NY hospitals are paying big penalties for understaffing. Nurses hope that leads to change.

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By Dan Sears

The 16-bed Post-Anesthesia Care Unit at Mount Sinai Morningside hospital, where patients go after coming out of surgery, is supposed to have at least eight nurses on its 11 a.m. shift to perform tasks like monitoring vital signs and doling out pain medication.

That’s the number Mount Sinai agreed to in its contract with the New York State Nurses Association.

But the hospital failed to meet that minimum 203 times last year, including 36 days when there were just four or five nurses available, an arbitrator found when deciding a case brought by unionized nurses at the hospital.

On Jan. 7, the arbitrator ordered Mount Sinai to pay a penalty of nearly $250,000 for chronic understaffing in violation of the union contract, despite acknowledging that the hospital “made good-faith efforts to recruit and hire additional nurses.”

The New York State Nurses Association and the Federation of Nurses/UFT say that for the first time in 2023, they began securing cash payments over complaints about understaffing. The awards must be paid out to nurses who worked those understaffed shifts.

The New York State Nurses Association has won nearly $1 million in six separate penalties against Mount Sinai Hospital, Mount Sinai Morningside and Montefiore Medical Center since May. The Federation of Nurses/UFT won financial awards in two additional cases against NYU Langone Brooklyn last month, but the amounts still have to be calculated. Arbitration cases are not public and there may be others that have not been reported.

The unions, which represent a combined 58,000 nurses statewide, say the trend gives them hope about making progress fighting hospital understaffing — which multiple studies show can lead to worse outcomes, including higher mortality rates. According to one University of Pennsylvania study, every additional patient a nurse is assigned increases the odds of a patient dying within 30 days of admission by 7%.

“This is a new tool that we can use to put pressure on the hospital,” said Matthew Allen, president of the New York State Nurses Association’s local bargaining unit at Mount Sinai Hospital.

In some cases, union leaders say, it’s working. Allen said nurses saw better staffing ratios in a Mount Sinai Hospital step-down unit, which serves patients who require a less intensive level of care than an ICU, after they were awarded nearly $283,000 for an understaffing complaint in September. In other cases, they’re seeing little change so far.

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We have a case scheduled every month on short staffing, and we are rapid-fire intending to roll them over with the facts.

Anne Goldman, head of the Federation of Nurses/UFT

But representatives for the three New York hospital systems that have been ordered to pay these awards say they’re working to beef up staff. Spokespeople for Montefiore and Mount Sinai added that they are struggling to fill vacancies amid a nationwide nursing workforce shortage.

Union representatives say the progress they’ve seen with cash awards seems to stem both from new provisions in recent contracts, and an apparent growing willingness by arbitrators to assign financial penalties. Nurses at Mount Sinai Hospital and Montefiore Medical Center first won the right to pursue financial compensation for understaffing after walking off the job a year ago.

“We have a case scheduled every month on short staffing, and we are rapid-fire intending to roll them over with the facts,” Anne Goldman, head of the Federation of Nurses/UFT, said. “That, I think, will give us the change we’re seeking, which is enforcement.”

Challenges recruiting nurses

“Hospitals everywhere have grappled with nursing and other health care worker shortages, and these are not challenges unique to any health care provider and have been well documented across the city, state and country,” Lucia Lee, a spokesperson for Mount Sinai Health System, said in a statement. But she said Mount Sinai still has the resources to provide excellent care to patients.

Shilpa Ingram, a spokesperson for Montefiore, also pointed to what she described as a “national staffing crisis for nurses.”

During the COVID-19 pandemic, many nurses left permanent hospital jobs for more lucrative travel-nursing gigs or left hospital care altogether.

Health care employment in New York is generally on the rise again after dipping 3.6% in 2020, but is growing at a slower rate than it was pre-COVID, according to Gov. Kathy Hochul’s 2024 State of the State report. She set a goal in 2022 of growing the health care workforce by 20% over the next five years.

Hochul has made attempts to improve the nursing pipeline, such as allowing nurses to practice in New York with out-of-state licenses and allowing nursing students to complete up to a third of their clinical training through simulations.

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But the Greater New York Hospital Association, a hospital lobbying group, says the state Medicaid program also needs to boost its funding for hospitals in this year’s budget to help pay for their efforts to recruit and retain nurses.

Steve Ritea, a spokesperson for NYU Langone, called Federation of Nurses/UFT claims about understaffing at the health system’s Brooklyn campus “reckless,” despite the recent arbitration awards.

“We have worked tirelessly to address appropriate staffing in our units and union leadership knows that,” Ritea said in a statement.

He noted that the hospital has recruited travel nurses, worked to increase the pool of nurses who can “float” from unit to unit and created an expedited procedure for job applications to recruit new nurses.

NYU Langone Brooklyn has hired 226 nurses in the past year and is actively recruiting for 65 more, Ritea added.

Arbitrators have given hospitals some leeway because of the staffing challenge. One awarded $127,057 to nurses in Mount Sinai Hospital’s Neonatal Intensive Care Unit — an amount discounted by 20% because of “the extraordinary financial efforts Mount Sinai Hospital has made to address staffing and meet ratios” by paying for overtime and temp nurses.

These are not challenges unique to any health care provider and have been well documented across the city, state and country.

Lucia Lee, a spokesperson for Mount Sinai Health System

Under Mount Sinai Hospital’s contract with the New York State Nurses Association, nurses on the unit are supposed to be responsible for just one or two infants at a time, since the babies need their focused attention. But Nina Horowitz, a nurse on the unit, testified in the case that nurses sometimes had to take care of three or four babies at a time instead.

Staffing levels improved for a time after the award, aided by floating nurses, Horowitz said. But ultimately, the unit wound up short-staffed again, she said.

“It means you don’t get a break,” said Horowitz. “Our shift is 7 [a.m.] to 7 [p.m.]. Last week, personally, I was at work until 10 p.m. every night.”

Last year, shortly after nurses began tracking staffing levels in the NICU and found them falling short of the January contract, Mount Sinai chief nursing executive Beth Oliver told Gothamist it takes time to fill vacancies because the unit is “so hyper-specialized.” The hospital declined to comment on the current situation.

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Waiting on backup from the state

These arbitration awards are rolling in as the state Department of Health is also starting to enforce a new hospital staffing law that took effect in 2022, which could bring additional financial penalties.

Nurses had been fighting for legislation on hospital staffing for years and were finally able to propel it forward as the issue got more attention during the COVID-19 pandemic.

The law required each hospital in the state to create a staffing committee and work with employees to set clear nurse-to-patient ratios for each unit. Hospitals are now supposed to adhere to staffing plans they submitted to the state last July.

As of Jan. 3, 804 complaints have been submitted and the health department has so far cited 14 hospitals for violations, according to health department spokesperson Cadence Acquaviva. She said those violations could result in fines of up to $2,000 per citation, as well as other civil penalties. She added that she could not comment on whether any fines have been issued to date because investigations are ongoing.

Goldman, the head of the Federation of Nurses/UFT, said nurses from her union filed some of those complaints. She said she hopes that the law creates greater transparency and accountability when it comes to hospital staffing — but until then, the arbitration cases will keep coming.

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