As New York City hospitals continue to grapple with staffing shortages three years into the pandemic, competition for nurses has become fierce and many who remain in full-time jobs said they now feel more empowered than ever to fight for better working conditions and pay.
Labor tensions crescendoed in January when 7,000 nurses went on strike for three days at Mount Sinai Hospital in Manhattan and Montefiore Medical Center in the Bronx.
Historic wins at those facilities and others that narrowly avoided a strike had a domino effect. They quickly precipitated sizable pay raises at other medical centers represented by the New York State Nurses Association (NYSNA) and the health care union 1199SEIU. The latter was able to re-open negotiations with a group of 90 hospitals and nursing homes midway through their contract and secure a new deal within days.
But some nurses working at hospitals in New York City say theyre still not out of the woods. Many of their colleagues left their full-time hospital jobs during the pandemic. And while workforce data shows new nurses are still entering the profession, those monitoring health care trends said they have yet to alleviate hospitals reliance on temporary staff.
Nurses who have won new staffing commitments from their employers in recent contracts, and through legislation that was passed in Albany in 2021, said they have to stay vigilant to make sure hospitals actually adhere to them.
Meanwhile, NYC Health + Hospitals, which is currently in contract negotiations with NYSNA, is facing new pressure to close the pay gap between public and private institutions so they can better compete for nurses who are in high demand. The NYC Health + Hospitals system primarily serves lower-income New Yorkers who are on Medicaid or uninsured, and pays entry-level nurses about $20,000 less than the average private hospital, according to NYSNA.
Musu King has been a nurse at Lincoln Medical Center, a public hospital in the Bronx, for seven years. She said she watched many colleagues leave during the pandemic and thought about following them.
But then when I looked at it, I said, OK, if everybody is running away, who is going to serve our population? If I get sick, I’m going to end up in a city hospital. Who is going to take care of me?
How the pandemic ushered in new nurses as the experience exited
Kind of an absolute disaster is how nurse Mark Vetter describes the stressful early days of the coronavirus pandemic in New York City, when he was working at NewYork-Presbyterians Weill Cornell campus on the Upper East Side.
As COVID patients flooded in that spring, the hospital more than doubled its intensive care capacity from 114 to 270 beds over the course of two weeks. N95 masks were scarce and no one knew much yet about this new viral threat. We watched so many patients die, Vetter said.
Still, at the time, he was eager to be on the frontlines, rather than isolated at home.
I still had my community around, Vetter said. I had my friends at work as a support system.
But after the omicron surge battered hospitals again in late 2021, Vetter and his wife, who also worked as a nurse at Weill Cornell, decided to step away from that nursing community. Like many nurses in New York and across the country, they left behind their full-time hospital positions during the pandemic in favor of short-term contract work that offers bigger pay days, more time off and a chance to explore different opportunities in their field.
All of a sudden, we were like, Oh, we just have time between contracts and we can just relax, Vetter said of the five weeks he and his wife took to go camping, spend time with family and enjoy their New Jersey home.
Vetter, who is currently based outside of Boston, said he doesnt necessarily see himself living this itinerant lifestyle long term. But its part of a broader set of trends that is still having a profound impact on the nursing workforce in New York City and the hospitals that rely on them for everyday patient care. Other nurses have retired early or moved on to less stressful positions outside of hospitals during the pandemic, draining years of experience from the bedside, according to nurses, hospital administrators and health care workforce experts
Studies have linked lower staffing levels in hospitals to worse patient outcomes and higher mortality rates. And the New York State Nurses Association has capitalized on this moment to secure staffing protections in contracts and legislation that the union was fighting for well before COVID-19 arrived.
Watching the strike felt really hopeful to me, said Laurel Katz-Bohen, a student at the SUNY Downstate College of Nursing in Brooklyn.
I feel like we’re going into nursing in a really good time for nurses, maybe the best time ever.
Its clear from employment data that the pandemic hasnt deterred a new generation of nurses from entering the workforce. In fact, New York is ramping up the number of new nurses it mints each year. The state licensed 30,458 registered nurses in 2022, a 65% increase over 2018, according to data from the state Education Department. And according to data from the National Bureau of Labor Statistics, there were 188,000 registered nurses employed in New York in May 2021, which was nearly 10,000 more than in May 2020.
New York Gov. Kathy Hochul has vowed to help nursing schools pump out even more grads to ensure the long-term stability of the states health care workforce especially since more Baby Boomers are expected to retire in the next few years.
But that alone may not be enough.
There are large numbers of opportunities for nurses and, while we may have a lot of them, theyre not necessarily working in the areas of greatest need, said Jean Moore, director of the Center for Health Workforce Studies at SUNY Albany.
Will the rebuild affect hospital care?
At NYC Health + Hospitals, its become particularly difficult to staff intensive care units, emergency rooms and surgical units across the systems 11 hospitals, Dr. Mitchell Katz, the health systems president and CEO, said at a City Council hearing. He added that the cost of hiring temp nurses, who are currently filling some 2,000 vacancies across the system, is contributing to an anticipated $144 million operating shortfall this fiscal year.
Even well-funded private hospitals are facing new challenges.
At Mount Sinai Health System, recent grads and temp nurses make up a much bigger share of the workforce than they did pre-pandemic, making it more difficult to train new hires, Beth Oliver, the hospital networks chief nursing executive, said in an interview.
All your senior people have retired or gone to less stressful jobs, Oliver said. They want to go into [outpatient care], need to turn out to be faculty nurses, need to go to work for an insurance coverage firm. They do not need to maintain the sickest of the sick.
Meanwhile, she said, new graduates who were in nursing school during the height of the pandemic had to do more of their clinical education over Zoom and might have missed out on key in-person training. Oliver said this, combined with less opportunity for mentorship on the job, has led to greater turnover among new hires.
