Labor unions hoping for permanent workplace safety standards to protect healthcare staff from COVID-19 infections in the workplace were dealt a blow Friday when an appeals court denied an emergency petition they filed.

Unions pushed heavily for the Occupational Safety and Health Administration to implement a federal emergency temporary standard for medical facilities amid shifting guidance from national and local agencies through the first year of the pandemic.

OSHA did so in June 2021 with a rule mandating hospitals and other healthcare facilities follow requirements around ventilation, physical barriers and other protections intended to reduce virus transmission.

In December, the agency then announced it would withdraw the rule though it was working toward a permanent regulatory solution while considering broader infectious disease rulemaking.

In January, unions including National Nurses United, the New York State Nurses Association, and other major unions representing teachers and other workers, petitioned the court to compel OSHA to quickly codify a permanent standard on occupational exposure.

The U.S. Court of Appeals for the D.C. Circuit on Friday ruled it lacked the authority to force the agency to make certain rules, leaving discretion up to OSHA, according to court documents.

“Since the start of the pandemic, America’s labor movement has fought to protect the lives and livelihoods of millions of health care workers who face serious risk of contracting COVID-19 on the job,” Liz Shuler, president of the American Federation of Labor and Congress of Industrial Organizations said in a statement.

The agency should work fast to complete and issue the permanent rule it announced in December and return to enforcing emergency protections until that happens, Shuler said. 

When the standard was initially implemented, healthcare employers pushed back, noting the rule was long and complex with a quick compliance date and short comment period.

“While we are disappointed in the court’s decision, we will not relent in our efforts to ensure that nurses and all other health care workers have the occupational health and safety protections they need to stay safe during the ongoing pandemic,” NNU President Jean Ross said in a statement.

“We urge OSHA to issue its promised permanent Covid standard for health care workers as soon as possible,” Ross said.

Dive Brief:

• Providence is hosting a three-day virtual hiring event at the end of August and beginning of September in a bid to hire more full-time registered nurses to work at its Portland area facilities, according to a Linkedin post.
• Experienced and early-career nurses are welcome to apply and will go through a 30-minute virtual interview with a panel of nurse managers, according to the post.
• Applicants will be able to discuss their preferences for specialty, location, shifts and scheduling during interviews, and sign-on bonuses of $5,000 to $10,000 will be granted to eligible new hires.

Dive Insight:

Ongoing nurse shortages have spurred some systems to boost benefits to attract needed staff. Last year, some hospitals advertised sign-on bonuses of up to $30,000, with stipulations new hires would commit to their roles for at least two years.

Washington-based Providence is now holding the hiring event as staffing shortages continue.

Some qualifications needed among RN resident applicants include a nursing degree or diploma upon hire, a bachelor’s degree in nursing or higher within three years of hire or equivalent experience, state licensure and completion of a pre-licensure nursing program, according to the Linkedin post.

Applicants with 20 years of experience or more will not be required to obtain a BSN, according to the post.

Providence, like other systems across the country, has grappled with staffing challenges throughout the pandemic that are continuing to weigh on financials. Fitch ratings said the outlook for nonprofit hospitals is “deteriorating” on Aug 17, revising its sector outlook from neutral as hospitals are squeezed by pricier labor and more expensive supplies due to inflation, among other items.

Providence posted a $424 million operating loss in the second quarter of this year, citing higher labor costs, among other items like weak investments and inflation. Operating expenses ticked up slightly year over year for to $13.6 billion, driven mostly by higher salaries and benefits expenses like increased temporary labor expenses and overtime, according to the system.

By: Thomas Sugarman, MD and Hartwell Lin, MD

As COVID-19 surged through New York City this spring, local hospitals increased their ICU capacity by 500%. But despite this feat, they still hit a wall.

They didn’t have enough critical care physicians to staff those beds.

The takeaway: when it comes to pandemic preparedness, your clinical staffing plan is every bit as important as your facilities plan. You not only need more beds and providers; you also need the right expertise — plus systems to support and manage it.

As emergency physicians, we learned this firsthand while providing critical care relief in New York.

In April, California Gov. Gavin Newsom’s office asked our physician group, Vituity, to provide clinical support to New York City Health and Hospitals. In addition, we were charged with helping develop policy recommendations to prepare California for future COVID-19 surges.

When we arrived at our assigned hospitals, we were moved by the resilience of the New York City providers, who had been working tirelessly for weeks. At the same time, the process of integrating relief physicians with diverse backgrounds into clinical care proved complicated – especially as knowledge of COVID-19 changed daily.

