Last week nurses in New York City’s public hospitals used their break time to stand in front of three of their hospitals, bringing a message of protest to Mayor Michael Bloomberg. That message: Poor working conditions and chronic understaffing threaten patient care. Two thousand nurses repeated this message in an evening vigil at City Hall.
But the 11 hospitals in the city’s public system have long been in bad shape, and nurses have been protesting for some time â€“ out of the public eye. In a new report (in pdf format), we show how the staffing crisis has spread throughout the five boroughs and is endangering patients.
Bad Nurse-Patient Ratios
In the past two years, registered nurses employed by the Health and Hospitals Corporation have filed 3,700 “protests of assignments,” which document work assignments that nurses, in their professional judgment, consider to be unsafe for patients. They are mostly related to being stretched too thin in covering too many patients.
Nurses have the option of adding comments to their protest forms. Here are two examples:
Medical/Surgical Unit, January 6, 2004, 8 a.m.: There are 2 RNs on duty for 23 patients. "I’ve been assigned 12 patients. No head nurse. Tasks include blood glucose monitoring, dressings, nasogastric tubes, suctioning, medication administration through both IV and PO, full and safety rounds, assist and supervise nurses aides with total care, assist in feeding. All patients are over age 65."
Intensive Care Unit, October 12, 2003, 3 a.m.: There are 7 RNs on duty for 19 patients (full capacity). “I am now assigned 3 patients and am covering for another nurse with 3 patients. There is one nurses aide to cover the floor and break time.”
The Critical (or Intensive) Care Units present a stark example of how the staffing crisis endangers patients. The American Association of Critical Care Nurses recommends that the ratio of registered nurses to patients on such units should be 1:1 or 1:2, depending on the condition of the patients. In the last two years, nurses in New York City’s public hospital system have repeatedly documented RN-to-patient ratios in these facilities as high as 1:4. On one day last April at Woodhull Medical and Mental Health Center, there were two RNs in the intensive care unit trying to care for 12 critically ill patients (1:6).
Numerous studies show the number of licensed nurses in hospitals is a strong predictor of both health crises and burnout. For example, the Journal of the American Medical Association published a study in 2002 showing that the likelihood of a patient’s dying within 30 days of admission depended on the nurse-patient ratio.
Lower Salaries, Higher Departures
Why are nurses stretched so thin? Nurses are leaving public hospitals faster than they can be replaced. Nurses at New York City public hospitals earn an entry-level salary (about $55,000) that is about 11 to 15 percent below what the same nurse can make at a private hospital ($61,000 to $64,000). After 30 years on the job, the salary difference grows to 20 percent. The private hospitals are located in the same neighborhoods as the public hospitals, in many cases directly across the street, making the transition from public to private even simpler and more tempting.
Roughly 44 percent of registered nurses leave the public hospital system before completing their third year of service. The number of full-time nurses working in public hospitals dropped nearly ten percent over the past five years.
There are common sense solutions to this crisis. City Hall should negotiate a fair contract that improves working conditions and thus the quality of patient care. To address the nursing shortage, the Health and Hospitals Corporation spent nearly $67 million over the past year on agency nurses (temporary staffing). Much of this money can instead be redirected to hiring more full-time nurses at salary levels comparable to private hospitals.
It’s good that Mayor Michael Bloomberg is investing $1.3 billion in capital construction at public hospitals, but what about the human infrastructure? The city’s nurses have been working without a contract since Dec. 31, 2002. The deteriorating working conditions are driving valued nurses away, to the point that unsafe nurse-patient ratios are demonstrably endangering patients throughout the public hospital system.
We need a contract that induces nurses to join and remain in the service of patients at public hospitals. But the latest offer that the Bloomberg administration brought to the bargaining table â€“ no raise the first year, none the second year, and only four percent the third year â€“ is a completely inadequate solution to the looming healthcare crisis.
As the New York Times reported, the Bloomberg Administration insists on “productivity increases” to finance significant raises. But the most meaningful measure of productivity in a hospital is quality patient care. Expecting overworked and understaffed nurses to work even longer hours or give up vacation days and sick days for salaries still grossly uncompetitive with what they can earn at private hospitals is a prescription for losing even more nurses and endangering even more patients.
Nancy Kaleda is one of the staff members of the New York State Nurses Association negotiating with New York City’s Health and Hospitals Corporation.