Labor

It’s not unusual for Kimberly Mullen to get kicked, scratched, pushed or threatened during one of her shifts as a registered nurse in the telemetry unit at Kaiser Permanente's South Bay Medical Center in Los Angeles.

It’s considered part of the job when dealing with patients who are sometimes confused, frustrated and feeling a loss of control in an unfamiliar hospital setting, she says. Still, she's thankful she hasn’t fared worse, like one of her coworkers who was attacked by a patient's family member.

Mullen and millions of other healthcare workers nationwide are becoming accustomed to workplace violence, which can range from verbal abuse and threats to physical violence and even homicide.

The degree to which the pandemic has exacerbated the problem still isn't entirely clear, though a number of attacks already have occurred this year.

Yelling, name-calling and shouting obscenities are now daily occurrences, and "that did not use to be the case," said Hannah Drummond, an RN at HCA's Mission Hospital in Asheville, North Carolina.

Workers in the healthcare and social service industries experience the highest rates of injuries caused by workplace violence and are five times as likely to get injured at work than workers overall, according to data from the Bureau of Labor Statistics. Those incidents have risen nearly every year for healthcare workers since the BLS began tracking them in 2011.

Sometimes they turn fatal. On average, 44 workplace homicides to private healthcare workers occurred each year from 2016 through 2020, according to the BLS.

Currently, there are no federal requirements healthcare employers must follow to protect employees from workplace violence, though the Occupational Safety and Health Administration offers voluntary guidance. A handful of states have rules for employers or laws penalizing offenders, putting much of the responsibility on individual hospitals.

Some nurses say the hospitals where they work have protected them effectively during the pandemic, citing measures like ongoing visitor restrictions and workplace violence prevention programs often spearheaded by labor unions or mandated by state law.

Others disagree, and say a lack of security, training and staffing challenges worsened by the pandemic are hindering their ability to provide timely, adequate care to every patient, resulting in patient and family frustrations that sometimes turn violent.

'Less and less resources to care for patients'

This comes as hospitals deal with unprecedented staffing shortages. They are unlikely to abate anytime soon as widespread stress and burnout spurs healthcare workers — especially nurses — to consider leaving their roles.

A quarter of U.S. hospitals reporting their data to the HHS said they faced critical staffing shortages in early January, according to the agency. 

Drummond at HCA’s Mission Hospital said a patient recently ended up striking one of her coworkers when staff couldn’t get into the room with pain medication quickly enough.

"So much of the frustration that's taken out on nurses is justified, because each passing year we're getting less and less resources to care for patients," Drummond said.

So far this year, a number of attacks on healthcare workers already have occurred.

In one instance in late January, a patient's family member attacked an ICU nurse at Ochsner Medical Center’s West Bank Campus in New Orleans, according to a statement from the system’s CEO Warner Thomas.

Thomas now is advocating for state legislation to make violence against healthcare workers a felony as "hospitals grapple with an increase in disruptive or violent incidents in hospitals — many involving hostile visitors – adding further stress to the healthcare workplace," the CEO said.

In some states like Utah, lawmakers currently are considering legislation that would enhance penalties for assaulting healthcare workers.

Wisconsin already has a law that makes battery against certain healthcare workers a felony, though a bill moving through its legislature would extend that penalty to anyone threatening violence to a healthcare worker — similar to laws covering police officers and other government workers.

At the same time, there are no federal laws that directly address violence against healthcare workers, though last April the U.S. House of Representatives passed the Workplace Violence Prevention for Health Care and Social Service Workers Act. The Senate hasn't passed it.

That legislation would mandate healthcare employers to develop and implement comprehensive workplace violence prevention plans based on guidelines that are voluntary from OSHA.

They would also be required to provide employees with annual training, keep detailed records of violent incidents and submit annual summaries to the federal labor department.

Currently, California has a law similar to that with guidance and enforcement coming through the state’s OSHA department.

California and a handful of other states — such as Connecticut, Illinois, Maryland, Minnesota, New Jersey, Oregon and Washington — also have laws requiring healthcare employers to run workplace violence prevention programs, according to the American Nurses Association.

Some provider groups like the American Hospital Association opposed the federal bill, saying hospitals already have specifically tailored policies to address workplace violence and a one-size-fits-all OSHA standard isn’t warranted.

