The Montefiore medical centre in the New York City suburb of New Rochelle is known as a safety-net hospital because it cares for patients regardless of their ability to pay. For nurses at the facility, that has translated into a crushing burden during the coronavirus pandemic.
This month, about 200 union-represented nurses at the privately owned hospital staged a two-day strike, picketing for 12 hours at a time to protest against working conditions they said had made their lives nearly impossible.
As the number of Covid-19 patients surged, they claimed, the hospital pushed nurses to care for too many people at one time and handed out personal protective equipment (PPE) that gave off a harsh chemical smell and left some staff with rashes.
“If you can safely care for one or two patients, but you’re given four or five, you have to make some decisions about who you’re going to rescue,” said Judy Sheridan-Gonzalez, president of the nurses’ union at the hospital. “That is just a horrible thing for health professionals to confront.”
Shortages of staff and PPE have tormented healthcare workers across the nation during the pandemic. But such problems are particularly acute at overburdened hospitals serving poor and minority communities, says Dr Linda Aiken, a nursing professor at the University of Pennsylvania.
Each nurse in pre-pandemic New York City was responsible for an average of 6.5 patients, the highest anywhere in the state, according to a study by Dr Aiken published in the BMJ medical journal. New York state does not cap the number of patients that can be assigned to one nurse; California, in contrast, mandates that nurses care for no more than five patients each. Studies have shown that patient mortality rates jump 7 per cent for each additional patient a nurse is assigned. Individual hospitals do not typically make their staffing ratios public.
“This is a bad commentary on how US hospitals are trying to manage staffing even in normal circumstances,” Dr Aiken said. “They’re very much in love with this idea of just-in-time staffing and just-in-time supplies. It’s a manufacturing idea that doesn’t work out in hospitals.”
This cost-cutting philosophy keeps hospitals from maintaining stockpiles of PPE beyond the 90-day supply mandated by the state or scheduling more than the minimum number of workers at a given time, Dr Aiken said.
Ms Sheridan-Gonzalez, who works a few miles south of New Rochelle in a Montefiore hospital in the Bronx, New York City’s poorest borough, said staffing shortages existed even before the pandemic. After Covid hit, she said, conditions grew worse — and some patients were left lying in their own waste until a nurse or healthcare assistant could be found to help them.
“It’s extraordinarily painful,” she said.
Ms Sheridan-Gonzalez said she was reminded of a dystopian movie when she compared her emergency room with outposts of the Montefiore health system in wealthier suburbs. “It’s like you see the rich people in the sky and the poor people in the ground,” she said. “It’s two worlds.”
If the US does not bring the pandemic under control, Dr Aiken warned that the problems facing nurses in places like the Bronx could become more widespread. “You expect this in minority-serving hospitals,” Dr Aiken said. “What’s unexplainable is how it’s started to happen everywhere.”
At least 213 registered nurses nationwide had died of Covid by September, according to a study by National Nurses United, a healthcare workers union. They estimate another 258,768 had been infected. Nurses’ mental health has also suffered, with 86 per cent of the 1,100 healthcare workers surveyed by non-profit Mental Health America reporting anxiety.
At Montefiore New Rochelle, a nurse and a nursing assistant died from Covid-19 this year, and a handful of older nurses were so afraid of getting sick that they retired early, Ms Sheridan-Gonzalez said.
Bea Grause, president of the Healthcare Association of New York State, said member hospitals including Montefiore were working to recruit nurses from out of state and lure others out of retirement to prevent shortfalls but faced financial limits. Budgets are tight after bans on lucrative elective procedures earlier this year reduced revenues.
“I was a staff nurse for a long time, and I think for the vast majority of healthcare workers, physicians, nurses, others, they understand that it’s one team, and that their administration is there to support them,” Ms Grause said. “I don’t understand why, particularly now, when there is great opportunity to sit down at the table and work out these issues without putting patients at risk, why that is not happening.”
Marcos Crespo, a Montefiore executive, said in a statement before the strike that the nurses’ union was “selfishly putting the community at risk and using Covid-19 as a political football”. He said the hospital network had offered the nurses a pay raise, fully funded health insurance, tuition reimbursement and other benefits but would not negotiate on staffing levels.
Ms Sheridan-Gonzalez says their offers were “too little, too late”.
“What has Montefiore done since June?” New Rochelle nurse Maria Castillo asked in a statement released by the union on the second day of the strike. “They put a bunch of billboards up on the highway. They bought TV commercials calling us ‘heroes’. They want the community to think they appreciate us. The reality is, they would rather spend millions of dollars on their public image, instead of making sure we have enough nurses to care for everyone who is sick!”
Dr Aiken said solutions to the staffing dilemma could include state legislation to cap nurse-to-patient ratios and an expansion of reciprocal licensing agreements that allow nurses to move across state lines.
Until then, Montefiore New Rochelle’s nurses remain at odds with hospital management. Some reported losing shifts after their walkout. Hospital representatives did not respond to a request for comment.
For nurses, a strike is “not the first thing they think of”, Ms Sheridan-Gonzalez said. “They just don’t know what else to do.”