New York City hos­pi­tal nurses de­mand­ing ‘safe staffing’ lev­els

The Buffalo News - - STATE NEWS - By Pa­trick McGee­han

NEW YORK – At Mor­gan Stan­ley Chil­dren’s Hos­pi­tal in New York City, the 58 tiny beds for sick new­borns are al­most al­ways filled. But nurses who work there say there are often too few of them to pro­vide all the care the ba­bies, and their wor­ried fam­i­lies, need.

One of those neona­tal in­ten­sive care nurses, Shanna Mur­phy, says she has not for­got­ten the new mother who got up­set when she felt her cry­ing in­fant was be­ing ig­nored. Mur­phy, 28, said she wanted to soothe the baby, but she had her hands full with an­other pa­tient whose con­di­tion had be­come un­sta­ble and re­quired near-con­stant mon­i­tor­ing.

“I’m often put in a sit­u­a­tion where I’m hav­ing to choose be­tween pa­tients and not able to fully sup­port my fam­i­lies,” Mur­phy said. “We have a fam­ily-cen­tered care model, but I can­not do that un­der these cur­rent con­di­tions.”

Now, she and more than 10,000 nurses are de­mand­ing a sharp in­crease in their ranks at three of the city’s big­gest hos­pi­tal sys­tems – Mount Si­nai, NewYork-Pres­by­te­rian and Mon­te­fiore. Their union, the New York State Nurses As­so­ci­a­tion, has threat­ened to strike over staffing lev­els, an is­sue that has be­come an in­creas­ing source of con­tention at hos­pi­tals around the coun­try.

Last year, staffing dis­putes were a cen­tral topic when nurses in five states pick­eted and threat­ened to strike hos­pi­tals op­er­ated by HCA, one of the coun­try’s largest health care providers. In Ver­mont last year, hun­dreds of nurses walked out while de­mand­ing in­creases in staffing.

“It’s one of those is­sues that you could get a fist­fight started in a room full of nurses around,” said Sean Clarke, ex­ec­u­tive vice dean of the NYU Rory Meyers Col­lege of Nurs­ing.

Nurses and their unions often cite as a model the rules Cal­i­for­nia adopted 20 years ago, which re­quire hos­pi­tals to main­tain pre­scribed ra­tios of nurses to pa­tients in each treat­ment unit. No other state has im­posed staffing lev­els, though Mas­sachusetts re­quires in­ten­sive care units to have at least one nurse for ev­ery two pa­tients, Clarke said.

Last fall, vot­ers in Mas­sachusetts over­whelm­ingly re­jected a bal­lot ques­tion about plac­ing broader lim­its on how many pa­tients nurses could be as­signed to care for af­ter the hos­pi­tal in­dus­try mounted an in­tense cam­paign against it. That was the first statewide vote any­where on the is­sue, Clarke said.

In New York, the three hos­pi­tal sys­tems, ne­go­ti­at­ing col­lec­tively as the New York City Hos­pi­tal Al­liance, have re­fused to agree to ra­tios or other lim­its on nurses’ work­loads. Ex­ec­u­tives of the hos­pi­tals pre­fer a more fluid ap­proach to al­lo­cat­ing nurses based on the needs of pa­tients at any given time. The al­liance claims that the three sys­tems have added 2,000 nurses over the past four years.

“Our hos­pi­tals have been rec­og­nized time and again as among the high­est-qual­ity in­sti­tu­tions in the na­tion, prov­ing our ap­proach to staffing works,” Lin­den Zakula, a spokesman for the al­liance, said. “Rigid, in­flex­i­ble staffing ra­tios are un­nec­es­sary and do not work, be­cause they over­ride the pro­fes­sional judg­ment of our nurses and crowd out other im­por­tant care team mem­bers.”

Ne­go­tia­tors for the hos­pi­tals re­cently of­fered $50 mil­lion to­ward the hir­ing of more nurses, a move that spurred the union to post­pone a strike date that had been set for Tues­day. Though ne­go­ti­a­tions have re­sumed, the two sides re­main far apart. The union, how­ever, has not set a new strike date.

Staffing de­ci­sions should not be re­duced to a one-siz­e­fits-all ap­proach when it comes to some­thing as com­pli­cated as health care, hos­pi­tal in­dus­try of­fi­cials said.