Verbal attacks on the rise amid COVID-19 frustration

Still, labor groups such as National Nurses United say a uniform, consistent and enforceable rule is necessary. The NNU opposes state laws aimed at criminalizing perpetrators of violence against healthcare workers, as those who do so are often vulnerable patients and locking them up does more harm than good, the union said in an emailed statement.

Nurses like Drummond say better staffing would allow nurses to give their full attention to patients and provide them with the best care possible while solving many of the issues that lead to violence. Having more ancillary staff like CNAs and security guards also would help, she added.

Earlier in her career, Drummond felt she had more time to have therapeutic conversations with patients and their family members.

"Now, I don't get to put that same time and attention into my patient care that I want to," said Drummond, who has been an RN for eight years.

How much of an impact the pandemic has had on violence against healthcare workers, which takes many forms, is still unclear, as the labor department's most recent data is from 2020 and the agency tracks workplace injuries and illnesses by looking at incidents causing days away from work.

Nursing assistants, registered nurses, licensed practical and licensed vocational nurses all had increases in days away from work in 2020, according to the BLS.

Nursing assistants had the highest number of days away from work among all occupations, which rose 2.5-fold from 2019 to 2020, the agency reported.

While some nurses have missed work because of COVID-19 infections, others have had to take days off to recover from violent incidents on the job. At the same time, nurses say frustration and misinformation around COVID-19 and the pandemic are spurring more verbal attacks in particular than they had experienced previously.

At the South Bay Medical Center where Mullen works, "frequent flyers," or patients who frequently return to the hospital with chronic conditions, often can be the most frustrated, and one such patient is known for hurling racial slurs at staff repeatedly throughout their shifts, she said.

However, a limited visitor policy throughout the pandemic has helped keep physical attacks at bay, Mullen said. The hospital still allows visitors for patients who are confused or dying.

Her hospital is covered by the state's workplace violence prevention law, though it's also a Kaiser facility with unionized nurses and a unique labor-management partnership with the hospital system.

Her hospital also has a dedicated workplace violence prevention committee that develops new techniques to ensure staff are safe.

One technique staff now employ involves putting a green card on the window of a patient who previously displayed violence or placing a green blanket on the patient.

That gives a signal to other staff, who may be food or environmental service workers, to be especially mindful if they haven’t interacted with that patient yet.

The green blanket program started at one location then was rolled out to all the other medical centers in Southern California, said Charmaine Morales, executive vice president of United Nurses Associations of California/Union of Health Care Professionals. The union represents over 32,000 healthcare workers.

In addition, panic buttons also have been installed on every computer at those facilities, Morales said.

Still, hospitals in other states without laws against workplace violence or unions pushing for more protections often don’t have panic buttons or committees established to create new prevention methods.

Morales says a national regulation like the Workplace Violence Prevention for Health Care and Social Service Workers Act would help, "versus leaving each state to decide what to do."

However, "just because you don't have a law in place, doesn't mean that you should not do the right thing to protect workers physically and mentally," she said.

Article top image credit: Drew Angerer / Staff via Getty Images

Dive Brief:

• The federal Occupational Safety and Health Administration will boost the number of inspections it performs at healthcare facilities that previously received pandemic-related complaints or citations now through June 9 to assess employers' ongoing efforts to mitigate future COVID-19 surges, according to a Monday press release.
• The agency said it's targeting hospitals and nursing homes that treat COVID-19 patients to ensure the facilities are complying with guidelines to reduce the spread of potential new variants and protect workers at heightened risk for infections.
• In December, OSHA withdrew the emergency temporary standard it implemented last summer making healthcare facilities follow rules around ventilation, personal protective equipment and other measures to reduce virus transmission. However, continued compliance with the ETS would satisfy "employers' related obligations under the General Duty Clause, Personal Protective Equipment and Respiratory Protection standards," the agency said.

Dive Insight:

As new COVID-19 cases continue trending downward and more areas relax masking rules, the workplace safety agency will ramp up investigations at healthcare facilities to make sure they're effectively prepared and able to prevent the rise of another variant.

OSHA will expand its presence in high-hazard healthcare facilities for three months starting Wednesday, initially focusing on efforts employers are taking to protect their workers from the virus. It will perform inspections at facilities where COVID-19 citations were previously issued and at facilities that received complaints but haven’t yet been investigated in person, according to the release.

