After big drop during pandemic, number of H+H nurses rebounds

Although the number of full-time nurses in the city’s public hospital system has rebounded significantly, city hospitals are still spending more than projected on temporary nursing staff, a recent report by the state comptroller’s office found.

During the pandemic, NYC Health + Hospitals increasingly relied on temporary nurses due to a higher patient volume and a growing shortage of permanent, full-time nurses. Between February 2020 and June 2023, the number of registered nurses on staff declined more than 6 percent, from 8,939 to 8,376. Nurses across the state retired early, or left the profession altogether, the report noted. The number of licensed practical nurses dropped significantly, by 37 percent, from 710 to 446 during this same period.

To offset these losses, NYC H+H more than doubled the number of temporary patient-care staff, the majority of whom were nurses. In February 2020, H+H had 1,038 temporary staffers, which had grown by 138 percent to 2,472 temporary employees by June 2023. Woodhull Hospital in Brooklyn’s Bedford-Stuyvesant neighborhood saw a 24-percent decrease in full-time nurses on staff, representing the largest decline in the H+H system. Harlem Hospital’s 22-percent decline was not far behind.

Spending on temporary staff — who were paid about 20 percent more than permanent nurses — ballooned during this period. While H+H spent $55 million on travel nurses in Fiscal Year 2019, temporary patient care workers cost the hospital system $600 million in FY 2020. Three years later, H+H still spent $410 million on travel nurses, according to the report.

Hiring increases

Between June 2023 and March of this year, the number of full-time nurses has grown by 18 percent. During that time frame, H+H administrators worked to recruit permanent nursing staff, growing the number of full-time nurses to 9,893. The number of temporary staffers also decreased by 6.7 percent, to 2,306 employees.

Despite the uptick in hiring permanent nurses, H+H spent $298 million on temporary staff in FY 2024, $168 million more than projected, the comptroller’s office found.

“The COVID-19 pandemic led to a major nursing shortage nationwide and in New York City, but Health + Hospitals has taken important and meaningful steps recently to recruit and retain more nurses,” State Comptroller Thomas DiNapoli said in a statement accompanying the report. “The number of full-time nurses at H+H now exceeds pre-pandemic levels, but temporary staff costs are still elevated. Further hiring and training are needed for H+H to achieve its fiscal targets and provide quality health care to all New Yorkers.”

The report attributed the shift in the hospital system’s ability to recruit and retain full-time nurses to the contract agreement reached with the New York State Nurses Association during the summer of 2023. That pact provided H+H nurses with more than $21,500 in parity payments, granting them salaries equal to their counterparts in private-sector hospitals.

“The recent NYSNA collective bargaining agreement appears to have boosted H+H’s ability to retain and hire additional RNs, although hiring still varies by facility,” the report indicated.

Between June 2023 and March, Kings County Hospital saw the largest number of full-time nurses — 246 — onboarded, a 27-percent increase in nurses on staff. As of March, eight of the city’s public hospitals had nurse vacancy rates below 10 percent, with Woodhull Hospital experiencing the largest gap at 18.1 percent, according to data from a City Council hearing cited in the report.

The comptroller’s office also noted that H+H opened three COVID-19 Centers of Excellence, grew the number of inpatient psychiatric beds and created new divisions in its maternal health units, which required additional hiring.

Despite these gains, though, “the process of onboarding RNs resulted in a delay in the planned reduction of patient care temporary [nurses] due to the time it takes to train new RNs, which can be up to six months,” the report noted. 

The comptroller’s office attributed the higher than projected expenses on temporary staffing delay to these onboarding delays. “As newly hired RNs complete training, contracted temporary RN staffing should continue to decline to 330 by December 2024,” the report stated.

clewis@thechiefleader.com