Many local physicians assigned to the COVID-19 unit had minimal experience managing ICU patients. (Imagine a psychiatrist or pediatrician who hasn’t changed a central line since medical school.) As emergency physicians, we were comfortable with critical care procedures and resuscitation but were less experienced with ongoing management. We therefore depended on local physicians for both clinical direction and practical help navigating our new hospitals.

Fortunately, the strong climate of teamwork meant no provider was left behind. In addition, we were supported by Vituity critical care partners, who were available to advise and consult with front-line volunteers.

So how can health systems plan now to staff a potential surge? Here are our recommendations.

1. Adapt Your Clinical Command Structure

Because the New York City hospitals had far too many ventilated patients for the available pulmonology/critical care physicians to manage, they implemented an effective pyramid model.

• Native intensivists and pulmonologists (1-2 per hospital) served as both clinical experts and incident commanders who coordinated needed resources with hospital administration.
• Each COVID-19 unit was managed by intensivist fellows or physicians with critical care experience. Emergency physicians sometimes filled this role when needed.
• Finally, teams of clinicians consisting of an attending, resident, and intern from various specialties managed direct patient care. Physician assistants provided additional bandwidth, sometimes replacing interns and performing many procedures.  
• Additionally, dedicated clinical teams covered night shifts, and specialist teams were available for renal, infectious disease, cardiology and related consults.   

Relief clinicians were plugged into the pyramid based on expertise. Each team included local physicians familiar with the hospital.

2. Build Your Team in Advance

While the exact composition of your clinical pyramid will be situation-dependent, it’s never too early to start identifying key leaders. Imagine your hospital sees a three-to-ten-fold increase in critical patients. What roles you can fill from within your health system? If you notice gaps, start reaching out now to potential clinical partners.

Consider how you will integrate visiting doctors, including those working outside of their specialties. It’s vitally important that your local clinical leaders connect with incoming relief physicians to ensure they understand their responsibilities and points of contact.

Also consider logistics. When possible, centralize or outsource credentialing, travel, scheduling, training, orientation and related tasks to free up bandwidth for your front-line clinicians. It’s usually easiest to work with one or two organizations that can supply the specialists you need. Some physician groups also have the infrastructure to assist with the logistics.

3. Connect Daily with the Front Line

Finally, as a healthcare leader, stay engaged with your clinical teams. While centralized support is essential, rapidly shifting knowledge of COVID-19 requires agile decision-making that is best left to front-line providers.

Perhaps the best way to harmonize executive and clinical agendas is through daily outreach. Identify pain points and help to create solutions. Giving your teams just 10 to 15 minutes of undivided attention sends a message of support and solidarity.

In Summary

Adding beds may be the easiest part of preparing for a COVID-19 surge. Don’t forget to give equal attention to clinical capacity, including onboarding, scheduling, and providing practical and moral support to your expanded teams. Ensure that leadership stays visible and keeps communication lines open. Having a well-prepared surge plan along with leadership support will go a long way toward improving patient outcomes and boosting provider morale.

Read more insights from the New York City delegation.

Thomas Sugarman, MD, helped coordinate and deployed to New York City with the Vituity delegation. He is a practicing emergency physician and assistant medical director.

Hartwell Lin, MD, led the Vituity delegation of more than 50 clinicians to New York City. He is a practicing emergency physician, regional director, and elected member of the Vituity Board of Directors.

A strike that began Monday involving 2,000 mental health clinicians at Kaiser Permanente facilities in Northern California has led to more than a thousand canceled appointments for behavioral health services, according to the union and system.

About 1,600 follow-up therapy appointments have been canceled so far this week, the health system confirmed to Healthcare Dive in an email on Wednesday.

Some patients have opted out of visits with other therapists if those they’d previously had appointments with are on strike and unavailable, the system said.

Those who walked off the job include psychologists, therapists, chemical dependency counselors and social workers who want measures in new contracts that allow for more manageable caseloads, among other items, according to the National Union of Healthcare Workers, which represents those workers.

They say they’re stretched too thin and unable to provide adequate care to patients with mental health conditions, according to the union.

Workers raised the alarm over canceled appointments prior to the strike, citing internal emails and communications in a complaint to state regulators filed Thursday.

Under California law, if timely access to mental health care service is unavailable from in-network providers, health plans must arrange for care to be provided out-of-network.