Labor unions have fought hard since the start of the pandemic to get clearer, enforceable standards healthcare facilities must follow around virus transmission, and the ETS issued in June was a major win for those groups.

When the agency effectively dissolved it in December, those unions petitioned an appeals court to compel OSHA to quickly codify a permanent standard on occupational exposure in healthcare settings.

The ETS drew ire from provider groups, though, which pushed back, noting the rule was long and complex and carried a variety of exemptions for vaccinated employees. They also argued providers had largely been following most of the guidelines or made their best attempts to do so.

"We are using available tools while we finalize a healthcare standard," OSHA's Assistant Secretary of Labor Doug Parker said in the release. "We want to be ahead of any future events in healthcare."

Article top image credit: Justin Sullivan via Getty Images

There’s an emerging crisis in healthcare. According to one recent study, roughly one in three clinicians are considering leaving their role by 2024. Physicians, nurses, technicians, administrators—they’re all burned out, overworked and frustrated. And in the current economic climate, they have other employment options. Each day, there are fewer reasons to stay. 

Pandemic-related stress is a major contributor to the exodus, but there are other long-term, systematic factors at play. And one of the most likely drivers of this growing dissatisfaction is the changing nature of the work healthcare providers do. They spend an increasing amount of time each day on administrative overhead, and less on time providing care to patients. 

As in so many industries, the technology and software systems that were meant to make healthcare more efficient and accountable have actually created more work. Healthcare pros spend more of each day collecting, entering and reentering data into different systems, and less time on patient interactions. Some of the chief culprits include:

• Quality and safety controls - Throughout the day, nurses and clinicians have to stop what they’re doing to work on regulatory and insurance reporting that they’re obligated to complete. 
• A lack of systems integration - This is the classic “swivel chair” problem. Every hospital, clinic and office now relies on multiple systems for providing and tracking patient data. These systems weren’t designed to work together and share data, so clinicians are continually taking information entered into one system and reentering it into another. 
• Risks and claims - Every patient visit involves a lot of pre-work to confirm that a patient qualifies for care. It's a complex process that involves a lot of documentation just to verify that an insurance provider will cover the cost of care. 
• Front-office management - Patient outreach is one of the most time-intensive aspects of healthcare delivery. Historically, these tasks were the domain of support staff. But as more administrators leave for greener pastures, more of the burden falls to nursing staff and doctors. 

• Clinical performance - Think of the process of discharging a patient. It’s a complex workflow that can involve multiple physicians with multiple checklists. A patient sits and waits for the required digital paperwork to be completed—paperwork that can pile up and make a physician’s long to-do list even longer. 

In essence, today’s clinicians have become de facto data entry clerks. So it’s no surprise that the healthcare industry is undergoing massive turnover. And it’s more than just an industry problem. It affects everyone who visits a doctor’s office, lab and emergency room. Even worse, healthcare providers are finding they can’t hire their way out of the dilemma. There simply aren’t enough qualified candidates to fill the void.

Now, imagine a world where a digital workforce takes over a lot of the repetitive, rules-based digital tasks that eat up so much time each day. Imagine giving back three or four hours each day to a clinician to use on patient care. With a technology like robotic process automation (RPA), software robots can make the clinician’s work experience better by:

• Reducing clicks - A single task can involve dozens of selections in multiple systems. A software robot can complete routine sequences of clicks and prompt the assistant for any needed information.
• Streamlining navigation - Software robots can easily toggle between internal and external applications to complete a task.
• Creating a ‘single pane of glass’ - Robots can collect all the relevant information from different sources and present it to clinicians on one active screen—making it possible to see the ‘big picture’ without switching between multiple systems.
• Managing data - Information from one system (for example, an insurance portal) often needs to be entered into another (such as a lab system). A software robot can extract the right information and reenter it where it’s needed.  

Throughout the average week, the time saved starts to add up. Clinicians spend less time and effort on administrative tasks, and more time working with patients. The quality of care improves, and the clinician’s work becomes more engaging and rewarding. And with artificial intelligence and machine learning, the range of administrative and support tasks that software robots can tackle keeps growing. 

It’s time to stop the bleeding in healthcare industry turnover.  Automation can take over a lot of the work that no one wants to do, so clinicians can get back to what they were meant to do.