“No two hos­pi­tals are alike,” said Lor­raine Ryan, a se­nior vice pres­i­dent of the Greater New York Hos­pi­tal As­so­ci­a­tion. “Staffing de­ci­sions need to be made by nurs­ing pro­fes­sion­als based on pa­tient acu­ity, the ex­pe­ri­ences and com­pe­ten­cies of the nurs­ing team de­liv­er­ing di­rect pa­tient care, and other de­mands on the care-de­liv­ery team.”

But the nurses said the al­liance’s of­fer was far from suf­fi­cient to yield enough staff mem­bers to pro­vide proper care in all ar­eas of the hos­pi­tals. Karine Ray­mond, a nurse in the car­diac catheter­i­za­tion lab at a Mon­te­fiore hos­pi­tal in the Bronx and a ne­go­tia­tor for the union, said each of the three hos­pi­tal sys­tems needs at least 300 to 400 ad­di­tional nurses.

Mur­phy said the neona­tal unit she works in, which is part of the NewYork-Pres­by­te­rian sys­tem, should have about 30 nurses on duty – one for ev­ery new­born whose con­di­tion is un­sta­ble and one for ev­ery two who are “get­ting ready to go home” – but often has only about 25.

“We’re al­most drive-by nurs­ing,” Ray­mond said, adding that nurses want to “ac­tu­ally sit with our pa­tients and spend time with our pa­tients and their fam­i­lies.”

An­thony Ci­ampi, a car­diac teleme­try nurse at NewYorkPres­by­te­rian and a vice pres­i­dent of the union, said nurses some­times have to care for as many as 15 pa­tients at a time. “That’s not fair and it makes no sense,” he said.

Pa­tients no­tice how short­staffed the hos­pi­tals are “when they hit the call bell and no­body comes,” Ci­ampi said.

The union has been cam­paign­ing for years for what it calls “safe staffing.” It cites a study pub­lished in the Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion in 2002 that found that the like­li­hood of a pa­tient dy­ing in a hos­pi­tal rose by 7 per­cent when the av­er­age num­ber of pa­tients as­signed to each nurse there in­creased by one.

Still, Clarke, who was a coau­thor of that study, said it re­mained a mat­ter of de­bate whether the ben­e­fits of min­i­mum staffing lev­els, unit by unit, are worth the costs to hos­pi­tals

In Cal­i­for­nia, hos­pi­tals are al­lowed to as­sign nurses as many as four pa­tients in emer­gency rooms and some units where pa­tients’ ill­nesses are not so acute, but as few as one or two in op­er­at­ing rooms and in­ten­sive care units.

The 2018 bal­lot ques­tion in Mas­sachusetts would have set sim­i­lar ra­tios. It was sup­ported by many Demo­cratic of­fi­cials, in­clud­ing Sens. El­iz­a­beth War­ren and Bernie San­ders. But it was op­posed by the Mas­sachusetts Health and Hos­pi­tal As­so­ci­a­tion, which was armed with an in­de­pen­dent study that con­cluded the changes would add as much as $949 mil­lion to health care costs in the state.

The New York State Nurses As­so­ci­a­tion points to the ris­ing in­come of hos­pi­tals in Cal­i­for­nia as proof that the ra­tios did not bring about the fi­nan­cial doom that some op­po­nents had fore­cast. No Cal­i­for­nia hos­pi­tals went bank­rupt or closed be­cause of the man­date, the as­so­ci­a­tion said. Higher lev­els of staffing also re­duced nurses’ in­juries and burnout, cut­ting down turnover and the costs as­so­ci­ated with re­plac­ing ex­pe­ri­enced nurses, the union added.

Ray­mond said that af­ter no progress was made on the is­sue at a re­cent ne­go­ti­at­ing ses­sion, some nurses felt they had been “hood­winked” by the al­liance. Those nurses ar­gued that the union should have stuck to its threat to strike while con­tin­u­ing to try to reach a deal, she said.

Both sides said nei­ther pay nor ben­e­fits were stick­ing points in the talks.

If the nurses were to walk out, the hos­pi­tals would have to bring in thou­sands of re­place­ments from around the coun­try at a cost of sev­eral mil­lion dol­lars. In a let­ter to their chief ex­ec­u­tives, City Coun­cil Speaker Corey John­son and sev­eral other coun­cil mem­bers urged the hos­pi­tals not to let the im­passe reach the point of a “reck­less and need­less shut­down of our hos­pi­tals.”

The let­ter said the staffing agen­cies that would pro­vide the re­place­ments were “ill-equipped and not com­pe­tent” to pro­vide ad­e­quate care. “More pa­tients will die and more pa­tients will suf­fer need­less ad­verse health ef­fects,” it con­cluded.

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