Hospitals struggle to fill nursing jobs as more quit, burned out by workloads

Long Island hospitals are struggling to hire enough nurses and keep them on staff amid a nationwide labor shortage and an epidemic of stress and exhaustion among the professionals on health care's front lines.

In a recent survey, 100% of New York hospitals responding said they were unable to hire enough nurses. The labor shortfall exacerbates nurses’ crushing workloads as the region copes with a “tripledemic” of flu, RSV and COVID-19, increasing the odds that more nurses will leave local hospitals in search of less stressful work. And as the pool of hospital nurses shrinks, the risk increases that patients will have trouble getting needed care.

The crisis made headlines during the recent three-day strike by some 7,000 nurses in New York City. It hit closer to home when a majority of the roughly 800 nurses at Mount Sinai South Nassau in Oceanside voted Jan. 12 to join the New York State Nurses Association, the union that led the city strike.

Adding to the impetus for change is an influx of new nurses who seek competitive pay, work-life balance, flexible schedules, opportunities for advancement and the ability to speak up if they believe conditions are not safe. Hospital officials said they sympathize but face financial constraints in meeting demands.

NYSNA contracts are set to expire on March 31 at two Long Island hospitals, St. Charles Hospital in Port Jefferson and St. Joseph Hospital in Bethpage, according to NYSNA. St. Catherine of Siena Hospital's contract with NYSNA expires in July. All three belong to the Rockville Centre-based Catholic Health system.

Northwell Health's South Shore University Hospital in Bay Shore is in contract talks with NYSNA, which represents more than 800 nurses there, a Northwell spokesman said. Northwell's Plainview Hospital and Syosset reached deals in December, the union said.

Nurses at South Shore and at hospitals throughout the region have been overwhelmed, often working 12-hour shifts without breaks, said Marie Boyle, 74, who has been a nurse at South Shore for 50 years and serves on the NYSNA board of directors.  "This cannot go on," she said.

A Northwell spokesman said in a statement, "The hospital remains committed to being recognized as a great place to work. … It’s our goal to reach an agreement as soon as possible, while continuing to provide outstanding care to our patients."

Empowered

The negotiations come as nurses and hospital leaders alike say nurses have gained prestige from their prominent role confronting the COVID-19 pandemic, and leverage from the acute staffing shortages. But burnout, illnesses and deaths are also a pandemic legacy.

COVID-19 “exposed nurses as being the health care heroes, but it also exposed nurses as being tired and stressed and distressed,” said Patricia Bruckenthal, dean of Stony Brook University’s School of Nursing, who started her career at Stony Brook University Hospital as a registered nurse in 1981.

'It's kind of a self-fulfilling prophecy…because there's a shortage, the nurses on those units are typically very stressed.' 

-Kenneth Chiu, a rehabilitation nurse at Glen Cove Hospital who said he has observed such conditions at other hospitals, though not at Glen Cove.

Credit: Debbie Egan-Chin

Nurses say their profession is undergoing seismic shifts as an exodus from hospitals during the pandemic, and an insufficient supply of new nurses willing and able to work in hospitals, has worsened workloads for some of those remaining.

“It's kind of a self-fulfilling prophecy … because there's a shortage, the nurses on those units are typically very stressed,” said Kenneth Chiu, 22, a rehabilitation nurse at Glen Cove Hospital who said he has observed such conditions at other hospitals, though not at Glen Cove. “Patient safety is a really big priority in nursing, we want to be able to provide effective and quality care. And in order to do that, we need safe patient ratios.”

At the same time, with nurses in short supply, Bruckenthal said now “is actually a great opportunity for individuals to think about going into nursing. … New nurses entering the field have a wide-open job market, and so they will shop around for better pay, better benefits.”

The Healthcare Association of New York State reported last month that 100% of hospitals responding to a survey said they had nursing shortages they could not fill. An analysis published last year in the journal Health Affairs found that the number of registered nurses fell by 115,220  from 2020 to 2021, the biggest decline in 40 years.

Across Long Island, managers say it can be challenging to hire enough new graduates from nursing schools, and even harder to bring experienced nurses on staff.  

Pre-pandemic, “looking for nurses, it was basically selecting the best candidate,” said Djimmitry Jeanlouis, a nurse manager at Plainview Hospital who spoke with potential job candidates at Northwell’s recent invitation-only job fair at Crest Hollow Country Club in Woodbury. Now, he said, “the new nurses that are coming into the field feel like they have an upper advantage because  [they] know we are in dire need.”

Budget squeezes

Hospitals say they’re doing their best to hire more nurses and offer competitive salaries and benefits, but there’s not much room in budgets. “The nurses are so important and so valuable,” and hospitals would close a unit if necessary rather than risking patient safety, said Jonathan Sobel, vice president of strategic workforce planning and development at Northwell Health. The system offers a wide array of educational programs and other benefits, he said. “But we need to keep the overall margin where it can sustain the organization and the responsibility we have to the community. … It's not an unlimited source of funds.”

Labor costs account for 60% of hospital expenditures, and nurses make up the majority of workers, said Wendy Darwell, president and CEO of the Hauppauge-based Suburban Hospital Alliance of New York State, a hospital trade group. And even as labor, supply and fuel costs rise, most hospital revenues remain unchanged due to fixed payments by the government-sponsored Medicare and Medicaid programs, which make up about 70% of revenues, Darwell said. Inflexible multiyear contracts with insurers make up most of the rest, she said.

“There is certainly a desire to raise salaries to keep up with inflation, every single hospital leader I know wants to be able to do that,” Darwell said. In fact, in a survey of New York hospitals, 96% reported offering retention or hiring incentives for nurses, she said. “But the amount of revenue coming in isn’t increasing ... so there's a simple math problem here." Some hospitals are forced to close the staffing gap with expensive temporary worker contracts, she said.