Article top image credit: Edwin Tan, E+ Collection via Getty Images

Dive Brief:

• Turnover among primary care physicians cost public and private payers $979 million annually, according to a new American Medical Association-backed study published in Mayo Clinic Proceedings.
• About $260 million of those excess costs are attributable to burnout spurring physicians to leave the field, the study, which is based on pre-pandemic data, found.
• The costs are incurred when primary care physicians leave and patients lose continuity of care. For example, Medicare beneficiaries spend an additional $189 within the first year of losing a primary care provider due to greater use of specialty, urgent and emergency care services, according to the study.

Dive Insight:

Studies have shown that patients receiving continuous care from their primary care provider results in better outcomes like more accurate diagnoses, fewer emergency department visits, fewer hospital admissions and ultimately lower costs.

The flipside is also true. Primary care physician turnover was a costly issue even before the COVID-19 pandemic began in the U.S. two years ago, according to the study.

While past research has focused on how physician burnout impacts productivity or recruitment and replacement costs, this is the first study looking at the excess spend associated with disruptions in care continuity between primary care physicians and their patients, according to the its authors.

Researchers used data from a survey of more than 5,000 U.S. physicians conducted between October 2017 and March 2018 focusing on questions around burnout and intentions to leave one's current practice within two years.

They estimate that 11,339 primary care physicians are expected to leave their current practices each year, with 3,006 departing due to burnout.

Public and private payers in turn spend almost $1 billion a year on expenses related to patients losing their primary care providers, the study found.

Burnout is a key driver of turnover. While it has long been an issue in the healthcare field, the pandemic has greatly exacerbated burnout, according to numerous surveys among nurses, physicians and other healthcare workers.

A December report from Doximity found more than 73% of physicians reported feeling overworked and 50% are consequently considering a career change.

Doximity also identified a spike in retirements during the first few months of the pandemic that never fully recovered, resulting in roughly 1% of the entire physician workforce retiring earlier than expected based on pre-pandemic trends.

Burnout can have a number of adverse effects beyond increased physician turnover, including more frequent errors leading to higher medical malpractice claims, reduction in clinical hours and other organizational costs, according to the AMA study.

Article top image credit: Flickr; Connor Tarter

Dive Brief:

• The healthcare sector added 64,000 jobs in February with gains in home health services (+20,000), physician offices (+15,000) and offices of other healthcare practitioners (+12,000), according to data out Friday from the Bureau of Labor Statistics that showed strong overall recovery for U.S. jobs.
• February's gains are higher than recent months for healthcare jobs — in January the sector gained about 17,000 jobs and in December employment in the industry remained largely unchanged.
• Healthcare employment is down about 2% from levels in February 2020.

Dive Insight:

The healthcare industry faced massive job losses in the first few months of the pandemic as systems grappled with stay-at-home orders and restrictions on nonemergency care, leading many to institute furloughs and some layoffs.

Many of those jobs have since recovered, but recovery across the sector has been uneven.

While jobs in ambulatory care services have seen mostly consistent gains throughout the pandemic, jobs in nursing homes have fallen nearly every month.

Job gains for hospitals have fluctuated throughout the pandemic amid various coronavirus waves and staffing shortages.

In February, hospitals added 2,800 jobs, according to BLS.

Hospitals most recently have grappled with some of their most acute staffing shortages since the pandemic began as frontline workers deal with stress and burnout spurring many to consider leaving their roles.

A recent survey from USA Today and Ipsos Research of 1,170 healthcare workers found more than half reported feeling burned out, and nearly a quarter are considering quitting their jobs in the near future.

In a recent Congressional hearing, witnesses pointed to the difficult working conditions. Margaret Flinter, senior vice president and clinical director at Community Health Center, said some jobs have become untenable because they've "been understaffed for a long time, under-resourced and people are just frustrated."

Staffing shortages have been acute, also, during the omicron wave as more people called out sick with COVID-19. That's led to huge demand for traveling nurses, who can now garner much higher salaries than other nurses, as well as perks like sign-on bonuses.

Recently, hospital lobbies and members of Congress have pressed for investigations into the staffing firms that supply traveling nurses, with the American Hospital Association alleging exploitation of the ongoing staffing shortages. The staffing firms have defended their practices.

AHA has also called on Congress to alleviate the problem through policies like boosting support for nursing schools and lifting the cap on Medicare-funded physician residencies.