Oliver said Mount Sinai is trying out different strategies to acclimate new nurses to the hospital environment, including implementing more team-based care and bringing nursing school faculty onto the units to act as a sounding board for their questions and concerns. At the same time, she said, the health system is seeking to put nurse managers on less grueling work schedules.
At Mount Sinai, as at other hospitals around the city, nurses say some staffing issues predated the pandemic. But recent labor victories gave them new tools to try to force hospitals to address them.
Before we went on strike, there was just a lot of apathy, there was a lot of burnout, said Matthew Allen, a labor and delivery nurse at Mount Sinai Hospital who also serves as vice president of NYSNAs local bargaining unit at the hospital. Nurses really wanna fight now.
Nurses in Mount Sinais neonatal intensive care unit (NICU) have been tracking staffing levels during day shifts since mid-January and found the hospital is falling short of the nurse-to-patient ratios they agreed on in their new contract nearly 75% of the time, according to NYSNA, which shared the data with Gothamist.
Nurses on the unit recently requested that an outside arbitrator step in to enforce the ratios an option that became available to them through the contract.
Our patient population is obviously very vulnerable.
Our patient population is obviously very vulnerable, said Nina Horowitz, a nurse on the unit who said she and her colleagues frequently care for three or four infants at a time, rather than the agreed upon one or two. They’re babies. They can’t communicate like you or IYou need an extra set of eyes to say, Hey, this isn’t normal.
But even if a hospital faces penalties for staffing shortfalls, it doesnt necessarily mean they will be rectified overnight. Oliver admitted that it can be difficult to quickly fill in gaps in the NICU because it is so hyper-specialized. But she said she is optimistic because many of the new grads Mount Sinai has hired have expressed interest in that area.
Oliver said the Phillips School of Nursing at Mount Sinai is working to double its class size within three years, while also trying to entice more students to work at the health system upon graduation. Of the 100 nurses who graduated in December, Oliver said about half will work at a Mount Sinai facility.
I want the other 50%, she said.
Still, Oliver said as Mount Sinai seeks to hire and train new nurses, temporary staff remain essential especially those with more experience.
We need them, she said. The patients are still coming in.
Has the travel nursing trend passed its prime?
In December 2021, the omicron variant created acute staffing shortages at hospitals across New York City. Clinicians were calling out sick, while patients were streaming in so, travel nurses became in high demand.
In New York, their average pay reached a pandemic-era peak of $4,087 per week in January 2022, according to data the health care recruiting site Vivan Health shared with Gothamist.
Vetter met a traveler in his unit at Weill Cornell around that time who he said was making more money than him while taking care of less sick patients, since full-time staff were still assigned the more complex cases. At that point I was like, Well, we have a lot of student loan debt to pay off, Vetter said.
Travel pay in New York has since leveled off, reaching an average of $3,268 per week in February, but it has not dipped back to pre-pandemic levels. A national survey of 1,663 nurses and other clinicians conducted by Vivian between November and December of last year found that 86% of contract workers were open to accepting full-time employment in 2023 if they were offered a competitive salary.
But we haven’t yet seen that desire play out, said Kate Harris, director of client development at Vivian, who said interest in and demand for contract nurses is still high.
The report suggested that hospitals would also have to offer more flexible schedules and healthier work environments to lure full-time staff back.
Still, travel nursing has its downsides, according to Vetter and three other travelers who spoke to Gothamist. Nurses constantly have to be on the lookout for the next gig and may have to use their high wages to cover rent in two places at once if they find a job far from home. There isnt necessarily the same opportunity for professional development. And, while some hospitals are decently staffed, others use travel nurses as a Band-Aid to deal with extreme shortages, they said.
Vetter said his current contract is up in August and hell re-evaluate then whether he wants to find a full-time staff job although he said hes unlikely to return to the New York metro area, in part because the cost of living is so high.
In the meantime, some full-time nurses say hospitals efforts to fill vacancies with travelers are coming up short.
Nurses in the emergency room at Lincoln in the Bronx have been tracking staffing levels over the past month and estimate that temporary staff typically make up about a third of the nurses working a given shift, according to NYSNA. But they said overall staffing levels still often fall short of producing the nurse-to-patient ratios the hospital system committed to in a staffing plan submitted to the state last year.
Nearly half of the hospitals across the state have reduced or cut some services during the pandemic in response to staffing challenges.
The impact is nurses not getting a break, nurses being overwhelmed, nurses being burnt out, said King, who works in Lincolns ER. She added that, anecdotally, she has also seen understaffing affect patient wait times, at a hospital where federal quality data shows 9% of patients leave the emergency room before getting care.
Asked whether staffing challenges have affected wait times in the emergency room at Lincoln or other public hospitals, Chris Miller, a spokesperson for NYC Health + Hospitals said, The health system has seen major changes in [emergency department] quantity over the course of the pandemic, however total there was no important change in ready instances to see sufferers.
In keeping with a survey carried out this fall by the Healthcare Affiliation of New York State, practically half of hospitals throughout the state have diminished or minimize some companies throughout the pandemic in response to staffing challenges.
However for sufferers who depend on New York hospitals, the turmoil behind the scenes is not at all times obvious. A half-dozen sufferers who walked out of Lincoln on Tuesday mentioned they had been usually happy with the care they obtained there, and a few mentioned issues have even gotten higher lately.
Keith Atkins was exterior the hospital on crutches. He mentioned he was rushed to Lincoln in November after being shot within the leg and had since undergone a number of surgical procedures and bodily remedy.
I did not need to come to this hospital as a result of I’ve heard unhealthy issues in regards to the hospital, mentioned Atkins, 62. However he had no explicit complaints. On the finish of the day, he mentioned, they saved me.