A bidding war for critical nursing talent

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As the pandemic rages on, hospitals across the country are experiencing significant labor shortages for critical clinical roles. In the graphic above, we highlight the shortage of nursing talent, perhaps the most sought-after role for which health systems are struggling to hire.

Even before the current COVID surge, many nurses reported feeling dissatisfied or feeling burned out. In a May 2021 survey, more than one in five nurses said they were considering leaving their current jobs, citing insufficient staffing, workload, and the emotional toll of the work. Many health systems are offering lucrative incentives, such as five-figure signing bonuses, to fill immediate critical care needs, and to address the growing backlog of patients returning for delayed care.

As more nurses quit or retire from their permanent positions, health systems are being forced to fill workforce gaps by luring temporary talent at much higher costs (now cresting $8K a week to fund a single travel nurse in some parts of the country). Travel nurse demand reached an all-time high in August, up almost 40 percent from the previous peak in December 2020. As they struggle to fill essential openings, hospital leaders must also focus on keeping the current nursing staff engaged—a challenge that only gets harder as staff nurses compare their salaries to those paid to the temporary colleagues working alongside them.

Cartoon- Bearing the Burden of Anti Mask/Vax Freedom

RN hourly wage in 10 US metro areas

RN Salary -Registered Nurse wages and employment information

The hourly mean wage for registered nurses in the U.S. is $38.47, according to the U.S. Bureau of Labor Statistics’ latest occupational employment and wage statistics survey.

Among 10 metropolitan areas with the highest employment level in registered nurses, registered nurses have the highest hourly mean wage in the Los Angeles area and the lowest in the Miami area.

Ten hourly mean wages for RNs by metropolitan area, in descending order:

1. Los Angeles: $54.38

2. Boston: $47.79

3. New York City: $45.63

4. Houston: $40.85

5. Washington, D.C.: $40.14

6. Philadelphia: $38.45

7. Dallas: $37.50

8. Chicago: $37.48

9. Detroit: $36.64

10. Miami: $34.76 

Vaccination shortfall making it harder to fully staff hospitals

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Your Messages of Support | Emerson Hospital

With vaccine mandates on the rise among healthcare organizations, including many of the health systems we work with, we’ve begun to hear a new argument in favor of getting staff vaccinated—one that weighs against the worry that mandates will drive scarce clinical workers away.

With staffing already stretched, some systems have been concerned that implementing mandates could worsen shortages and force an increase in the use of costly agency labor. But, some executives are now telling us, so could not vaccinating staff. As the highly contagious Delta variant continues to sweep through unvaccinated populations, clinical workers who haven’t gotten their shots are especially susceptible to contracting the virus.

That’s driven a sharp increase in unvaccinated nurses and other workers calling out sick with COVID symptoms, which has made a difficult staffing situation even worse.

Some of the high-profile reports of hospitals running out of beds in the face of the Delta variant are actually driven by running out of staff to keep those beds in use—making it even more critical to ensure that frontline workers are protected against the virus.

As a growing number of hospitals and other care facilities mandate that their workers get vaccinated, we’d hope this unwelcome pressure on an already stretched workforce begins to wane.

US’s largest registered nurses union calls on CDC to bring back universal mask guidelines

Nurses' Union Condemns C.D.C.'s New Mask Advice - The New York Times

The largest union for registered nurses in the U.S. called on the Centers for Disease Control and Prevention (CDC) to bring back recommendations for universal masking in public regardless of people’s vaccination status. 

The National Nurses Union (NNU) in a Monday letter to CDC Director Rochelle Walensky requested that the agency reinstitute guidelines for all people to wear masks in public and in close proximity to those outside their household.

NNU Executive Director Bonnie Castillo pointed to a 16 percent uptick in U.S. COVID-19 cases from last week, according to CDC data, as well as rises in case counts in more than 40 states and hospitalizations in more than 25 states as reasons to return to previous, stricter guidelines.

“NNU strongly urges the CDC to reinstate universal masking, irrespective of vaccination status, to help reduce the spread of the virus, especially from infected individuals who do not have any symptoms,” Castillo wrote in the letter. “Our suggestions are based on science and the precautionary principle and are made in order to protect nurses, other essential workers, patients, and the public from Covid-19.”