Article top image credit: Getty Images

Thousands of healthcare workers have waged strikes this summer to demand better staffing levels as the pandemic brought greater attention to what happens when a nurse must take care of more patients than they can reasonably handle.

In New York, a report from the attorney general that found nursing homes with low staffing ratings had higher fatality rates during the worst COVID-19 surges last spring helped spur legislators to pass a safe staffing law long-advocated for by the New York State Nurses Association.

While unions elsewhere face a steeper climb to win the success found in New York, through strikes and other actions, they're attempting to get new staffing rules outlined in their employment contracts.

Most nursing strikes include demands for ratios, or limits on the number of patients a nurse can be required to care for, Rebecca Givan, associate professor in the School of Management and Labor Relations at Rutgers University, said.

"And employers are very anxious about that because it threatens their bottom line, so often when a compromise is found, it's something that approaches a ratio but maybe has a bit more flexibility," Givan said.

Some have been successful, like the 1,000 Chicago-area nurses at Stroger Hospital, Provident Hospital and Cook County Jail who waged a one-day strike on June 24 after negotiating with the county over a new contract for nearly eight months.

They reached a tentative agreement shortly after the strike, stipulating the hiring of 300 nurses, including 125 newly added positions throughout the system within the next 18 months.

The deal also includes wage increases to help retain staff, ranging from 12% to 31% over the contract's four-year term, according to National Nurses United.

Meanwhile, 700 nurses at Tenet's St. Vincent Hospital in Worcester, Massachusetts, have been on strike for over 100 days over staffing levels. Nurses represented by the Massachusetts Nurses Association have been trying to get an actual nurse-to-patient ratio outlined for specific units in their next contract.

The two sides haven't come close to reaching a deal yet, and some nurses will travel to Tenet's headquarters in Dallas on Wednesday in an attempt to appeal to corporate executives, according to MNA.

At the same time, federal lawmakers wrote to Tenet CEO Ron Rittenmeyer seeking details on the chain's use of federal coronavirus relief funds amid the strike and alongside record profits it turned last year.

The hospital denied lawmakers' claims in the letter that Tenet used federal funds to enrich executives and shareholders rather than meet patient and staff needs, saying in a statement it strongly objects to the "mischaracterization of the facts and false allegations of noncompliance with any federal program."

The strike is currently the longest among nurses nationally in a decade, according to the union.

A number of other major hospital chains have contracts covering their nurses expiring this summer, including for-profit HCA Healthcare and nonprofit Sutter Health.

Unionized nurses at 10 HCA hospitals in Florida have reached a deal on a new collective bargaining agreement, though members still need to ratify it, according to National Nurses United. The details are still unclear.

And after joining NNU just last year, 2,000 nurses at HCA's Mission Hospital in Asheville, North Carolina, ratified their first contract Saturday, which includes wage increases and the formation of a nurse-led staffing committee.

Newly-formed unions take an average of 409 days to win a first contract, according to an analysis from Bloomberg Law. In the healthcare industry, new unions take an average of 528 days to win a first contract, the longest among all sectors examined.

Across the country at Sutter's California hospitals, disputes haven't been so easily resolved. Healthcare workers at eight Sutter hospitals planned protests throughout July "to expose the threat to workers and patients caused by understaffing, long patient wait times and worker safety issues at Sutter facilities," according to Service Employees International Union United Healthcare Workers West, which represents the workers.

Similar to the ongoing Tenet hospital strike, SEIU is highlighting Sutter's profits so far this year and the federal relief funds it received.

 

Article top image credit: Permission granted by Massachusetts Nurses Association

UPDATE: July 13, 2021: The 1,000 Cook County nurses who waged a one-day strike in June voted to ratify a new contract July 3 that stipulates the hiring of 300 nurses, including 125 newly added positions throughout the system within the next 18 months, according to the union representing them. The deal also includes wage increases to help retain staff, ranging from 12% to 31% over the contract's four-year term.

And the 1,500 healthcare workers at the University of Southern California hospital and clinics reached a tentative agreement and will hold a ratification vote next week, according to a spokesperson from the National Union of Healthcare Workers, which represents them. However, 1,400 USC nurses represented by the California Nurses Association will hold a two-day strike on Tuesday and Wednesday over a separate contract they’ve been negotiating with the university since November 2020.

