Nurses at Mount Sinai Hospital have voted to finalize the deal that ended their three-day strike last week. It was approved Wednesday by 98% of members of the New York State Nurses Association at the hospital.
An inside look at the agreement, which a Mount Sinai nurse shared with Gothamist prior to the vote, shows the strike delivered some key concessions around staffing that nurses said were key to patient safety and their own wellbeing – but that hospital administrators were initially reluctant to budge on.
That includes committing to specific nurse-to-patient ratios and a plan to fill existing vacancies. Along with the previously reported 18% increase in pay over three years and the new staffing commitments, the hospital also agreed to a process for rectifying violations of the deal.
“The three-year contract, which can now go into effect, puts patients first,” David Reich, the president of Mount Sinai Hospital, said in a letter to staff announcing the results on Thursday morning.
But it remains to be seen how these changes will be implemented, given the challenges hospitals across the country cite with recruiting full-time nurses.
Under the new contract, Mount Sinai has committed to maintaining set nurse-to-patient ratios in all inpatient units across the hospital – not just intensive care settings. That piece was a particular point of contention going into the three-day walkout.
Ahead of the strike, there were also hundreds of open nursing positions at Mount Sinai, including more than 600 at the main campus in East Harlem as of mid-December, according to a list of the vacancies shared with Gothamist.
Fran Cartwright, Mount Sinai Hospital’s chief nursing officer, said prior to the strike that filling those positions was a top priority, but the nurses’ union said the hospital wasn’t making enough of an effort. With this new agreement, the hospital has committed to hire 40 new nurses each month until the number of vacancies drops to fewer than 40 overall – and to update nurses on staffing on a weekly basis.
The hospital will have to share not only the number of open positions in each unit, but also how many travel or temp nurses are filling in and how many of the nurses are new to their units and in their orientation phases.
Travel and temp nursing have become particularly lucrative during the COVID-19 pandemic, with many hospitals using travel and temp nurses to fill in after permanent staff leave. The high wages they garner have led even more nurses to abandon full-time jobs in favor of contract positions.
This trend has exacerbated staffing challenges and ratcheted up labor costs for hospitals, according to a recent industry report from the Healthcare Association of New York State. In recent months, Mount Sinai has sought to address understaffing on some of its units by relying on these contract workers, Cartwright told Gothamist prior to the strike.
Gothamist reached out to Mount Sinai Wednesday to ask what the hospital would do to recruit a steady supply of full-time workers, and whether it would still pose a challenge.
“The challenges of hiring, growing and retaining a talented health care workforce can’t be overstated,” Lucia Lee, a spokesperson for Mount Sinai, said in a statement. “At Mount Sinai, we’ve implemented strategic recruitment strategies, including dramatically increasing the class size of our nursing school and ensuring robust training and continuing education opportunities are the best available.”
The hospital had previously submitted a staffing plan to state regulators, in compliance with a new law that took effect last year. That submission included the overall number of nurses that should be working on a given unit depending on how many patients were present. But this agreement puts in concrete terms the number of patients each nurse should handle. For instance, a nurse in Mount Sinai’s geriatric psychiatry unit is supposed to have a maximum of five patients at a time, while a nurse in the labor and delivery department shouldn’t be treating more than two patients in active labor. In some cases, the ratio depends on how severe the patients’ conditions are.
Just days before the strike started, Cartwright had argued that the ratios didn’t provide the kind of flexibility that was necessary in hospital staffing to respond to changing circumstances and patient needs.
“There’s not just a financial reason to say no to that,” Cartwright told Gothamist at the time. “It’s actually a nursing practice issue.”
In the new contract, Mount Sinai is also boosting nurse salaries by 18% over three years – similar to the raises nurses at other local hospitals received in contract deals reached in recent weeks.
If Mount Sinai doesn’t meet its staffing commitments, it has agreed to take certain steps to remedy the situation. If the union believes there’s been a pattern of violations, a committee of hospital administrators and employees will meet to discuss the issue — and if they don’t reach a solution, an outside arbitrator will be recruited into the process. Mount Sinai has also agreed to pay nurses working on understaffed units extra in certain cases — amounting to what they would have paid full-time staffers in the open positions.