The Healthcare Association of New York State survey found that 64% of the state’s hospitals reported they spent more than they earned providing care. The result can be conflict at the negotiating table.

Negotiations for the South Nassau nurses’ first union contract have not yet begun, and it could take a year for an agreement to be hammered out, according to NYSNA, the state’s largest registered nurses’ union, with 42,000 members, and an affiliate of National Nurses United, AFL-CIO, which has more than 225,000 members nationwide.

Nurse-to-patient ratios

The Oceanside nurses are seeking lower nurse-to-patient ratios to improve working conditions and patient safety, as well as better salaries and benefits, according to NYSNA.

Mount Sinai South Nassau said it hired 250 nurses last year and increased nurses’ pay by 17% over the last 15 months. “Our focus remains on supporting Mount Sinai nurses — and all our employees — in delivering the excellent patient care we are known for,” the hospital said in a statement.

The strike by 7,000 nurses at Mount Sinai and Montefiore hospitals in New York City was the largest in NYSNA’s more than 120-year history, the union said. The tentative three-year agreement at Mount Sinai Health System’s main hospital calls for nurse-to-patient ratios of 1:2 in intensive care units — or 1:1 for the sickest patients — and 1:5 in medical/surgical units,  as well as a 19% pay raise over three years.   Nurses there have said they have cared for up to 10 patients at a time, twice the recommended number.

Even before the pandemic, there were shortfalls of nurses in certain areas, such as intensive care units, said Gara Edelstein, chief nursing officer at Catholic Health. “Then COVID hit, and everything kind of just blew up,” she said.

Now, she said, Catholic Health is able to hire nurses, but like other health care systems, “what we are struggling with … is the retention of those nurses, particularly the younger nurses.” The health care system is offering education and training programs for new nurses, as well as behavioral health services and flexible schedules, she said.

“We work with our staff to say, ‘how can we be more flexible for you?’” she said.

One of the biggest challenges facing new nurses is that  a larger proportion of patients in hospitals are suffering from severe illnesses, in contrast to decades ago when patients often stayed in the hospital longer before and after routine procedures, said Rose Schecter, an associate dean at Molloy University’s Barbara H. Hagan School of Nursing and Health Sciences.

Schechter said that as a new nurse working a night shift decades ago, she looked after 15 patients.

“Of those 15 patients, only one or two of them were what you would consider ill,” she said. These days, she said, “people are very ill in the hospital … even on a general unit.”

New blood

Despite the challenges, a nursing career can offer stability, more flexibility than a 9-to-5 job and the chance to make a difference in people’s lives, along with a comfortable salary, nurses say.

In the New York metropolitan region, registered nurses working 40 hours a week earned an average annual wage of $98,460 in 2021, up 13.4% from five years earlier, the most recent Bureau of Labor Statistics figures show. Nationwide, nurses earned $82,750 on average in 2021, up 14.6% from five years before.

At Northwell, many job listings for registered nurses offer wages of $47 to $82 an hour for staff jobs and $52 to $125 an hour for short-term jobs. Annual salaries can reach $140,000 to $245,000 for nurse anesthetists, who have advanced training and experience.

Nurses “have worked so long and so hard and take care of all these people,” said Averiana Worrell, 21, a senior in Adelphi University’s undergraduate nursing program who attended Northwell’s job fair. Nurses, she said, “should be acknowledged and treated properly ... and I feel like respect is getting paid properly.”

'[Nurses] have worked so long and so hard and take care of all these people ... respect is getting paid properly.'

-Averiana Worrell, a senior in Adelphi University’s undergraduate nursing program 

Credit: Newsday/Alejandra Villa Loarca

For many nurses, the profession also is a calling.

Catherine Zaharis suffered a brain hemorrhage when she was 20. During her two-week stay in an intensive care unit, some of the nurses “really inspired me to keep going and get better,” recalled Zaharis, 40, of Wantagh.

Zaharis said she had felt drawn to a career in nursing, but she didn’t have the confidence to pursue it until a few years ago. Instead, she worked in a dentist’s office and as a teacher. “After my kids were born, I got to a point in my life where I said to myself, it's now or never,” she recalled.

Zaharis earned her bachelor’s degree in nursing from Molloy University this month and will start working at St. Francis Hospital & Heart Center next month.

Her schoolmate Emily Thompson, 28, of Coram, was working as a patient care aide in a surgical intensive care unit and deciding what career path to pursue when the pandemic hit in 2020. Nurses “saved the day during that time, so I said, ‘I have to go to nursing school,’” she said. Thompson graduated from Molloy this month and is attending a surgical ICU residency program for nurses at St. Francis. Without such programs, nurses would typically need to spend years working in medical/surgical units before advancing to the ICU.

'It's important for me to have a career that pulls me out of bed in the morning, that has a sense of meaning ... [and] that has good benefits, good pay.'

-Jason Goldman, a patient transporter at South Shore University Hospital and a nursing student at Molloy University.

Credit: Courtesy Jason Goldman

Jason Goldman, 41, of Hauppauge, spent 18 years working in finance but came to find the work “soulless.”

“It's important for me to have a career that pulls me out of bed in the morning, that has a sense of meaning,” he said. Nursing checks that box, he said, and it’s also “a recession-proof job, a career that has good benefits, good pay.”

In 2019, while still working full time at a bank, he started taking science classes at Suffolk County Community College. Now he works as a patient transporter at South Shore, where he is learning about all areas of the hospital while attending nursing school at Molloy.

He hopes to eventually work as a flight nurse on medical transport helicopters, he said.

“This is probably the best decision I've ever made in my life,” he said.

By Maura McDermott

maura.mcdermott@newsday.commauramcdermott

Maura McDermott covers health care and other business news on Long Island.