The union also cited the World Health Organization’s (WHO) call for vaccinated people to continue wearing masks in public amid the spread of the highly transmissible delta variant. Several U.S. officials and experts have said the WHO’s guidance reflects the state of the pandemic worldwide, which overall has seen lower vaccination rates than the U.S.

Castillo acknowledged that COVID-19 vaccines are effective at preventing severe illness and death but noted “no vaccine is 100 percent effective, and the emergence and spread of variants of concern may reduce vaccine effectiveness.”

The NNU in its letter also appeals for the CDC to update its guidance to “fully recognize aerosol transmission,” mandate tracking and reporting of cases among health care and essential workers, and keep records of cases, including mild and asymptomatic infections, among fully vaccinated people to measure the shots’ effectiveness. 

The CDC did not immediately return a request for comment on the letter, but officials have consistently defended the updated mask guidance, saying fully vaccinated individuals are protected against the virus.

The NNU vocally opposed the CDC’s current mask guidance updated in May to permit fully vaccinated individuals to go maskless in virtually all settings. The union has argued that the change in recommendations endangered patients, front-line workers and nurses as the pandemic continues.

In the Monday letter, the union wrote that the CDC’s relaxation of mask guidance “failed to account for” the possibility of fully vaccinated people contracting and spreading the virus. It also said the agency’s guidelines do not protect people, including children, who cannot get the vaccine.

The NNU sent the letter days after the CDC urged schools to reopen for full in-person learning in the fall, saying that fully vaccinated teachers and students do not need to wear masks.

It also comes after Los Angeles County and St. Louis County recommended their residents to wear masks in public indoors.

Are recent labor actions getting nursing unions what they want?

While nurses in Cook County, Illinois, struck a deal in recent days, those on a three-month-plus strike against a Tenet hospital in Massachusetts plan a protest at the chain’s Dallas headquarters.

Thousands of healthcare workers have waged strikes this summer to demand better staffing levels as the pandemic brought greater attention to what happens when a nurse must take care of more patients than they can reasonably handle.

In New York, a report from the attorney general that found nursing homes with low staffing ratings had higher fatality rates during the worst COVID-19 surges last spring helped spur legislators to pass a safe staffing law long-advocated for by the New York State Nurses Association.

While unions elsewhere face a steeper climb to win the success found in New York, through strikes and other actions, they’re attempting to get new staffing rules outlined in their employment contracts.

Most nursing strikes include demands for ratios, or limits on the number of patients a nurse can be required to care for, Rebecca Givan, associate professor in the School of Management and Labor Relations at Rutgers University, said.

“And employers are very anxious about that because it threatens their bottom line, so often when a compromise is found, it’s something that approaches a ratio but maybe has a bit more flexibility,” Givan said.

Some have been successful, like the 1,000 Chicago-area nurses at Stroger Hospital, Provident Hospital and Cook County Jail who waged a one-day strike on June 24 after negotiating with the county over a new contract for nearly eight months.

They reached a tentative agreement shortly after the strike, stipulating the hiring of 300 nurses, including 125 newly added positions throughout the system within the next 18 months.

The deal also includes wage increases to help retain staff, ranging from 12% to 31% over the contract’s four-year term, according to National Nurses United.

Meanwhile, 700 nurses at Tenet’s St. Vincent Hospital in Worcester, Massachusetts, have been on strike for over 100 days over staffing levels. Nurses represented by the Massachusetts Nurses Association have been trying to get an actual nurse-to-patient ratio outlined for specific units in their next contract.

The two sides haven’t come close to reaching a deal yet, and some nurses will travel to Tenet’s headquarters in Dallas on Wednesday in an attempt to appeal to corporate executives, according to MNA.

At the same time, federal lawmakers wrote to Tenet CEO Ron Rittenmeyer seeking details on the chain’s use of federal coronavirus relief funds amid the strike and alongside record profits it turned last year.

The hospital denied lawmakers’ claims in the letter that Tenet used federal funds to enrich executives and shareholders rather than meet patient and staff needs, saying in a statement it strongly objects to the “mischaracterization of the facts and false allegations of noncompliance with any federal program.”

The strike is currently the longest among nurses nationally in a decade, according to the union.

A number of other major hospital chains have contracts covering their nurses expiring this summer, including for-profit HCA Healthcare and nonprofit Sutter Health.

