Kiera Downes Vogel

DELIVERING SOME HARD TRUTH: Kiera Downes-Vogel, a nurse in the labor-and-delivery unit of Mount Sinai West, said that while the hospital's contract with her union requires there to be 17 nurses per shift working in the unit, it frequently is at least five short of that number. A day earlier, she said, 'At the birth of a gorgeous baby boy, there was no baby nurse,' and so besides delivering the infant, 'I had to check him into the system, I had to check his vitals and send labs, I had to document everything that was done and I had to assist with breast-feeding.'

There was a time, a New York State Nurses Association official said, when the old Roosevelt Hospital—now Mount Sinai West—"was renowned as a birthing center."

But when Kiera Downes-Vogel, a Registered Nurse working in Mount Sinai West's labor-and-delivery unit, spoke at a union rally Dec. 1 that stretched along 10th Ave. down to the hospital's corner at West 58th St., she spoke of staff shortages that were requiring her and her colleagues to do more than should be reasonably expected.

While the NYSNA contract reached in early 2019 with Mount Sinai provided for 17 nurses to be working per shift in the unit, she said, "Yesterday, every bed was taken and there were 12 nurses."

Noting that there were other days when just 10 nurses were on duty, Ms. Downes-Vogel continued, "At the birth of a gorgeous baby boy, there was no baby nurse." And so besides delivering the infant, she said, "I had to check him into the system. I had to check his vitals and send labs. I had to document everything that was done, and I had to assist in breast-feeding."

Lucia Lee, the Mount Sinai Health System's vice president for media and public affairs, declined to respond to specific questions about conditions at Mount Sinai West and Mount Sinai Morningside, which also had nurses who made the trip downtown to speak of the problems they confronted daily. Instead, she emailed a statement saying, "Since the pandemic, Mount Sinai has fought for our nurses, from securing [personal protective equipment] to providing bonuses that recognize their heroic efforts. Nurses are essential to providing the best medical care in the world and we are confident we will continue to attract and retain the talent we need."

A Statewide Problem

The nursing shortage is not confined to the two Mount Sinai facilities. The rally was one of five that NYSNA has been holding since mid-November to call public attention to the problem and the impact it has had on patient care. A week earlier, the union made its case at New York Presbyterian Hudson Valley Hospital; the day after the Manhattan rally, it assembled nurses outside Staten Island University Hospital to dramatize the shortages there.

But Ms. Downes-Vogel, a 12-year veteran of the profession who has spent six years working in the Mount Sinai network, the last three at Mount Sinai West, told the crowd, "We have tried to work with hospital management to address recruitment and retention. Things have gotten worse over the past year."

One of her colleagues, Rebecca Dornfeld, had no basis for comparison, since she only recently completed her first year at Mount Sinai West. At 39, she came to the profession relatively late, having previously worked in real estate, with time off as a stay-at-home mom.

But her career change, even as the worst of the pandemic was beginning to ebb, couldn't be called completely unexpected—her father, she said just prior to the start of the rally, is a Doctor of Nurse Practitioners. If she wasn't becoming a nurse at the ideal time, she said, there was a feeling of "it's now or never" that brought her to Mount Sinai West.

There have been times, though, when she couldn't be blamed for thinking that "never" might have been the better option, and for reasons beyond her having gotten the coronavirus a month earlier.

'Job Has Been Hell'

"The job has been hell," Ms. Dornfeld said. "They are constantly, consistently pushing us to the brink."

She spoke of having to deal with more patients than she could give all the attention each needed in the Medical-Surgical Unit, and shortages of support staff that added to the burden. "You don't have Nursing Assistants to do basic toileting needs" for elderly patients who have just had surgery, Ms. Dornfeld said. "The entire year I've worked here it's been an issue." 

She recalled one overnight shift when a Nursing Supervisor at 2 a.m. told her to transfer her patients to another area of the hospital for space reasons. "I'm asking old grandmothers who have just had knee surgeries to move to another room," rousing them from sleep to do so, she said.

Asked what made her decide to participate in the rally, Nurse Dornfeld said it was about "advocating for better staffing ratios, advocating for patient safety."

The Hudson Valley Hospital rally eight days earlier was designed in part to prod New York Presbyterian to negotiate its first contract with NYSNA since it won the right to represent nurses there three years earlier. The union and its members there made the argument that its staff shortages were partly a consequence of inadequate wages and benefits and difficult working conditions,

Among the Mount Sinai West and Mount Sinai Morningside nurses, Ms. Dornfeld said, wages weren't the issue, partly because their contracts have another year to run. "We're not even asking for hazard pay, working in a pandemic," she said.

Meetings Haven't Helped

But the hospital network has been unable to accommodate the union's calls for adequate staffing in all departments.

"We have done everything we can do," Lucy Eisenstein Waldman, a Nurse Midwife who is part of NYSNA's Mount Sinai West executive committee, told the rally. "We have had countless meetings with Mount Sinai management."

The focus of those talks, she continued, had been to "stem the flow of nurses who are leaving, improve patient safety."   

Ms. Downes-Vogel during an interview said, "Last month alone, we lost five nurses" from the labor-and-delivery unit. While there should be 84 nurses in that unit, she said, there were at most 70 on staff.

Ironically, the problem was less severe during the crisis months when the virus was at its worst, she said. "At the real heart of the pandemic, we had a severe drop in our patient census," so turnover among nurses wasn't felt as acutely.

But as the normal volume of births there resumed, "The hospital didn't fill those positions in a timely manner."

Those who were quitting now, she said, had several reasons.

Safety, Money Both Factors

"Some nurses are leaving because they just don't feel safe" in the midst of a shortage that requires more than they may be able to deliver without neglecting some of their duties, Nurse Downes-Vogel said.

"There are some nurses who are leaving for lucrative travel contracts."

And she said, another factor is that under the current conditions, "You don't necessarily feel like you're getting supported by the hospital, either."

So then why, she was asked, had she decided to stay on?

"I'm in school—they're paying for me to be in school," Ms. Downes-Vogel said of hospital management. She was able to continue her graduate study at night because she was working day shifts.

Given that a move to another hospital would likely mean night shifts, and might not be free of the staffing issues that make her job more taxing and stressful, she added, "And I'm not sure I'd be better off anywhere else."       

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