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This year is shaping up to be an active one for healthcare labor unions, whose members worked on the front lines of the historic COVID-19 pandemic that strained hospital resources and claimed hundreds of thousands of lives across the country.

In Massachusetts, about 700 nurses at Tenet’s St. Vincent hospital are currently waging the second-longest nurses' strike in state history, over staffing levels they want in their next contract, and nurses in a handful of other states have also threatened to strike or done so this year. At the same time, employment contracts covering tens of thousands of nurses employed by chains like HCA expire this summer.

After a tumultuous year for the industry, most large health systems came out unscathed financially, with many turning profits and most receiving federal relief funds. Unions are underscoring this trend in their campaigns.

Major healthcare worker unions were vocal last year throughout the worst of the pandemic, too. The Bureau of Labor Statistics only tracks strikes involving 1,000 or more workers, but among the eight work stoppages it tracked that began in 2020, five involved healthcare unions.

While not exhaustive, here's a look at some recent disputes between health systems and their unionized employees:

Cook County Health nurses waging 1-day strike

Over 1,000 nurses represented by the National Nurses Organizing Committee are slated for a one-day strike Thursday in Chicago. They work for Cook County Health at Stroger Hospital, Provident Hospital and Cook County Jail, and have been negotiating with the county for a new contract for nearly eight months.

Following the one-day nurses strike, over 2,000 social workers, technicians and other Cook County staff represented by Service Employees International Union Local 73 will start an open-ended strike Friday.

Staffing is a key issue, as is pay — according to SEIU 73, the county's latest proposal offers no pay increase for the year, and a 2% increase each year between 2022 and 2024.

A proposal that would boost health insurance premiums is also a central concern for the unions.

"The working conditions won't keep nurses there and the wage scales are not enough to attract new nurses," Consuelo Vargas, a nurse at Stroger hospital and nurse representative for the union, said.

Thousands of nurses in Illinois waged strikes last year, including a weeklong strike at the University of Illinois and another at Ascension's AMITA St. Joseph Medical Center in Joliet, Illinois.

A Cook County Health spokesperson did not respond to questions on how the hospitals will continue their operations through the strike.

Massachusetts hospital, nurses no closer to deal after more than 100 days on strike

On March 8, about 800 nurses at St. Vincent Hospital in Worcester, Massachusetts, began an open-ended strike when they couldn't reach an agreement with management on staffing levels in their next contract. The Massachusetts Nurses Association and hospital have been negotiating a new contract since November 2019.

The nurses are fighting for specific nurse-to-patient ratios that the hospital strongly opposes be included in their next contract. MNA has unsuccessfully lobbied for staffing ratios through the state legislature for over a decade, and in 2018, voters rejected a nurse-to-patient ratio measure.

Eleven weeks into the work stoppage, the hospital started permanently hiring replacement nurses. It posted at least 100 open positions online, though it's unclear how many roles have been filled. A hospital spokesperson did not respond to a question on those potisions.

Among the 800 nurses who went on strike, 200 have crossed the picket line to return to work, according to the hospital.

Throughout the strike, the two sides have only met a handful of times and currently have no future sessions scheduled.

USC healthcare workers threaten strike without setting a date

At the end of May, 1,500 healthcare workers at the University of Southern California's Keck Hospital, Norris Comprehensive Cancer Center and other university clinics voted to authorize a five-day strike. They still haven't set a date, though, according to the National Union of Healthcare Workers, which represents the USC employees.

Contracts expired in April, and similar to the Cook County nurses, a proposal that would increase health insurance premiums is a key issue at the bargaining table.

The union also wants pandemic preparedness measures outlined in the next contract, including emergency housing and hazard pay guarantees. Negotiations are continuing this week, an NUHW spokesperson said.

Some 96% of members voted to authorize the strike, though the union must set a date and provide a 10-day notice to the university to allow it to make arrangements to continue services through a work stoppage.

Montana nurses waged 3-day strike in June

Over 600 nurses at Logan Health in Kalispell, Montana, went on a three-day strike on June 1 after 19 months of bargaining for their first contract with hospital management.

The nurses joined SEIU Healthcare 1199NW in July 2019, and in their first contract want increased staffing through a nurse-led staffing committee and the reinstatement of charge nurses in every unit. They also want improved wages and benefits to help recruit and retain nurses in the rural region, according to a union release.

