Newark Star Ledger Editorial
September 24, 2023
We are facing a national crisis in healthcare: Tens of thousands of frontline nurses have fled the profession, and those left behind say they are burnt out and fed up with chronic understaffing at their hospitals.
Remember who these people are – they’re the ones by your parents’ bedside when they’re dying, holding their hand, the ones flipping them over to avoid bed sores. And in the pandemic, they were the heroes, the reason we were all banging pots and pans.
Now, nearly two thousand nurses at one of New Jersey’s biggest hospitals, Robert Wood Johnson University Hospital in New Brunswick, have been driven to strike since Aug. 4th for good reason. Unlike most strikers, their primary demand is not better pay or benefits, but better care, which means more nurses.
You could pay these folks up to 300k with all their hours of overtime, but bedside nurses will still leave if you make them miserable enough – because they’re the verge of giving someone the wrong medication, or by the end of their shift at 11 p.m., they still can’t make it to see all their patients, one of whom almost dies. It’s a moral injury.
So what 1,700 nurses at RWJ and thousands of other nurses around the country are demanding is enforceable nurse-to-patient ratios, with support from folks like Senators Cory Booker and Bernie Sanders. Gov. Phil Murphy should step in, too, the way he did to hammer out a deal for the Rutgers strikers. Because if anyone has a pulse what’s really going on with patient care in hospitals, it’s nurses.
Granted, Robert Wood Johnson is in a tough spot here, facing a national shortage of nurses that’s particularly acute in New Jersey – even though some of its tactics, like cutting off the healthcare coverage of the striking nurses, are bound to infuriate. The hospital has tried to respond to the shortage, although not sufficiently, hiring 200 more nurses in 2022; it also says it offers the highest pay at hospitals in New Jersey and among the best staffing levels.
To deal with this strike, RWJ brought in about 1,000 temporary nurses from the Midwest at a cost of more than $54 million and is paying them about double the $110k base pay of its striking nurses, according to a job ad shared with us by their union. So while it can find these folks, it’s an expensive proposition.
But it’s impossible to root for the hospital, given its executive pay led by the CEO: Barry Ostrowsky, who recently retired, was earning a salary of more than $16 million in the face of this crisis, making him the highest paid hospital executive in the New York area, according to Crain’s New York. That’s just obnoxious.
And this strike has an important public policy purpose: It’s hard to believe that hospitals aren’t legally required to have a certain number of nurses on hand per patient. We have strict regulations when it comes to airplanes – pilots need a certain number of hours of sleep and a minimum number of flight attendants or they’re not taking off. Yet even federal inspectors from the Centers for Medicare & Medicaid Services who look closely at hospital processes don’t monitor nurse-to-patient ratios, says Karen Lasater, a hospital nursing researcher at the University of Pennsylvania.
“We just kind of let the hospital fly by the seat of its pants, with no accountability,” she remarked.
Here’s the main problem with not having enforceable staffing ratios, according to the RWJ nurses’ union: If a nurse calls out sick, the usual nurse-to-patient ratio goes out the window. It leaves double the work for a colleague’s 12-hour shift. When that happens frequently, it eventually wears you down, and it’s not good for patients either.
The hospital has offered the union a $20-an-hour bonus for nurses if their respective units fall below certain staffing guidelines, but that does nothing to reduce the overwork. And if it were your father left unchanged and unfed in his room, or waiting for pain medication, would you say, well, at least his nurse gets a bonus?
RWJ says it gets high marks on patient satisfaction on surveys, but the union says its nurses lodged about 400 complaints of being understaffed last year – more than one a day, on average. Kelsey Khan, a registered nurse for two years, told the NJ Monitor she had so many patients at a time that the stress drove her to transfer to the operating room, where she could focus on one patient at a time.
“Many nurses are running from the bedside within our first year because we’re so burned out,” she said. “I lasted one year, and I said I couldn’t take it anymore. And I did not want to leave — I love bedside nursing.”
Other nurses leave for a job at a school, doctor’s office or insurance company, where they can have a better work-life balance and raise a family. So if hospitals want to draw bedside nurses, they need to make their working conditions better. And that starts by hiring sufficient staff so people don’t feel like they’re practicing recklessly.
“People would be attracted to a hospital where they can guarantee they’re going to have the ability to give good care, because they’re not going to have too many patients to care for,” says Renee Bacany, a veteran nurse who’s part of the union’ bargaining team.
This strike is seen as a test case by other hospitals, says Debbie White, who leads New Jersey’s largest nurse union, which supports but doesn’t represent nurses at RWJ. “They know there are many contracts up next year,” she says, and if RWJ’s nurses establish staffing ratios for their hospital through collective bargaining, other unions will likely seek the same.
This is also the sort of situation that gives rise to laws. California is currently the only state with a nurse-patient ratio law, and a proposal for same in New Jersey has been stuck in the Legislature for decades due to strong opposition from hospitals. The New Jersey Hospital Association did not respond to our request last week to discuss this.
One of the primary sponsors of the bill, Sen. Joe Vitale, hopes lawmakers will have more interest, sympathy and understanding of the problem now because of the RWJ strike. At the very least, he says, the proposal is “worthy of informed public discussion,” in which they actually speak with experts on the issues and not just put up with the politics.
These nurses really stepped up for us at the height of the pandemic: Even those in ancillary roles suddenly found themselves putting dying people on ventilators like it was a war zone. So now, when they say they need more help, let’s stand with them.