Mount Sinai RNs blaze trail to better staffing enforcement

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Large group of nurses cheering on picket line, some with raised fists

By Kristi Barnes

National Nurse Magazine - July | August | September 2023 Issue

In January, New York State Nurses Association (NYSNA) nurses at Mount Sinai Hospital went on strike for better patient care and to win what their chief nursing officer told them they would never win: safe staffing ratios. Not only did nurses win new ratios in their contract, but they also won strong new staffing enforcement language — another first at Mount Sinai Hospital.

In March, Mount Sinai neonatal intensive care unit (NICU) nurses put their new contract language to the test. Frustrated that Mount Sinai administration did not improve staffing after their strike, the Mount Sinai NICU nurses began tracking their staffing levels every day. From January to April, they found that the NICU was understaffed 87 percent of the time.

NICU nurses tried to address understaffing with their manager and learned that she was not informed of the basics of their new contract and ratios, including the maximum safe patient ratio of 1:2 in the NICU and the need to staff safely for break times so that nurses are not doubled up on patient assignments if a coworker goes on break. NICU nurse Meghan Hurlbut, RN, explained to Politico in an interview: “This is about life and death for some of our patients. If you’re five, six nurses short, you feel that. You just feel like you’re constantly playing catchup.”

NICU nurse Nina Horowitz, RN, described the consistent understaffing and campaign to enforce the contract to WNYC/Gothamist in April, saying: “Our patient population is obviously very vulnerable. They’re babies. They can’t communicate like you or I…You need an extra set of eyes to say, ‘Hey, this isn’t normal.’”

Mount Sinai nurses rallied around their colleagues in the NICU and worked with them to bring this case to arbitration, in the first real test of the safe staffing enforcement language in their new contract. At an arbitration hearing on April 21, NICU nurses testified passionately and in detail about how they are sometimes asked to care for four to eight sick babies at a time and how that puts nurses and vulnerable patients at risk. The 46-bed unit’s average census is 52, and the unit regularly surges, which has put additional stress on nurses, patients, and families.

At another hearing on May 3, nurses heard from Mount Sinai administrators who admitted that they were flagrantly violating the contract. The nurse manager confirmed that when nurses go on break, they are doubling up on assignments in violation of the new contract language. And the hospital’s finance department testified that it budgeted for traveler nurses, but not the 50 full-time positions that the hospital would need to meet the contract’s new safe staffing ratios.

A week later, the arbitrator came back with his ruling, finding that: “There has been a persistent pattern of violations and a continuous chronic pattern of ratios being violated during the shifts.” He found that when RNs are “routinely and systematically responsible for additional patients above the contractual mandates, those impacted nurses are entitled to and deserving of additional compensation.” He awarded a total financial penalty of $127,057 for 65 day and night shifts that will be distributed to potentially 150 impacted nurses depending on the number of understaffed shifts they worked. Management must pay no later than the second pay period following the decision.

That arbitration decision was not only a first for the Mount Sinai nurses enforcing a new contract but the first time in New York City or anywhere in the U.S. that an employer has been fined for understaffing. The groundbreaking staffing enforcement language that Mount Sinai nurses fought for and won, combined with the determination of nurses to enforce it, made all the difference.

NYSNA Director at Large Matt Allen, RN, a labor and delivery nurse at Mount Sinai, said: “I am so proud of the solidarity the Mount Sinai nurses have shown. This ruling should send a strong message that we will do everything we can to hold our hospital accountable for patient safety.”

Kristi Barnes is Communications Director for New York State Nurses Association