Andrew Wettengel / Wednesday, April 24, 2019 / Categories: Work World


For years, hospitals and nursing unions have grappled with a major problem: How to balance budgets while providing enough nursing staff to meet prevailing workloads.

The unions have long been a proponent of minimum staffing levels on the basis that understaffing overworks nurses and leaves patients at risk. Hospitals have argued for the need for flexibility when trying to optimize staffing levels using available funding.

In New York, that issue came to a head earlier this month when more than 10,000 nurses threatened to walk off their jobs at three major hospital systems. The event resulted in what’s being called a groundbreaking agreement; the Mount Sinai, New York-Presbyterian and Montefiore hospital systems agreed to spend $25 million annually to add 1,450 more nurses to its 11,000-strong nursing staff while also enforcing minimum nurse-patient ratios that have yet to be set. Nurses in New York have pushed for such ratios for years.

Nationwide, California remains the only state that requires minimum nursing ratios in hospitals. Research indicates that the higher ratios imposed in California have saved lives, enabled shorter hospital stays and created overall improvements in quality care.

“We now have a voice in the process and a real say and a real mechanism in which to challenge patterns of staffing shortages, and to get those rectified,” Anthony Ciampa told the New York Times following the agreement. The vice president of the New York State Nurses Association said the ratios themselves should be established within a month of the contract's ratification.

In the same report, the hospitals' lead negotiator Marc Kramer said the decision will also have a positive effect on the facilities. “This significant investment in our nursing teams will ultimately benefit patients in the long term, while preserving hospitals’ flexibility to deliver the individual, tailored health care our institutions are known for around the world.”

The four-year contract establishes a collaborative process in which the union and hospitals will meet at least annually to address staffing needs, reports Jonathan Lamantia in Crain’s New York. The hospitals will also establish an independent third party for the enforcement of staffing levels and will provide nurses a standard 3 percent annual pay raise.

Prior to the threat of strike, multiple attempts by the union to negotiate nursing ratios had been unsuccessful, reports Heather May, a medical-surgical nurse at Mount Sinai St. Luke’s Hospital.

“Nurses are mentally and physically exhausted,” she recently told “We joined this profession to heal and provide compassion to those who are ill … (but) our working conditions do not allow us to fulfill our purpose.”

Union officials predicted the agreement will also impact upcoming negotiations with other large hospitals in New York City.

“It will be the trendsetter of the industry,” advised Ciampa. “What we decide in these major city hospitals tends to set the framework for other hospitals. We’re moving slowly but surely, I feel, in the right direction.”

At press time, the agreement was still subject to union ratification. It’s set to expire Dec. 31, 2022.

What are your thoughts about mandated nursing ratios as hospitals work to balance their budgets?

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