America’s hospitals are in the throes of a workforce crisis that’s driven by the lack of safe nurse to patient ratios that’s forced tens of thousands of veteran nurses to flee the profession and one in five new nurses to leave in their first year, according to witnesses who testified before a field hearing convened by Sen. Bernie Sanders (I-VT) on Oct. 27 on the New Brunswick’s Rutgers University campus.
As a consequence, even though hospitals are scrambling to find nurses, over one million nurses are opting to stay sidelined with just half of New Jersey’s 140,000 licensed nurses choosing to work in the state’s hospitals.
“The reasons for these departures are understaffing, poor working conditions and the corresponding fear of harming patients and witnessing this harm is resulting in moral injury, a form of trauma caused by not being able to provide the care they believe patients need and feeling they are powerless to make change,” testified Dr. Patricia Pittman, with the Milken Institute of Public Health at George Washington University.
Pittman continued. “Among the outcomes of this distress is depression and suicide. Nurses commit suicide at twice the rate of the general population,” Pittman said. “Nurses concerns over staffing have been born out by 20 years of research outcomes associated with low staffing levels including patient mortality, failure to rescue, hospital acquired pneumonia, respiratory failure, ulcers, falls, urinary infections and patient satisfaction.”
The hearing of Sen. Sander’s Health, Education, Labor, and Pensions Committee drew a standing room only crowd of several hundred union nurses and other healthcare professionals from throughout the region. At times it took on the feel of a high energy union rally with the entire audience wearing t-shirts with their respective union’s logo.
Captioned “Overworked and Undervalued: Is the Severe Hospital Staffing Crisis Endangering the Well-Being of Patients and Nurses”, the hearing was convened as Sander’s hopes to advance a federal standard for nurse patient ratios. Such a mandatory benchmark was established by the State of California in 2004 which subsequent research confirmed significantly improved patient outcomes and nurse retention.
Similar legislation has passed in Oregon while a coalition of New Jersey’s nurses’ unions, led by Health Professional and Allied Employees [AFT] is pressing for Trenton to follow suit.
Sen. Sanders told the audience he had come to the Middlesex County to bring national attention to what he saw as the issues underlying the 3 month long strike by the United Steelworkers Nurses Local 4-200 for safer staffing at the Robert Wood Johnson University Hospital, which is part of the non-profit RWJBarnabas system.
Judy Danella, RN, president of the USW Nurses Local 4-200, testified the nurse staffing crisis preceded the COVID pandemic. Yet, she said, since 2020, according to the National Council of State Boards of Nursing, 100,000 nurses have left the profession, with New Jersey now one of the top three states with the most projected vacancies.
Danella described “a vicious cycle” where efforts to fill nursing slots are consistently undermined by nurse attrition due to stress and burnout caused by short staffing.
“According to that same study, 20 percent of current nurses are considering quitting their jobs as front line caregivers and as nurses we know that safe staffing is crucial to the health and wellbeing of our patients and our ability to provide quality, safe patient care—It is crucial to our patient satisfaction rates, nurse retention, safety, and the future of nursing,” said Danella.
“The pressure to be everywhere at once while keeping everyone safe is enormous,” Carol Tanzi, RN, with the USW Local 4-200 testified. “This is physically and emotionally exhausting….All nurses know the people making decisions are not the people providing care. They are often not even healthcare professionals themselves. If these execs have a loved one in the hospital, they will have a dedicated nurse, or what is called a one to one ratio, not even close to what the public will get.”
“An increasing number of nurses don’t work in hospitals anymore because their employers have made this job unsafe for patients and for us,” testified Nancy Hagans, RN, president of the New York State Nurses Association and National Nurses United. “We are exhausted. We are overwhelmed. We are suffering moral distress. The leading cause of this crisis is that the hospital industry refuses to have enough nurses to staff our units safely.”
Hagans, whose union executed a successful strike in New York City for safer staffing earlier this year, said that as nurse on a surgical floor she had experienced ratios of one per 18 patients, more than four times what’s considered medically safe.
“As a result our patients are at a higher risk of preventable medical errors or avoidable complications, and even death,” Hagans said. “I’ve been in situations where I know if I had fewer patients, I might have been able to safe a patient’s life. It is the worst feeling you can imagine. Those experiences lead to moral distress….There is no nursing shortage. There is a staffing crisis.”