The system said it’s currently reaching out to each patient with impacted appointments and prioritizing urgent and emergent cases while the strike continues. It also noted that several hundred therapists did not end up walking off the job, according to the email statement.

The strike is open-ended, with no set end date.

The California Department of Managed Health Care, which regulates the system, issued a notice Monday that it is monitoring access to mental health services for patients enrolled in Kaiser health plans that could be impacted by the strike.

The workers and system have been in negotiations for over a year and were near an agreement prior to the planned strike date. Although clinicians accepted a wage offer from Kaiser, they were unable to get provisions around staffing and wait times, according to the union.

As more contracts covering unionized healthcare workers on the front lines of the COVID-19 pandemic come up for expiration, nurses, technicians and other staff are pushing for measures to improve working conditions and safety in the years following the historic public health crisis.

They’re taking the opportunity to broker deals improving wages and staffing, just as hospitals continue grappling with recruitment and retention issues driven by burnout and persistent, heightened labor costs in recent quarters.

Workers are using that as leverage to help negotiate the terms they want, though for some that still means heading to the picket line.

A number of major strikes occurred last year, including one at a Tenet hospital in Massachusetts where 800 nurses held a picket line for 285 days.

The Bureau of Labor Statistics only tracks strikes involving 1,000 or more workers. In 2020, the agency tracked eight such strikes across all industries, with five of those strikes involving healthcare workers. In 2021, the BLS tracked 16 strikes involving 1,000 or more workers across all industries, and four of those involved unions representing healthcare workers.

Healthcare Dive has developed a tracker to keep up with work stoppages waged by healthcare workers so far in 2022, including those involving 500 or more workers.

Dive Brief:

• Median base salaries for executives at healthcare companies increased by 4.5% from 2021 to 2022, according to a report from consulting firm SullivanCotter.
• Executives also saw incentive payouts similar to those before the pandemic, after those awards fell below historic levels last year due to COVID-19-driven financial challenges.
• Ultimately, median total cash compensation, which equates to base salary plus annual incentives, rose by 9.7% over the past year for healthcare executives, according to a statement. SullivanCotter did not make the full report available to Healthcare Dive.

Dive Insight:

The findings reflect a competitive labor market and confirm that the search for talented employees in the healthcare sector extends beyond physicians, nurses and other staff facing pandemic-driven burnout.

This year’s rebound in executive compensation is partially due to improved financial metrics, but is also driven by high demand for talent that is outpacing supply because of burnout and accelerated retirements, according to the report, based on survey data collected from executives at more than 3,000 organizations.

Executives saw modest base salary increased in 2021 after many organizations froze those salaries at the beginning of the pandemic, according to the report.

Salary growth for other healthcare roles did outpace that of healthcare executives though amid widespread recruitment and retention challenges.

Most clinical roles saw median base salaries rise 5% or higher, with registered nurses seeing over 8% growth, according to the report.

While total compensation for executives grew year over year, there were no shifts in annual incentive plan prevalence or award opportunity levels.

Growth in total cash compensation instead is being driven by higher incentives awards in light of improved organizational performances in the aftermath of the first years of the pandemic, according to the release.

“It shows that the performance-based incentive programs are operating as designed by tempering awards in challenging years and increasing them when performance improves,” Bruce Greenblatt, managing director at SullivanCotter said in the release.

Organizations should anticipate salary increases above norms of 3% in 2023 if they want to retain key talent, mitigate the impacts of inflation and address pay equity issues, the report said.

The HHS is investing $60 million through the Health Resources and Services Administration to strengthen healthcare workforces in rural communities through a number of initiatives, according to a Monday release.

About $46 million in funding through the American Rescue Plan will go to 31 recipients with the goal of expanding healthcare capacity in rural and tribal areas by creating job development, training and placement programs for dental hygienists, medical assistants, doulas and other community-based healthcare professionals.

Another $10 million will go to 13 organizations to create new medical residency programs in rural communities to boost the number of physicians training in those areas.

And about $4 million will go to 18 recipients with the goal of improving health outcomes and quality for rural patients and veterans living in those communities.

While the pandemic caused massive shifts in the healthcare labor market, rural communities have always faced shortages and issues recruiting and retaining a sufficient amount of talented medical staff.

About 14% of Americans live in rural communities, though those areas represent nearly 75% of primary care health professional shortage areas in the county, according to a February report from the Center for American Progress, a left-leaning think tank.

