New York City nurses’ deal is just the beginning — health care advocates are calling for major reforms

More than 7,000 nurses, represented by the New York State Nurses Association (NYSNA) and working at two major hospitals in New York City, ended their strike in the early hours of this week on Jan. 12. And the administration returned to the negotiating table to meet with the nurses. The basic demands are to increase employment and increase wages. These nurses, from Montefiore Medical Center and Mount Sinai Hospital, were part of the last two negotiating units to settle their contracts in the city. They got back to work early and early for 7 in the morning.

Although the historic strike has ended, its repercussions will continue across the country. The strike was the largest nursing strike the city has seen in decades, and experts and advocates agree it took years to prepare.

Mark Hanay — longtime director of Metro NY Health Care for All, a coalition of community organizations and labor unions (including NYSNA) that has fought for health care reform in the state since 1995 — said: mouthout That issues ‘safe staffing and nurse-to-patient ratios’ [have] He’s been hanging out there for quite some time.”

NYSNA and other union allies have been working on staffing issues and nurse-patient ratios for a long time,” Hannay added. Two years ago, the groups made “significant progress in state budget negotiations,” when the state legislature signed into law a bill establishing new staffing limits. But its implementation has been delayed. “It didn’t work out very well,” Hannay said.

State nurses have not given up on this issue. “Especially in the aftermath of a pandemic, nurses have gone above and beyond the call of duty,” Hannay reminded me. Indeed, the COVID-19 pandemic has affected the profession. Many of the nurses are exhausted; Others left the profession, either temporarily or permanently. Many refused to tolerate the poor staffing conditions caused by permanent staff shortages. “The nurses had no choice but to get pregnant,” Hannay said [the issues] in contract negotiations.”

The result was “tremendous,” said Erin Hogan, a nurse at Mount Sinai Primary Hospital on Manhattan’s Upper East Side, mouthout On Jan. 12, Hogan, an active member of her union for the past four years and a union delegate for the emergency department, began working at Mount Sinai more than six years ago, when she worked in the inpatient oncology department. “A month after I started my studies in Sinai, I felt something was not right,” she said. Then I went to the emergency room.

The ER at Mount Sinai “is known to be incredibly understaffed and incredibly crowded. The working conditions were horrible. The patients were on top of each other. It was dangerous and unmanageable,” Hogan said. Hogan’s allegations are not new. In 2019, it was released New York Post He posted a rendering of the hospital’s emergency department, which the hospital staff called a “war zone”. At the time, the show prompted an investigation by the state health department. The Mount Sinai Company, at press time, did not respond when contacted for comment in response to these allegations of chronic staffing shortages.

Hogan described how she began to feel “helpless and hopeless” as an EM nurse.

“Our position is unique,” Hogan reminded me. “We are the first to receive patients. We stabilize people. We salute ambulances. We see mass casualties and trauma. But you are only one person, and you really cannot give patients the attention they deserve.” She said the majority of nurses go into their field out of a desire to care for the sick, but under these circumstances, the reality of the work looks very different.

Eventually, the ER environment was starting to wear on Hogan. Her mental and physical health began to suffer. She developed insomnia, panic attacks, and migraines. Some nights, she would have nightmares” in which the patient would reach out [her] hand f [she] I can not afford it “.

“It just got way too much,” she said. In October 2021, Hogan reduced her hours to become a part-time nurse.

Hogan recalled how long-standing these types of staffing issues are, even before the pandemic arrived. Her union expressed “the same concerns” in negotiations over their most recent contract, when they also placed a 10-day notice of intent to strike required by the National Labor Relations Board for Healthcare Employees. “Unfortunately, we didn’t hit,” Hogan recalled. This contract included new language about staffing “networks” — planning tools that help determine nurse-to-patient ratios — but it was “definitely unenforceable, and nothing really changed.” Nurses were left with little protection for safe recruitment. “We’ve doubled and tripled the number of patients. Each [bargaining] Unit, we will raise this matter to management.”

But little has changed. Hogan said the administration was “disrespectful to our nurses, and even to the public”. Meanwhile, management described NYSNA’s actions prior to the strike as “reckless” behaviour. Even as a strike looms, the nurses’ union said Mount Sinai has moved away from the negotiating table. The hospital also began preparing for the strike, moving at least 100 patients, including infants in the NICU, from the main hospital to others in the system.