Unionized nurses at 10 HCA hospitals in Florida have reached a deal on a new collective bargaining agreement, though members still need to ratify it, according to National Nurses United. The details are still unclear.

And after joining NNU just last year, 2,000 nurses at HCA’s Mission Hospital in Asheville, North Carolina, ratified their first contract Saturday, which includes wage increases and the formation of a nurse-led staffing committee.

Newly-formed unions take an average of 409 days to win a first contract, according to an analysis from Bloomberg Law. In the healthcare industry, new unions take an average of 528 days to win a first contract, the longest among all sectors examined.

Across the country at Sutter’s California hospitals, disputes haven’t been so easily resolved. Healthcare workers at eight Sutter hospitals planned protests throughout July “to expose the threat to workers and patients caused by understaffing, long patient wait times and worker safety issues at Sutter facilities,” according to Service Employees International Union United Healthcare Workers West, which represents the workers.

Similar to the ongoing Tenet hospital strike, SEIU is highlighting Sutter’s profits so far this year and the federal relief funds it received.

CommonSpirit and Essentia call off 14-hospital deal following nurse complaints

Dive Brief:

  • CommonSpirit Health and Essentia Health have called off a deal for Essentia to acquire 14 CommonSpirit facilities in North Dakota and Minnesota, the two Catholic systems announced Tuesday.
  • The deal, nixed just four months after being announced, would have doubled the size of Duluth, Minn.-based Essentia’s hospital network. One of the facilities up for grabs, CHI St. Alexius Medical Center, is a tertiary hospital and the other 13 are critical access hospitals. The deal would also have included associated clinics and living communities.
  • The systems did not provide details as to why they scrapped the deal in their release, and an Essentia representative did not respond to a request for comment by time of publication.

Dive Insight:

CommonSpirit and Essentia signed a letter of intent in January to explore the sale, but talks have now fizzled following months of deliberation.

“While we share a similar mission, vision, values and strong commitment to sustainable rural healthcare, CommonSpirit and Essentia were unable to come to an agreement that would serve the best interests of both organizations, the people we employ and the patients we serve,” a joint statement from the two systems said.

Earlier this month, more than 700 nurses and medical workers filed a petition noting their concern over the deal. In the petition, the Minnesota Nurses Association and employees at Essentia and CommonSpirit said they feared layoffs and restricted access to patient care resulting from the acquisition.

Nurses cited Essentia’s partnership with Mercy Hospital in Moose Lake, Minn., last summer, which they claimed hurt the quality of patient care.

“Ever since the takeover, we’ve lost numerous staff, causing shortages in how we care for patients,” a nurse wrote in a news release about the petition May 4. “We don’t want CHI’s hospitals and clinics to lay off workers, cut the services they offer or close entirely.”

Essentia did not respond to a request for comment about whether workers’ concerns affected the decision to call off the deal.

Hospitals maintain consolidation betters the patient experience and improves care quality, but numerous studies have suggested that’s not the case. One from early last year published in the New England Journal of Medicine found acquired hospitals actually saw moderately worse patient experience, along with no change in 30-day mortality or readmission rates, while another from 2019 found mergers and acquisitions drive up prices for consumers.

Despite that, provider mergers and acquisitions have continued at a rapid clip even during COVID-19, as hospitals look to divest underperforming assets and bulk up market share in more lucrative geographies. The letter of intent CommonSpirit signed with Essentia suggests the roughly 140-hospital system is taking stock of its smaller rural facilities.

Chicago-based CommonSpirit was formed in 2019 by the merger of nonprofit giants Catholic Health Initiatives and Dignity Health. The nonprofit giant was hit hard by the pandemic, losing $550 million in the 2020 fiscal year.

Striking Tenet nurses, hospital CEO trade jabs with no end in sight for standoff

About 800 nurses at a Tenet hospital are on the third week of a strike that’s shaping up to be one of the longest among healthcare workers in recent years.

At the hospital chain’s St. Vincent Hospital in Worcester, Massachusetts, nurses represented by the Massachusetts Nurses Association have been on strike since March 8 following a breakdown in negotiations over a new contract they’ve been bargaining for since November 2019.