Health disparities have also been exacerbated in those areas, nearly tripling from 1999 to 2019 compared to urban areas, with rural patients experiencing higher rates of heart and respiratory disease, cancer, stroke and other illnesses, according to the HHS.

“Access to quality health care is at the heart of these issues,” the release said.

The latest funding builds on others from the Biden administration focused on bolstering rural healthcare. Last year, $16 billion was invested in such initiatives, according to the release.

“Among the most important steps we can take to improve access to health care in rural communities, including access to behavioral health care, is to invest in growing the rural health care workforce,” HRSA Administrator Carole Johnson said in the release.

Dive Brief:

• More than 2,000 mental health clinicians at Kaiser Permanente facilities in Northern California said they plan to start an open-ended strike Aug. 15, according to a release the National Union of Healthcare Workers, the union representing them.
• Among demands their demands include increased staffing to expand access to behavioral health services for patients and more manageable caseloads to provide more adequate care in new contracts, according to the union.
• The two sides have been in contract negotiations for over a year and were near an agreement, according to an email statement from Kaiser. The system has contingency plans in place if the strike does occur.

Dive Insight:

Planned strikers include psychologists, therapists, chemical dependency counselors and social workers who say they’re stretched too thin and unable to provide adequate care to patients with mental health conditions.

Despite increased demand for those services amid the COVID-19 pandemic, Kaiser staffs about one full-time equivalent mental health clinician for every 2,600 members in Northern California, according to the union.

Some patients have had to wait weeks or even months for mental health services as a result, according to the union and reports from the Sacramento Bee.

Clinicians planning to strike are doing so “to compel Kaiser to put an end to its gaping disparity between the care it provides for mental and physical health conditions,” the union said in the release.

The system said the union has used this bargaining tactic before, and has called a strike every time the two sides have negotiated new contracts over the past 12 years, according to an email statement.

The two sides have made progress in reaching a deal and were about 1% apart on respective wage proposals during a bargaining session Friday, according to Kaiser.

“It is perplexing that NUHW leaders have chosen to strike when we were close to an agreement,” Deb Catsavas, senior vice president of human resources at Kaiser Permanente, said in an email statement.

The clinicians and system will continue negotiations in hopes of reaching a deal before the planned work stoppage.

Dive Brief:

• About 500 nurses at the Mayo Clinic’s hospital in Mankato, Minnesota, will no longer be represented by the Minnesota Nurses Association after voting 213-181 to decertify their labor union, according to a release.
• A registered nurse at the hospital filed the petition to decertify the union with legal representation from the National Right to Work Legal Defense Foundation, according to a release from that group.
• The hospital said in an email statement that this was a staff-led effort “and we are grateful for the confidence our nursing staff has in Mayo Clinic Health System. We look forward to working with them directly.”

Dive Insight:

The effort to dissolve the union was driven by the National Right to Work Legal Defense Foundation, a “highly powered, well-funded outside national organization bent on undermining worker power and collective bargaining rights,” the MNA said in the release.

That Right to Work group says its goal is to provide “free legal aid to employees whose human or civil rights have been violated by compulsory unionism abuses,” according to its website.

Earlier this year, that organization also led efforts for nurses at Tenet’s Saint Vincent Hospital in Worcester, Massachusetts, to decertify their union following a nine-month long strike.

The Tenet nurses, however, voted to keep their union, the Massachusetts Nurses Association, in a 302-133 vote in March.

Brittany Burgess, an RN at the Mayo Clinic’s Mankato hospital, filed the petition to decertify the union there, according to a release from the National Right to Work Legal Defense Fund.

More than 200 nurses signed it, which is more than needed to initiate a decertification vote through the National Labor Relations Board, according to the release.

The right to work group also recently helped nurses at Maine Medical Center in Portland, Maine, in initiating a vote to decertify their union. That vote hasn’t happened yet.

That petition “comes as Foundation staff attorneys are increasingly assisting healthcare workers in obtaining votes to remove unwanted unions, including in Michigan, Minnesota, New York, and Massachusetts,” the release said.

The results of the Mankato vote still need to be confirmed by the NLRB, which is expected in about a week, according to an email statement from the hospital.

“As outside anti-worker forces set their sights on other healthcare workers in our state, it is more important than ever that nurses stand together with other workers, patients, and our community to hold corporate power accountable to local interests,” Tammie Fromm, an operating room RN at Mayo Mankato, said in the MNA release.