We’ve heard for years now that the New York State Nurses Association has been loudly protesting staffing shortages at area hospitals and how this was leading to poor patient care and burnout among its members.
Now, almost two years into this global public health crisis, the situation with our nursing shortage has not only persisted but worsened, and we need to come up with short- and long-term fixes to a scourge that endangers lives every day.
With the recent surge in New York due to the highly contagious omicron variant, what was a deepening problem has escalated into a four-alarm fire.
I recently spent four days in both the emergency room and overnight patient care unit at Mount Sinai West hospital in Manhattan on 10th Avenue and 60th Street for a relatively minor medical problem involving my blood platelets, a residual impact of my recent coronavirus breakthrough infection. In this 96-hour period, I encountered close to a dozen nurses, all hard-working and extremely genial despite their harried pace. I got a chance to talk to them and ask them how their career has changed over the past two years and what impact this has had on patient care.
I was compelled to do these mini-interviews because of what I witnessed – and personally experienced – in my day in the emergency room: the chaos and stress on nurses and patients that the nursing staffing shortage is wreaking havoc on every day in even our highly-ranked and wealthier private hospitals. I dread to think how bad things have gotten in New York’s chronically underfunded public hospitals.
One nurse I spoke with in the ER said that she was so overstretched that day that she was expected to care for more than 12 patients at a time, when the standard ER ratio of nurse to patient shouldn’t exceed six patients, due to the triaging and routing of so many new and very sick patients.
I was one of the lucky ones in the ER. When I clicked the nurse button because an IV that was delivering much-needed steroids into my system malfunctioned, my wait of more than 45 minutes for a nurse to fix it wasn’t life or death – but for others it could have been, and we don’t know how many of the excess deaths in New York the last two years (mostly coronavirus-related) could have been avoided with proper nursing staffing in our hospitals.
There are numerous causes of this crisis: nurses retiring early due to burnout; fewer immigrant nurses moving to New York since the Trump administration’s crackdown a few years ago; programs that incentivize nurses with very high pay to become “traveling nurses” to meet high demand in other areas of the state and country.
It was this last factor – “traveling nurses” – that I heard over and over again in response to my queries about how things have changed and why they’ve worsened the past year. The number of traveling nurses mushroomed early in the pandemic to fill gaps in the parts of our country that were hardest hit by the pandemic at the time. Nurses can make up to $8,000 per week for three-month commitments to transfer – that’s more than three to four times their normal salary if they remain at their current posts at local New York hospitals. It’s no wonder that thousands of New York nurses have signed up to do this work.
By 2030, there is a projected shortage of more than 39,000 registered nurses in New York, according to a recent report by the New York State Department of Health. New York state averaged 12.25 nurses per 1,000 people in 2018, according to a breakdown from Nurse Journal. Wyoming leads the way at 19.86 nurses per thousand, and even some big states like California are near the bottom at 9.25 per thousand.
How to solve this chronic problem? There’s a number of things that need to happen to ensure that we’re shoring up this key part of the healthcare system:
* Expand the size of existing nursing schools in New York State and add new, affordable programs at CUNY and SUNY schools.
* Incentivize graduates from New York nursing schools to work in New York hospitals for at least the first 10 years of their careers by offering lower tuition incentives and loan forgiveness.
* Offer retention bonuses and hazard pay to current nurses, particularly the experienced boomers, who are retiring or quitting in record numbers because of the burnout they’ve experienced during the last two years of the pandemic.
* Create a “master nurse” program of talented, experienced nurses who can mentor new, inexperienced nursing graduates. Pay these master nurses at least $20,000-$40,000 per year more as an incentive to promote the great practitioners.
* We need to significantly improve our primary and secondary education system so that smart men and women are prepared to go into nursing. A friend’s granddaughter is currently in nursing school: her class which started with more than 520 enrollees has been whittled down to a mere 15 graduates because the other students couldn’t hack the rigorous curriculum.
*The state Legislature needs to mandate that each hospital – public and private – has enough nurses on staff — and in reserve — so that when some retire or get sick, like many have during COVID-19, this doesn’t lead to shortages and compromised care. Reward private hospitals that have “safe staffing” mandates each year with tax breaks that incentivize them to maintain this level.
Everyone in health care – and many patients like me – has known for years that the nursing shortage in New York is a ticking time bomb that could cripple our health care system. The pandemic has exposed this further and now that we’re in the midst of yet another surge, we must act urgently to ensure that we’re prepared for future crises.
With a new governor, mayor and an activist legislature in Albany, as well as a new, progressive New York City Council, the political stars are aligning for meaningful change and reform to combat this growing nursing shortage.
Tom Allon is the publisher of City & State.
Research assistance by Tom Bolen.