Nurses: Staffing law not working
Unions seek enforcement amid bumpy rollout of new patient-staff ratios
ALBANY — One year after New York’s minimum staffing law for hospitals went into effect, nurses continue to report exceptionally high patient loads as hospital leaders struggle to keep up with turnover rates.
Nurses had long complained of unreasonable staff-to-patient ratios, but the COVID-19 health crisis brought into focus the risks associated with understaffed hospitals and nursing homes, fueling the passage of statewide staffing standards in 2021.
Implementation of the new regulations — from the establishment of committees to negotiate those institutionspecific staffing standards to the mandate for hospitals to report departments’ actual staffing ratios to the state Department of
Health annually — has been rocky across the state’s
222 hospitals.
Since the minimum staffing requirements went into effect on Jan. 1,
2023, health care worker unions have identified thousands of violations at medical facilities across the state and are deploying a range of strategies to hold hospitals accountable.
At Ellis Hospital in Schenectady, where employees say shortages have led to crushing work conditions and a steep toll on patient care, nurses and their union representatives are pushing for stronger contract language to enable them to enforce the staffing standards through labor arbitration.
“There is a nurse shortage, but the shortage is because of the situation they’re putting them in. They’re burning them out as fast as they are orientating them,” Ellis Hospital emergency department nurse Fred Durocher said. “It’s like you’re bleeding out nurses and you’re trying to replenish them, but you’re not stopping the bleeding if you’re not fixing the ratios first.”
Researchers at the New York State Nurses Association (NYSNA) analyzed staffing data across six units at Ellis Hospital from February to November and found that overall, day and night shifts on these units were understaffed 91 percent of the time.
In one medical-surgical unit that cares
“It’s like you’re bleeding out nurses and you’re trying to replenish them, but you’re not stopping the bleeding if you’re not fixing the ratios first.”
Fred Durocher, Ellis Hospital ER nurse
for many elderly patients, including those with dementia, nurses are supposed to be assigned a maximum of four patients, according to their current contract, but they are sometimes assigned as many as seven patients, NYSNA found. Over nine months, there were 481 violations of the staffing standards in this unit, with nurse-to-patient ratios exceeding contractual limits 85 percent of the time.
Other units of the hospital were even more gravely understaffed during this time, NYSNA found. The A6 medical-surgical unit, for example, was understaffed 96 percent of the time. In 551 shifts, the nurse-to-patient ratio exceeded a safe staffing standard 528 times.
Nurses at that unit report being forced to work through their breaks and skip meals during their 12-hour shifts.
“If there’s nobody there, you’re not getting your lunch because you don’t have that extra person to watch those extra people,” Ellis nurse Suzanne Daley said. “The nurses are getting burned out and a lot of them are leaving to do other types of nursing because bedside is not what they expected.”
Hospital executives claim they are using creative strategies to bolster their workforce, but inadequate Medicaid reimbursement rates and a national labor shortage are hindering those efforts.
Ellis Medicine President and CEO Paul Milton noted that the hospital has a nursing school and has been working with other educational institutions to build a sustainable pipeline of new nurses for Ellis.
“Over the last 12 months, we have been able to gain real momentum and are moving in the right direction in creating that pipeline,” Milton said. “We offer our nurses — and all of our staff — competitive salary and industry-leading benefit packages and do everything possible to provide them with a caring and supportive work environment.”
Ellis recently provided nurses with a pay increase, increased bedside support staff, and implemented a retention program that has resulted in a better-thanmarket nurse retention rate and a reduction in overall turnover, according to Milton.
The nursing shortage is also blamed for the closure of hospital beds and extraordinarily long wait times in hospital emergency room departments. As the Times Union has reported, median emergency room wait times at local hospitals are among the longest in the state.
“Five, six years ago, we did not hold people 24 hours to wait for an inpatient bed. Now we do that on a daily basis. Psychiatric is even worse… [the wait] could be days,” Durocher said.
The state has a system for nurses and staff to file complaints with the state Department of Health, which can result in fines for hospitals that fail to correct violations of the law, but the process involves a complicated mechanism — which unions claim some hospitals have failed to establish — and requires diligent recordkeeping on the part of already overworked employees.
For most hospital units, ratios are to be set by staff and hospital executives at each facility through the bargaining process or staffing committees. Complaints about these patient assignments must come to the staffing committee before it is filed with the state.
Staffing committees were supposed to be established in January of last year, but union officials say some institutions have failed to meet that timeline in violation of the law. Hospitals were also required to make public their actual staffing ratios by June 2023, but union leaders contend that the forms submitted by hospitals do not sufficiently capture this information.
According to the Department of Health, agency officials have listened to feedback from unions and hospitals, created a new unit to investigate violations of the law and investigated hundreds of complaints.
“This is a new law with various evolving viewpoints on the best approach to implementation,” department spokeswoman Erin Clary said. “The department has and will continue to work with unions and hospitals to implement the law with the goal of improving the health and safety of patients while addressing the concerns of the health care workforce.”
The Department of Health also recently established a universal patient-to-nurse ratio of 2:1 for intensive care units and several
other critical care categories. The department has created a more streamlined complaint system for these units. Nurses don’t have to go through the staffing committee process to submit complaints when a critical care patient is involved.
But even in those high-pressure units, nurses across the state continue to report being assigned three to four patients at once.
Melissa Greenburg, a nurse in the neonatal intensive care unit at Albany Medical Center Hospital, said usually the strongest infants are placed in groups of three or four under the care of one nurse, exceeding the 2:1 mandated staffing ratios for ICUs. And when someone has to use the restroom or eat lunch, one NICU nurse may be looking after seven or eight infants at a time.
“You are also dealing with postpartum moms who have a lot of feelings and they are dealing with the worst day of their lives. It’s very, very scary,” Greenberg said. “We are rarely staffed to where we can have a resource nurse — someone who can sit with them for 45 minutes and talk them down — and sometimes needs are not getting met.”
But NYSNA-represented nurses who have successfully negotiated staffing ratios into their contracts are starting to see results through the labor arbitration process.
At Mount Sinai Hospital in Manhattan, nurses who work at the cardiac surgery and cardiovascular intensive care units won an arbitration award in August for
contractual violations. A total of $221,192 was divided among nurses who worked understaffed shifts depending on hours worked between Feb. 9 and June 23.
Other unions have begun testing the state Department of Health complaint process. Communications Workers of America, which represents 15,000 health care workers in New York and New Jersey, has filed nearly 8,000 staffing violations with the state that it says occurred at four facilities located in Buffalo, New York City and Elmira.
The breadth of the filed complaints illustrates the pervasive understaffing across New York state’s hospitals that has amplified burnout and exhaustion for health care workers, threatened quality of care for patients and resulted in recruitment and retention challenges, thus deepening staff shortages, union leaders said.
There have also been challenges on the reporting side. In July, hospitals were required to report actual staffing levels. Instead, they submitted revised staffing plans that described “planned averages.”
After unions objected to the format, hospitals were asked to revise their reports with actual staffing data by November, Department of Health officials confirmed.
A number of recent studies have shown that safe staffing improves patient outcomes and may save money. The state attorney general’s office in 2021 found that thousands of lives could have been saved if New York facilities had adequate staffing during the pandemic.