WHEREAS:
At the beginning of 2022, more than 1 in 6 hospitals in America reported critical nursing shortages, with many rationing care and closing units. By March, nearly every governor had been forced to address professional medical staff scarcities in their state, with some going so far as having to call in the National Guard for the second time in less than two years; and
WHEREAS:
Because of the apocalyptic rate of infection and illness of permanent nurse staff, the pandemic ushered in an explosive use of travel nurses - registered nurses who are contracted to work short stints at understaffed hospitals across the country for double, triple, or quadruple pay rates compared to permanent staff. Hospitals were forced to rely heavily on travelers with a nationwide increase in use of 35% in 2020 and an estimated additional 40% by the end of 2021. As demand grew and persisted, labor prices for temporary staff skyrocketed - some staffing firms are charging more than three times pre-pandemic rates while pocketing 40% or more of what hospitals were paying out; and
WHEREAS:
The traveler trend does not appear to be close to returning to pre-pandemic rates. Aya Healthcare reports there are 40,000 traveling nurse jobs open nationwide, a 77% increase over last year. More than 4,400 traveler postings, about 11%, are in California, the state with the highest demand; and
WHEREAS:
According to Kaufman Hall, contract nurses are earning an average of $132 an hour in 2022 versus $64 in 2019. Wages for permanently employed nurses for the same period have increased by only 11%. The lucrative pay travelers can earn creates a vicious cycle by luring tenured nurses away from their permanent hospitals only to leave their now former colleagues to bear the burden of yet another hole in the schedule for months to come; and
WHEREAS:
The U.S. Bureau of Labor Statistics reports that contract and travel nurses account for approximately 2% of registered nurses in the labor market, meaning the health care industry relies on the 2% cohort of travel nurses to make up for the 9% nurse shortage in hospitals. This sets the stage for an extreme supply and demand imbalance. Patricia Pittman, a professor of health policy and management at the School of Public Health at George Washington University, has called travel nurses “a double-edged sword” - helpful in times of high need but an “excuse” for hospitals not to focus on staffing issues; and
WHEREAS:
A recent report from Fierce Healthcare notes a third of nurses in permanent roles said that the massive increase in use of travelers made them feel dissatisfied or extremely dissatisfied. Travel nurses are not mandated to work beyond the hours designated in their contracts, while core staff are often subject to mandatory overtime. Permanent staff are often assigned the highest acuity patients because travel nurses are not versed in department layouts nor have developed a team-based relationship that nurses often rely on to provide constant and consistent care for the sickest patients; and
WHEREAS:
Although wages and benefits typically mark a significant percentage of operating costs, the health care industry is facing a significant labor crunch that is driving up labor costs like never before. Fitch credit rating agency recently reported that the national nurse shortage is fueling an average 8% increase in daily clinical labor costs for hospitals, and an additional $24 billion in nationwide annual spending on clinical labor. That translates to a $17 million increase to the annual labor budget of an average 500-bed health care facility. One underlying contributor to these costs is a roughly 130% increase in the use of agency and temporary labor. Experts note that contracted labor like travelers typically cost hospitals 50% or more than a typical, permanent and fully-benefit eligible employee; and
WHEREAS:
From the perspective of nurses, this financial strain on a hospital’s bottom line is the doing of corporate executives who see nurses as a cost and not a benefit and is partly self-inflicted. Many nurses left their permanent bedside roles because they were poorly treated or compensated, forcing hospitals to hire travel nurses at greater cost. Those nurses then stoke resentment among full-time staff who are paid substantially less but are often asked to care for the sickest patients; and
WHEREAS:
For too long, the U.S. health care industry and its corporate executives have relied on the individual “grit” of its workforce — a grit most nurses wear as a badge of honor. The industry’s challenge now is to create a health care system that is as resilient as the people in it have been forced to be.
THEREFORE BE IT RESOLVED:
AFSCME urges state legislatures to prohibit mandatory overtime for nurses. Eighteen states have enacted legislation limiting or eliminating mandatory overtime entirely, and Michigan is considering similar regulations through the Safe Patient Care Act; and
BE IT FURTHER RESOLVED:
AFSCME urges employers and hospitals to increase pay and strengthen wage structures of permanent, tenured staff instead of spending double or triple on travelers and contract nurses. If hospitals can afford triple pay for travelers, executives should increase pay for permanent staff to discourage the exodus of tenured staff; and
BE IT FINALLY RESOLVED:
AFSCME will continue to focus on expanding access to collective bargaining: Higher rates of unionization would allow registered nurses greater say in their workplace conditions, rates of compensation and approaches to patient care. During the pandemic, unionized nursing homes that employ RNs and many other health care workers have been associated with lower resident COVID-19 mortality rates and lower infection rates for staff.
SUBMITTED BY:
Denise Duncan, RN, President and Delegate
Charmaine Morales, RN, Vice President and Delegate
UNAC/UHCP, NUHHCE/AFSCME Local 1199
California