A contract deal between New York City private hospitals and the New York State Nurses Association which provides for enforceable patient nurse staffing ratios is being hailed by New Jersey’s largest union of healthcare workers as an essential benchmark. The tentative settlement between NYSNA, Mt. Sinai and Montefiore Hospitals that calls for a 19.2 percent wage increase over the next three years settled a three-day strike of 7,000 nurses.

Across the country, in the midst of the ongoing COVID pandemic, which killed thousands of healthcare workers and sidelined thousands more, the debate over staff/patient ratios has intensified. Decades ago, California adopted mandatory nurse to patient staffing ratios. In 2018, Massachusetts voted down a ballot initiative calling for such a standard. Last year, New York State put such a law on the books. Starting in 2003, New Jersey’s Health Professionals Allied Employees (HPAE), the state’s largest healthcare union, has been pressing for such a measure with no success.

“Research has shown over many years that safe staffing ratios lead to better healthcare outcomes for patients. Yet, we have seen lawmakers ignore the facts, year-in and year-out, failing to approve legislation mandating safe staffing,” wrote Debbie White, RN, president of HPAE, in response to a query from InsiderNJ.  “Chronic understaffing by hospital employers, exacerbated by the added stress of the pandemic, continues to force our colleagues to migrate out of hospital nursing.”

White continued. “As a result, the healthcare system is at risk. Of course, we must forge pathways that address recruitment of both new nurses and nurses who have left the field. But we also must address retention of nurses who remain at the bedside and stop the current migration out of the field. This is especially true when it comes to safe staffing levels. In our experience, we have seen employers continue to propose the same practices, over and over again, that caused this staffing crisis in the first place; practices that jeopardize both nurse safety and, ultimately, patient care. Employers need to prioritize patients’ needs over their financial interest of increased profits.”

The HPAE leader committed that her members would once again “take to picket lines to fight for safe staffing, now more than ever, the healthcare industry and lawmakers must listen to their healthcare workers. We must address the staffing crisis in our facilities before we have an alarming country-wide healthcare crisis.”

More than three days into the strike, Mount Sinai nurses won “wall-to-wall safe staffing ratios” for all impatient settings “with firm enforcement so that there will always be enough nurses at the bedside to provide safe patient care, not just on paper,” according to a NYNA fact sheet. Those staffing regulations take effect immediately.

At Montefiore Hospital in the Bronx management committed to one nurse per two patients in the critical care of the Emergency Department, one to five in acute care, one to eight in sub-acute care. “We won improved staffing enforcement including new language and financial penalties paid to nurses when management fails to comply with safe staffing levels in. all units,” NYSNA President Nancy Hagans said. “We won the preservation of the family nurse partnership program that saves at risk mothers and babies and a commitment to re-open closed units and renovate the Emergency Room Department at Montefiore Moses Campus to eliminate hallway beds. No more hallway beds.”

Hagans told reporters that securing the iron clad penalty provisions for the patient to nursing ratios was vital because the state was not enforcing the state law passed last year that mandated them.

“Unfortunately, the Department of Health never really enforced the law or the language and as nurses we are the front line, we have to continue to care for our patients so we had to bring it to the public so everybody could know the struggle with what we go through in the hospital, and we did it in order to save our patients. At the beginning of the pandemic, we saved New York, and we want to continue to protect our patients, to care for our patients and to save our community.”

While the precise number of nurses who died as a consequence of their occupational exposure during the COVID pandemic is not known, NYSNA has documented over 50 such fatalities. HPAE knows of eight of their members. A joint Kaiser Health News and Guardian Newspaper project, confirmed that in the first year of the pandemic, 3,600 nurses and healthcare workers died here in the U.S. in the first year from COVID. Throughout the pandemic, NYSNA, HPAE and other healthcare unions issued prescient warnings about the potential impacts of the CDC loosening N-95 mask protocols and other public health standards.

In October of 2020, Gov. Murphy signed legislation that required the establishment of minimum staffing for direct care staff-to-resident ratios for the state’s long term care facilities. “Sadly, too many nursing homes are run by companies more interested in making money than protecting patients, ” said Gov. Murphy at the time. “These long-sought reforms will help bring accountability to the industry and protect residents, staff and family members with a loved one living in a long-term care facility.”

In an in-depth investigative piece filed last April for the Record, Dustin Racioppi and Charles Stile documented how New Jersey’s hospital industry “routinely outmaneuvered the frontline workers in the corridors of the statehouse” when it came to winning healthcare workplace protections.

“From staffing levels to immunity from lawsuits to protection from property taxes, the state’s largest hospitals and the New Jersey Hospital Association, with their strong connections to state government, have successfully worked to protect hospitals from policies they fear could hurt the bottom line,” the Record reported. “And the influence has become most glaring at the most critical time for the industry: COVID-19 ravaged the healthcare industry, strained resources and led to 25,000 deaths — the fifth most of any state in the nation.”

Raicoppi and Stile observed that the “industry’s successful track record of influencing state health care policies has continued through the pandemic. It’s something current and former health officials say is the result of the cozy connections between the lobby and lawmakers — and the state’s increasing reliance on the private health care industry for advice and policy.”

As a consequence, the Record reported “hospitals, their lobbying arms and experts have shored up a depleted state workforce, and many lawmakers are deferential or connected to them, according to current and former health officials.”

Last spring, nurses at Newark’s Saint Michael’s Hospital went on strike for 31 days. They returned to work in June after winning a new contract with a three percent annual raise, a multi-year freeze on nurses’ healthcare insurance premiums as well as a bump in differential pay for weekend work.

Back in October, HPAE and Jersey Shore University Medical Center reached a contract settlement that boosted nurses’ pay between eight to 11 percent, according to the Asbury Park Press. The pact also addressed minimum staffing requirements in both emergency room and surgical settings. The deal also guaranteed the assignment of a full-time security guard in the emergency room.

While assaults on healthcare workers certainly predated the pandemic, it has only gotten worse in the midst of COVID.

The Joint Commission, a non-profit, and the nation’s oldest accrediting body for hospitals, reported that workers in healthcare are at least four times more likely to be targeted for violence than other workers. “Alarmingly, the actual number of violent incidents involving health care workers is likely much higher because reporting is voluntary,” the Joint Commission concluded.

“The statistics are staggering,” according to surveys by the American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA), with “almost half of emergency physicians report being physically assaulted at work, while about 70 percent of emergency nurses report being hit and kicked while on the job.”