New York hospitals, healthcare workers reach few agreements on staffing levels

Union officials and frontline healthcare workers said that, at most hospitals, they reached an agreement with management about the appropriate ratios for some units. In many cases, they agreed on 2-to-1 ratios for intensive care units. Only at a few hospitals did executives and clinical staff disagree across the board. 

“In some hospitals we did not reach consensus at all,” said Nadine Williamson, who heads the nursing division of 1199 SEIU United Healthcare Workers East. “It sort of lowered morale when you work for six months to attempt to get to a staffing plan and you don’t get there.”

Representatives of the New York State Nurses Association said the majority of hospitals refused to discuss ratios in certain departments, particularly ones that care for patients undergoing surgery.

Williamson said there also was widespread resistance to behavioral health departments being part of the staffing plans, although hospitals eventually relented.

“We had to fight unnecessarily to even get it included,” she said.

Asked to comment, the Greater New York Hospital Association did not directly address those allegations.

“Staffing is multifaceted and dynamic,” Lorraine Ryan, the association’s senior vice president for legal, regulatory and professional affairs, said in a statement. “A wide range of variables were considered in developing the plans.”

Ryan noted that the law “preserves management’s role in designing staffing plans while giving frontline workers an active role and voice in the process.”

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Jessica Montanaro, a longtime ICU nurse at Mount Sinai Morningside who was part of its staffing committee, said she felt disrespected during the planning process because hospital management declined to negotiate most of the time.

“We were having a one-sided dialogue essentially for months,” Montanaro said.

She said the committee eventually made some progress, after months of the unions presenting their proposals and management listening but saying nothing, but then the hospital scrapped it all at the last minute. 

Mount Sinai Morningside management’s final proposal for nurse staffing levels appears identical to its current grid for registered nurse ratios—which Montanaro said is part of the NYSNA contract but frequently violated.

Montanaro’s unit, the medical and surgical ICU, has a 24-bed capacity. She said that the NYSNA contract calls for 11 nurses but on some recent days the unit has had only seven. Union representatives on the committee proposed a ratio of 11 registered nurses plus one charge nurse, who typically is not assigned a patient, for an average daily census of 20 patients.

“The Mount Sinai Health System aspires to achieve staffing levels aligned with the needs of our patients while maintaining the financial sustainability for each of the system hospitals,” Dr. David Reich, the system’s chief executive, wrote in a letter to the Health Department that accompanies its staffing plans. “The system hospitals will continue to modify plans as additional resources become available.”

Mount Sinai was unable to provide a response to a request for comment before publication.

Hospitals are required to implement their clinical staffing plans by Jan. 1. Hospitals that are found by the Health Department to have violated the law will be required to submit a corrective action plan and might be subject to civil penalties.

This story first appeared in our sister publication, Crain’s New York Business.