Hogan stressed the fact that both Mount Sinai and Montefiore have hundreds of nursing vacancies — Mount Sinai, about 500; Montefiore, about 700. The vacancy numbers are much lower at other hospitals in the city, and they are also smaller establishments than the main Montefiore or Mount Sinai hospital. Nurses at several other hospitals, including some at Mount Sinai, reached the agreements days and hours before the strike began.

As early as January 12, Mount Sinai and Montefiore finally agreed to staffing ratios similar to those included in the tentative agreements made at the other hospitals. The contracts include clearer enforcement language than in previous years, including short employee penalties. Meanwhile, Montefiore announced that it would create at least 170 nursing jobs, with an emphasis on the emergency department. (This headcount increase does not directly address the hospital’s 700 nursing vacancies.) Ideally, the new contracts would also help the hospital retain existing nurses and hire new ones.

Hogan called the Mount Sinai Agreement “a great starting point to give New Yorkers the care, quality, love and affection they truly deserve.”

Haney also discussed how the strike is a stepping stone for New York State to get involved — in a big way. He said the state needs to provide “more support to all hospitals, but in particular, safety-net hospitals,” which serve “disproportionate numbers of low-income, uninsured patients compared to other hospitals that primarily serve commercially insured patients.” Hannay argues that safety net hospitals have been neglected in recent decades.

After years of Economic freedom An approach to state hospitals, which was deregulated by Governor George Pataki in the late 1990s and early 2000s, Hannay argues that the state also needs to “make a more deliberate effort to provide oversight of hospital systems.” In the past decade, Governor Andrew Cuomo has pushed cuts to safety net hospitals and outsourced oversight of the major hospital systems themselves. “They were running the show,” Hannay said. These large regimes, based in academic medical centers like Mount Sinai, “have dominated healthcare policy in New York for years and years. They suck out the vast majority of resources, leaving everyone else to fight over the crumbs. That must stop.”

Nonprofit hospitals across the country avoid paying taxes by providing so-called charitable care to those who cannot afford it. But many of these foundations have steadily moved away from their charitable missions. Montefiore and Mount Sinai are no exception. Reports indicate that although hospitals have also received generous pandemic aid from the state, they have spent recent years cutting charitable care, increasing executive salaries and investing millions in private equity.

Meanwhile, smaller safety-net hospitals, which depend on Medicaid payments from the state, will continue to struggle, Hannay continued, “unless the state puts money on the table” and raises Medicaid rates, rather than continuing to lower them. But this will require new sources of state revenue – a shift that will unsurprisingly entail a shift from “neoliberal austerity” towards requiring “big business and the rich to pay their fair share of taxes”. Hanai warned that the shift would be “a heavy political push for the governor and the state legislature.” “But the public is behind this effort to rebalance our tax system.” In fact, in 2021, a Data for Progress poll found that 73% of New York voters—including 66% of Republicans and 81% of Democrats—would favor taxing wealthy individuals and businesses over embracing budget austerity.

It makes perfect sense that the public would want this kind of reform—both for the overall tax system that funds hospitals as well as for conditions within them. These conditions, after all, affect patients and nurses in equal measure. Hannay said the city’s nursing strike itself “opens up a huge debate about the individual experiences of patients.” “The public trusts nurses greatly in health care issues,” he said, echoing polls that show Americans consistently rank nurses as the most trusted profession. In media interviews, patients at Mount Sinai and Montefiore expressed support for the strike, saying the striking nurses “deserve everything they ask for” after their work during the pandemic. Others felt that the staff shortage had affected their families.

“Every day, people are concerned about hospital care in their communities,” Hannay said. Even as the industry continues to consolidate, and as larger and larger networks like Montefiore and Mount Sinai form, patients are “valuing their local hospitals as institutions.”

But hospitals cannot be the truly local, community-driven institutions they are today. Although hospitals like Mount Sinai and Montefiore, for example, are legally nonprofit organizations, “they operate like they’re for-profit,” Hannay said. This reality “negatively affects patient care and quality of care.” The nurse shortage crisis is simply a prime example of the broader issues in health care in the United States.

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