Nurses have been active on the labor organization front in wake of the COVID-19 pandemic, and share a common issue at stake — staffing levels, and more specifically the nurse to patient ratio.

At St. Vincent, unionized nurses say their staffing has been worsened by the pandemic, affecting their ability to adequately care for patients. They point to hundreds of unsafe staffing reports filed by nurses over the past year, and the departure of more than 100 St. Vincent nurses over the past 10 months.

The hospital rejects those claims, and said only two citations have been issued by the Massachusetts Department of Public Health since 2019, according to a release.

The changes MNA is asking for are “excessive,” St. Vincent Hospital CEO Carolyn Jackson contended in an interview with Healthcare Dive, and the hospital cannot agree to the “aggressive” levels the union is proposing.

The two sides haven’t met again since the strike began, and do not have a timeline to get back to the table.

Right now, St. Vincent operates on staffing guidelines brokered after its nurses waged a 49-day strike over their first union contract in 2000Under those terms, one nurse in its medical surgical units can be assigned to either four or five patients.

The terms proposed by MNA stipulate that one nurse in those units would be assigned to four patients at a maximum. MNA is also asking for a five-nurse critical care float pool, and for the hospital to double its emergency department staff from 71 employees to 157, Jackson said.

California is currently the only state with mandated ratios of one nurse to five patients in medical surgical units.

“It has been our request for them to remove some of those unreasonable, or preferably all of those unreasonable staffing requests, and come back to the table and really work on getting a reasonable deal done,” Jackson said.

During the first week of the strike, the hospital paid over $5 million to hire replacement nurses, according to a release. When asked directly about how much the hospital has spent so far, Jackson declined to answer.

“It is definitely an added expense to the hospital, and that is challenging,” she said.

The strike in 2000 ended when both parties reached a deal brokered by former Sen. Ted Kennedy, D-Mass., that resulted in provisions to limit mandatory overtime and the staffing guidelines currently in place.

But this time it seems “there is no point at which anybody’s going to step in and settle this for the two parties,” Paul Clark, professor and director of Penn State’s school of labor and employment relations said.

The union has garnered support from Massachusetts lawmakers including Sen. Elizabeth Warren, Rep. James McGovern and former Rep. Joe Kennedy, who visited the picket line on March 12, along with state Attorney General Maura Healey, who visited Wednesday.

The Worcester City Council also approved a resolution in support of the striking nurses at St. Vincent on March 16.

But those moves wield little power to break the strike, although the political pressure could hurt the hospital.

“The increased cost is, perhaps, public opinion beginning to coalesce behind the union,” Clark said.

Strikes have costs for both sides, as nurses on the picket line have gone without pay for almost three weeks now.

“Until the cost becomes too great to one or the other sides, they’re going to continue down this road,” Clark said.

Executives, physicians at Texas hospital sentenced in $200M scheme

Kickback Definition

Fourteen defendants have been sentenced to more than 74 years in prison combined and ordered to pay $82.9 million in restitution for their roles in a $200 million healthcare scheme designed to get physicians to steer patients to Forest Park Medical Center, a now-defunct hospital in Dallas, the U.S. Justice Department announced March 19. 

More than 21 defendants were charged in a federal indictment in 2016 for their alleged involvement in a bribe and kickback scheme that involved paying surgeons, lawyers and others for referring patients to FPMC’s facilities. Those involved in the scheme paid and/or received $40 million in bribes and kickbacks for referring patients, and the fraud resulted in FPMC collecting $200 million. 

Several of the defendants, including a founder and former administrator of FPMC, were convicted at trial in April 2019 and sentenced last week. Other defendants pleaded guilty before trial.  

Hospital manager and founder Andrew Beauchamp pleaded guilty in 2018 to conspiracy to pay healthcare bribes and commercial bribery, then testified for the government during his co-conspirators’ trial. He admitted that the hospital “bought surgeries” and then “papered it up to make it look good.” He was sentenced March 19 to 63 months in prison. 

Wilton “Mac” Burt, a founder and managing partner of the hospital, was found guilty of conspiracy, paying kickbacks, commercial bribery in violation of the Travel Act and money laundering. He was sentenced March 17 to 150 months in prison. 

Four surgeons, a physician and a nurse were among the other defendants sentenced last week for their roles in the scheme. Access a list of the defendants and their sentences here