More nurses at the bedside: NJ unions bargain for better staff ratios - Health Professionals & Allied Employees

More nurses at the bedside: NJ unions bargain for better staff ratios

Taken from

By Scott Fallon

June 24, 2024

Nurses have testified at legislative hearings in Trenton for years that they are overworked, burning out and struggling to care for their patients adequately.

They have marched by the hundreds with signs and bullhorns chanting for lawmakers to pass a bill that would establish mandated nurse-to-patient ratios at hospitals. But the bill has languished for more than 20 years.

Now, nurses may have found a strategy that works better than lobbying. They are bargaining with their employers to get better ratios.

Within the last few weeks, New Jersey’s largest nurses’ union has settled contracts at three hospitals that included language to secure lower staffing ratios — a major sticking point in the negotiations and an issue that had been exacerbated by the COVID-19 pandemic.

“The outcomes were even better than we ever imagined,” said Debbie White, a nurse and president of the Health Professionals & Allied Employees union. “This is a huge step toward ending the number one reason why hospitals can’t retain nurses.”

Nurses leaving the bedside

Hospitals across the U.S. have been undergoing a crisis in staffing since the pandemic. The number of RNs dropped by more than 100,000 from 2020 to 2021, by far the largest one-year reduction in the nursing workforce in 40 years, a 2022 study showed.

A significant number of nurses leaving the workforce were under the age of 35, and most were employed in hospitals.

New Jersey hospitals were among the hardest hit in the nation by both the pandemic and consequently by staff defections. About a third of nurses left hospital care from 2020 to 2022 for either less stressful or more lucrative jobs, including outpatient care facilities, travel nursing, insurance company approvals, mobile Botox, primary care, teaching, or research project management, according to an HPAE survey.

Some went back to school to become nurse anesthetists or nurse practitioners, positions that have many of the same responsibilities as a physician. Staffing levels and burnout were the top two reasons for leaving hospitals among 512 nurses surveyed.

Since then there have been efforts to revive a long-stalled bill in Trenton that would establish mandatory nurse-to-patient ratios at all New Jersey hospitals and other health care facilities similar to one passed in California two decades ago.

While more sponsors have signed on and a rally by nurses last year at the Statehouse provided some momentum, the bill has not made significant progress. It’s a familiar story each year in the legislature.

A version of the bill goes back to at least 2003, according to a review of legislative records. The New Jersey Hospital Association has fought against the bill for years, saying it would not allow hospitals the flexibility to move staff around to deal with escalating situations.

“Hospital care teams, led by doctors and nurses, respond and adapt as patient cases are presented,” said NJHA President and CEO Cathy Bennett. “Appropriate staffing is about people, not one-size-fits-all formulas written by the politicians.”

Bargaining trumps lobbying

HPAE, the largest health care workers union with 14,000 members, entered 2024 with three contracts expiring on the same day at Palisades Medical Center in North Bergen, Englewood Health and Cooper University in Camden, which employ 3,000 nurses among them.

Leverage was on the union’s side after nurses represented by the United Steel Workers secured lower staffing ratios at Robert Wood Johnson University Hospital that ended a four-month strike and cost parent company RWJ Barnabas more than $120 million in replacement nursing costs.

“Almost every employer came to us and said we don’t want a strike,” White said. “That strike gave us much needed resolve. Feelings of apprehension were among the employers much more than the workers.”

A week before the contracts expired, HPAE threatened to strike at the three hospitals although union leaders were optimistic deals could be struck. Just before the deadline, Cooper and Englewood agreed to a new contract. Palisades — part of the massive Hackensack Meridian Health network — reached a deal a week later.

Each contract saw lower staffing ratios. Among them:

  • Palisades: The hospital, which employs 750 nurses, will have staff ratios for the first time under the new contract. Among them are one nurse to five patients in medical and surgical units, one nurse to two patients in critical care and at least eight nurses in the emergency department during its busiest hours. The hospital agreed to hire 29 new nurses to bolster the staff of 800.
  • Englewood: The ratio will be one nurse to five patients down from one to six. There is also a new enforcement mechanism. If the ratio is not met, the union and hospital will go to arbitration for a resolution that is binding. Previously, the sides could enter mediation which was not binding. Englewood employs 800 nurses.
  • Cooper: The ratio was lowered to an average of one nurse to four or five patients including one to two for any critical care patient anywhere in the hospital, which employs 1,500 nurses.

Bennett didn’t comment on the staffing ratios worked out in the three contracts, other than to say hospitals must negotiate for the good of staff and patients.

There are five contracts between HPAE and hospitals that are expiring next year. Staffing will remain a priority in negotiations, White said. She believes the union can ride the momentum from the three contracts this year.

Still, White believes a staffing ratio law will be the ultimate victory. Her team will continue to press lawmakers to pass it.

“It’s a two-way push — contracts and legislation,” she said. “It truly has to be put into law. It’s more permanent and it covers every hospital.”

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