“I work in one of the busiest ERs in the Bronx and I love it, but I want to be able to do right by our patients,” said Kelley Cabrera, a Registered Nurse at Jacobi Hospital, one of the 11 in the NYC Health + Hospitals network. “I want people to realize the consequences of not having enough nurses—we shouldn’t be cutting corners at a time when we’re very dependent on our public hospitals.”
Nurses at NYC H+H have long fought to address safe-staffing issues. Numerous studies have shown that adequate staffing of nurses improves patient outcomes—and that has been made especially clear during the fight against the coronavirus.
Crisis Point Last April
As the virus surged last spring, the city hospitals were especially hit hard because they served the low-income communities that were disproportionately affected by COVID. Last April, daily hospitalizations reached 12,000, and staff faced severe shortages of personal protective equipment.
In order to help maintain safe patient-to-nurse ratios, NYC Health + Hospitals recruited and deployed temporary agency nurses. So far, the hospital system has brought on nearly 5,000 nurses from nearly a dozen agencies, including the city Department of Health and Mental Hygiene and the U.S. Federal Emergency Management Agency, according to H+H.
But nurses say they’re concerned that the use of temporary agency nurses may be “unsustainable.”
Ivoline Lake, a Registered Nurse at Bellevue Hospital, said that in her 42-bed unit there were times when there was just one full-time nurse on shift and the rest were agency nurses, who are also referred to as travelers.
“I don’t know why they don’t have full-time staff instead of bringing in travelers,” she said.
'We Have to Jump In'
Ms. Lake added that there were certain duties—such as checking cardiac telemetry monitors, which keep track of a patient’s heart activity—that the agency nurses were unable to assist with.
“It’s helpful but still stressful. They’re not familiar with the unit and we have to jump in,” she said.
Ms. Cabrera, who works in a Level I trauma center, emphasized that she was “thankful” for the temporary staff, “but it’s very concerning to us when I look around and there aren’t many full-time staff. We obviously advocate for having full-time nurses because we want to make sure it’s sustainable. We want a long-term solution.”
To ensure that every hospital has adequate nurse staffing, the New York State Nurses Association, which represents the 8,500 nurses who work in city hospitals, has been urging legislators to pass the Safe Staffing for Quality Care Act.
NYC Health + Hospitals noted that agency nurses have made up a small percentage of nurses on staff, and stated that it has continued hiring full-time nurses.
'Keep Hiring Full-Timers'
“To help relieve our health-care heroes who are fighting day and night to save lives, the public-health system works with nearly a dozen agencies to secure nurses to provide care for New Yorkers stricken by this virus,” said H+H spokeswoman Karla Griffith. “We remain committed to and have never stopped hiring nurses full-time as a part of our ongoing recruitment efforts."
Adding to the challenges faced by nurses is the fact that there have also been shortages of other staff—including Primary Care Physicians, Patient Care Assistants and Certified Nursing Assistants—who take vital signs, feed and change patients, according to both Ms. Lake and Ms. Cabrera.
The shortages mean that “nurses have to do a lot more, on top of their nurse duties,” Ms. Lake said. “It’s been a big problem in the night shift, where they’ve had one PCP for years.”
NYC H+H's financial future is uncertain. After years of financial crisis, the safety-net hospital system began to stabilize prior to the pandemic. But last summer, its CEO and President, Mitchell Katz, stated that the system was losing $25 million per week.
Although H+H received $1.2 billion in initial Federal coronavirus funding, the costs associated with the first wave were $1.6 billion, according to a December report to the system’s board of directors.
Wary Eye on State
Advocates also feared future cuts to Medicaid, which would disproportionately hurt safety-net hospitals that serve low-income patients. And Governor Cuomo’s proposed budget would slash $473 million from the city’s public hospital system through June 2022.
“My biggest concern is that there will be more cuts to public infrastructure, and now is not the time to do that,” Ms. Cabrera said, explaining that more people were depending on public hospitals because so many New Yorkers were unemployed and had lost their health insurance. “It’s very scary, looking at what could happen down the line.”
Even prior to the pandemic, one in five hospital patients in the city were discharged from an H+H facility.
Ms. Cabrera noted that there was a lot of uncertainty regarding how long the agency nurses would stay on and the appearance of COVID variants that have been found across the city.
“I think H+H is trying to provide support as best as it can,” Ms. Cabrera said. “But there’s a difference between looking ahead to the next month and looking ahead to the next year.”
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