“We all know the pandemic was horrific, but it goes back to the corporatization of healthcare which has become big business and what’s the goal of big business? Make money. We make money off your sickness in this country,” testified Debbie White, RN, and president of the Health Professionals and Allied Employees, New Jersey largest healthcare union. “In New Jersey, most of our hospitals have made tremendous profits even during the pandemic. One would think the primary focus for spending those profits would be staffing. Instead, and this has gone on for decades, nursing care, in fact all hospital healthcare, is a line-item budget cut to its lowest number to maximize profits.”
Rep. Frank Pallone (D-NJ) ,who was in attendance, said afterwards it was his goal to get legislation passed that would have a minimum nurse patient ratio established nationally.
“There’s no question that unless you have a minimum nurse to patient ratio you are going to have problems, you are going to have problems with infections [control]—You will have problems with mortality,” Pallone said.
Pallone, whose district includes the New Brunswick hospital where the nurses have been on strike since Aug. 4, told InsiderNJ, it “was really important” that the RWJUH nurses get a contract and return to work.
“It is not a good thing that they [the hospital] continues to have temporary nurses,” Pallone told InsiderNJ. “The fact of the matter is that these [union] nurses who have been there for years are going to be much better than these temporary nurses in terms of patient care. There’s no question about it.”
According to Sanders, RWJBarnabas has spent $100 million on replacement nurses since the beginning of the strike.
“Well, I think this really puts a spotlight on this issue by bringing Sen Sanders here,” NJ AFL-CIO President Charles Wowkanech told InsiderNJ. “I think this was the shot in the arm we needed. The truth is coming out….This is starting to connect with other unions. They understand their families, their loved ones are going to be in this healthcare system and they are not getting the appropriate care.”
Sanders had invited Mark Manigan, the president and CEO at RWJBarnabas Health, to testify at the field hearing but he opted not to attend.
“Our negotiating team at Robert Wood Johnson University Hospital has met with the union six times since Oct. 6, including this past Sunday, Oct. 22, with the goal of reaching a fair and equitable resolution that provides the highest‐quality patient care and creates a safe and supportive working environment for our nurses,” Manigan said in a statement to News 12. “I believe and humbly ask that you understand that is where my focus should be at this time.”
Before the hearing got underway, the Vermont senator thanked all of the nurses assembled for their pandemic service and linked the current workforce situation to a deeper crisis of scarcity that’s undermining the nation’s entire healthcare system.
“I can remember 3,000 people a day dying during the worst public health crisis in a hundred years—We can all remember hospitals overflowing with patients and we remember nurses and doctors and other healthcare professionals going to work without the personal protective equipment that they needed—They didn’t have the gloves—They didn’t have the masks—They didn’t have the gowns and they went to work every day to save us and we owe them a debt of gratitude that can never be repaid,” Sanders said.
According to a joint investigation by the Guardian Newspaper and Kaiser Health News 3,600 nurses died in the first wave of the pandemic, with 700 of them coming from New York and New Jersey, two thirds of whom were people of color.
Sanders told the audience that nurses were not the only professionals in short supply in the nation’s healthcare system which he said was also shy of physicians, dentists, pharmacists, and other healthcare professionals.
“In the United States of America we spend almost as much per capita as any other major country,” Sanders said. “We are spending $13,000 for every man, woman, and child in this country. We should have the best healthcare system in the world. We are far behind many, many countries. Despite our large expenditure, 85 million Americans are uninsured or underinsured.”
Sanders, addressing his audience directly said “you deal with these folks every day and its not talked about at all but some 60,000 Americans die every single year because they don’t get the medical help they need it—you’ve seen it. They are sick and the doctors and nurses ask, ‘why didn’t you come in six months ago when you had your symptoms?’ and the answer was ‘I wasn’t insured or couldn’t afford the deductible.’”
“The other issue that is not discussed is our life expectancy—how long we live is much lower than other countries and is actually in decline and for working class people, lower income people the gap in their life expectancy with the rich is about ten years in America,” Sanders said. “That is unacceptable.”