A group of nurses at the hospital opposed to the union filed for a decertification election with the National Labor Relations Board in May, though the petition was withdrawn. The initial unionization vote in 2019 was a relatively close one: 372 to 199.

It's unclear whether any additional bargaining sessions are scheduled. A hospital spokesperson and union spokesperson did not respond to requests for comment.

Article top image credit: UFCW Local 400

Dive Brief:

• Hospitals and nursing homes in New York state will have to follow new staffing mandates under legislation Gov. Andrew Cuomo signed Saturday in a major win for labor unions that have advocated for such a law long before the COVID-19 pandemic.
• Hospitals will be required to form clinical staffing committees that include front-line nurses and other direct care staff when setting annual staffing standards for units, and the state health department can levy penalties against hospitals that fail to create or abide by the standards.
• The second law pertaining to nursing homes requires facilities to meet a minimum daily average of 3 1/2 hours of nursing care per resident. The two laws are set to go into effect in January 2022.

Dive Insight:

While staffing levels have always been a key concern for nursing unions, the pandemic highlighted the struggles of healthcare workers who say they sometimes take care of more patients than they can reasonably handle. Now they're using the COVID-19 crisis to advocate for change, either lobbying state legislatures or trying to negotiate new staffing rules in their employment contracts.

California is currently the only state with mandated staffing ratios on the books after landmark legislation passed there in 2004, though a number of other states have laws similar to New York's requiring nurse-led staffing committees.

California's law outlines nurse-to-patient ratios, or exactly how many patients a nurse can take care of in specified units, such as operating rooms and intensive care units.

New York's law lets hospitals form committees to set their exact standards, though at least half of the committee members must be front-line nurses or direct care staff.

"This law doesn't state that ratios must be stipulated, but inevitably that's what it means," Judy Sheridan-Gonzales, president of the New York State Nurses Association said.

The state health department will enforce the staffing plans with monetary fines for hospitals that are noncompliant, and will also establish new minimum staffing standards for ICUs and critical care units to be incorporated in each hospital's annual staffing plans.

The law also includes a provision to make each hospital's staffing data publicly available to staff and patients.

No federal staffing standards currently exist, and hospitals are generally opposed to such mandates, which they fear could hinder their operational flexibility. A spokesperson from the Greater New York Hospital Association did not respond to a request for comment.

New York was initially the hardest hit when COVID-19 arrived in the U.S., with nursing homes bearing the brunt as they dealt with an onslaught of critically ill patients.

A January report from the state's attorney general that found nursing homes with low staffing ratings had higher fatality rates lent momentum for both pieces of new legislation to pass, Sheridan-Gonzales said.

Article top image credit: Justin Sullivan via Getty Images

Labor unions have staged protests, gone on strike and even organized new members throughout the COVID-19 pandemic. National Nurses United is no exception — as the country's largest nurses' union with 170,000 members across the country, NNU notched two major election wins in the past year.

About 2,000 registered nurses at Maine Medical Center voted to join NNU in April, making it the largest successful union election with the National Labor Relations Board so far in 2021. And in September, 2,000 nurses at HCA's Mission Hospital in Asheville, North Carolina, successfully unionized in a state with the second-lowest union membership rate in the country, according to the Bureau of Labor Statistics.

Those nurses are bargaining for their first employment contracts, and will soon be joined by thousands of other NNU nurses across the country with contracts up for renegotiation this year. Staffing, safety, and other issues exacerbated by the pandemic are likely to be key issues.

The union is also currently lobbying for a number of bills in Congress, including the Workplace Violence Prevention for Health Care and Social Service Workers Act, and the Protecting the Right to Organize (PRO) Act, which would punish employers for a number of tactics used to dissuade workers from unionizing. Both passed the House but need Senate approval.

NNU President and registered nurse Deborah Burger reflected on nurses' experiences over the past year on the front lines, and outlined where the union is headed going forward. 

Editor’s note: This interview has been edited for clarity and brevity.

HEALTHCARE DIVE: Has NNU seen an uptick in organizing throughout the pandemic?

