d be crying my eyes out at the end of my shift,” she recalls. With so many patients, if one needs all your attention, “you just have to pray that the others are holding their own.” Conise adds, “Sometimes you would have a patient go, expire, and you didn’t anticipate it because you have so many.”

The lawsuits are based in part on evidence uncovered by the Service Employees International Union (SEIU)’s Nurse Alliance. Given the current political climate, no one wants to say publicly that the legal actions are part of an organizing strategy, but let’s hope that nurses in these cities do organize for better pay and conditions.

With three children, Conise did need to make more money. (Memphis hospitals are charged with conspiring to underpay nurses about $14,000 yearly.) But she also quit her hospital job because understaffing made it impossible to care for sick people, which she feels is her “calling.” Her description of her night shift should strike fear into the heart of anyone who might ever find themselves in a hospital bed. That is to say, all of us.