Patient Care Suffers at the Intersection of Nursing Shortages and Hospital Consolidation
Last week, New York City nurses at Mount Sinai and Montefiore hospitals went on strike for about three days before the hospitals reached a tentative agreement, bringing nursing staff back to work immediately. The New York State Nurses Association, which organized the strike, lead an incredible media campaign around the strike effort, warning communities (and hospitals) well ahead of the strike about the need for good faith negotiation and changes weren’t just about ensuring nursing staff compensation kept up with inflation, but primarily based on working environments and patient safety, with key demands around improving staff to patient ratios. The campaign was so successful, four other hospitals which would have been subject to the strike reached agreements ahead of the Monday deadline. While the American Nurses Association did not have a direct hand in the strike, they supported the move by the New York State Nurses Association, stating the need indicates a “systemic breakdown” regarding safe staffing levels, protecting nurses from workplace violence, and supporting nurses’ mental health and well-being, among other challenges.
That idea offered by the American Nurses Association isn’t wrong – this issue is systemic. Lats month, the New York Times outlined how Ascension, one of the nation’s largest hospital systems, had neglected staffing needs for years, leading to hospital locations across the country being ill-prepared for the demands and challenges COVID-19 brought. The piece, entitled How a Sprawling Hospital Chain Ignited Its Own Staffing Crisis, details how Ascension bragged about reducing its labor costs and reducing its number of employees per occupied bed. But this, in combination with other factors like health care workers becoming sick, left Ascension hospitals in a near unimaginably bad position to handle waves of COVID-19 patients. Indeed, the New York Time also ran a piece in August of 2021, highlighting the plight of nurses struggling to keep up with demand of the “Delta variant wave”. The beds were there, the staff to ensure those beds could be safely occupied were not. On top of already having poor staffing to patient ratios and many staff falling ill with COVID-19, thousands of health care workers died in these “crisis” waves. Several times throughout various COVID-19 “waves”, hospitals advertised their need for nursing talent and offered to pay exceptionally well for those traveling nurses who could help meet the immediate demands of the moment. Already retained nurses were not necessarily offered similar compensation as their traveling counterparts, even if some hospitals did end up offering supplemental pay. Largely, those supplemental payments have dropped off as CARES Act dollars have dried up.
Put yourself in the nurse’s position, for a moment. If you could get paid say… three months’ worth of salary working two weeks away from home by traveling, would you do it? Consider now, there is no end in sight for the demand in traveling nurses. You can find work whenever you want and it’s well-paid enough that you don’t have to worry things like negotiating to compensate for inflation. And if the area you’re working is experiencing workplace safety issues or violence from patients who have bought into conspiracy theories that you and your colleagues are somehow making up a respiratory pandemic, you can just leave. More and more nurses weighed this position and more and more nurses opted to travel. This has had likely one of the most significant drivers of hospital labor costs increasing by at least 37% since 2019. And hospitals, for their part, aren’t necessarily cutting out activities like buying up other entities or executive compensation in order to reinvest in their staff, rather, they’re billing insurance companies more. That increase in cost of care also translates to an increase in insurance premiums for consumers and other plan changes that might adversely affect patients and patients’ ability to afford care. For example, Health System Tracker, a project of Peterson Center on Healthcare and Kaiser Family Foundation, detail how the Affordable Care Act’s maximum out of pocket limit is growing faster than wages and how emergency department visits are now exceeding affordability thresholds for many consumers with private insurance.
These systemic changes need to be addressed immediately by state and federal policymakers. Unions alone cannot stop hospital consolidation and can only leverage so much to ensure appropriate staffing levels without risking the quality of care patients receive in any given community.
Because of the greed that drives hospital consolidation, the “rural hospital crisis” is coming to an urban area near you. An example of the emergency nature of this situation can be found in Atlanta Medical Center’s sudden closure, an issue Louisiana Children’s Medical Center’s purchase of Tulane hospitals from HCA Health could replicate in another majority Black city.
Given the billions of dollars hospitals have received in CARES Act dollars and continue to receive in 340B dollars, regulators need to slam on the breaks of approving hospital consolidation purchases. Communities and their elected officials should also critically ask hospital executives (and investigate a factual answer, not a public affairs answer), “Are you really operating as a health care provider or are you operating as a real estate entity and buying out all of your competition at the expense of our communities?” Indeed, the real question that’s going to drive some much, much needed oversight on hospitals would be, “Are you using these dollars meant for public benefit to buy out your competition?”
It's high time hospitals be held accountable.