DEBORAH BURGER: Actually it's about the same pace, because it does take time to go through the entire process. And we actually had to go through the Trump years and the Trump labor board, and sort of a hostile labor board and a hostile union environment. The nurses in Mission Hospital in Asheville that voted to join the union were up against some really heavy union busting, both on the part of the employers there, and politicians. It's a testament to how committed nurses were to making sure they had a voice that protected them, and protected their patients and protected their community that they overcame intense union busting. Maine was also extremely hostile, but what was really helpful was having the community support them. They had a lot of support, so that made a huge difference.

After the North Carolina win, is there an impetus to get nurses in states with lower unionization rates to join NNU?

BURGER: We already represent nurses in Kansas, Missouri, Florida, Texas, Georgia, North Carolina, Virginia, West Virginia and Arizona. I mean we do represent nurses in what you would call right-to-work states, so nurses actually understand once they're given the information, what their options are. And they can be heavily intimidated, even in California which is not a right-to-work state.

How will NNU leverage nurses' experiences through the pandemic to get the contracts it wants?

BURGER: Nurses were working 12, 16 hours a day with no days off, and then you want to furlough them when there's finally a break. Nurses have bills to pay, they have mortgages and often times they're the primary breadwinner or the sole breadwinner of their family. So I'm sure that nurses are going to want to have a discussion on, you know, a commitment that if you're hired for 32 hours a week, you get 32 hours paid.

We're also still fighting to have adequate [personal protective equipment]. In California, we got a law that said that hospitals had to stock three months worth of PPE. So part of our negotiations will be to ensure that we get more protections written into our contracts so that nurses have a say over what inventory is in the hospital because nurses were told, "We've got adequate stocks now," but the transparency for supplies is not there.

What do you want the healthcare industry to do for nurses to improve burnout in the profession?

BURGER: What we want the healthcare industry to do is not put us in a position where we're under such moral distress. We had to make very difficult decisions because we didn't have the support and the resources from our employers. We didn't have the staffing that we needed. We didn't have the security that we needed. We didn't have the patient protections that we needed, you know, to be able to get testing for a patient when they come into the emergency room.

I think that that's probably one of the things that makes nurses the angriest, is that there wasn't a true lack of supply, there wasn't a true lack of the testing capability, there wasn't a true lack or inability to communicate to nurses when they were exposed. It was outright deception and lying to the nurses. Nurses are pretty forgiving, but when you're outright lying to them, they remember that, and they remember how badly it hurt them.

Article top image credit: Permission granted by National Nurses United

Dive Brief:

• Six regional health systems are forming an alliance to share resources and information related to key workforce challenges facing hospitals nationwide as the pandemic hits the two-year mark, according to a Thursday press release.
• The partnership, named Evolve Health Alliance, includes Florida-based Advent Health, North Carolina-based Atrium Health, Michigan-based Henry Ford Health System, Utah-based Intermountain Healthcare, New York-based Northwell Health and Ohio-based OhioHealth.
• The systems will participate in reciprocal staffing arrangements and exchange information on best practices for improving diversity and employees' well-being and engagement, along with other labor-related insights.

Dive Insight:

The systems involved in the partnership have already shared information and resources during COVID-19 surges, according to the release. At one point, Intermountain deployed 48 employees to Northwell, and Northwell later returned the favor when Utah faced a wave of virus cases.

Those kinds of agreements are included in the compact between six health systems across the country with the formation of Evolve Health Alliance.

The group will also focus heavily on improving employee engagement and efforts to better retain their existing workforces. Part of that will involve shared skills development opportunities and programs for both clinical and non-clinical staff to collaborate and trade ideas with other systems.

"We know this alliance will help us evolve policies, practices and initiatives that ultimately benefit our patients and the communities we serve," Heather Brace, senior vice president and chief people officer of Intermountain, who also serves as co-chair of Evolve Health Alliance, said in the release.

The partnership comes as health systems confront dire staffing shortages with few solutions as burnout and higher-paying traveling nurse positions spur healthcare workers across the country to leave their permanent roles.

Hospitals in turn have seen elevated labor expenses and have spent more on salaries, sign-on bonuses and contract labor through recent surges.

Industry groups and Congress are pushing for the Federal Trade Commission to investigate travel nurse staffing agencies, alleging the firms are seizing the pandemic as an opportunity to inflate rates and increase their bottom lines. The agency has yet to do so.

Other systems with footprints across multiple states like UPMC have formed internal staffing agencies to shift their workforce between areas with the greatest need and better retain current staff.

Article top image credit: Win McNamee via Getty Images