Research and reports

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High and rising rates of workplace violence and employer failure to implement effective prevention strategies is contributing to the staffing crisis 

Health care workers are experiencing a surge in workplace violence rates nationally, which has been exacerbated by the health care industry’s actions during the Covid-19 pandemic. This report analyzes new data, gathered in 2023 by National Nurses United regarding nurses’ recent experiences of workplace violence. Survey data was collected from nearly 1,000 nurses working in 48 states and D.C. In-depth focus group discussions were held with 31 NNU members from seven states to gather detailed accounts of nurses’ experiences of workplace violence and employer prevention and response. This data underlines the need for additional action to protect nurses, other health care workers, their patients.

Dangerous Descent: How Ascension Betrays its Mission by Gutting Care for Pregnant Patients and Babies

Ascension, one of the nation’s largest Catholic, nonprofit health care systems with 140 hospitals, is using its market dominance to shut down its labor and delivery units, forcing patients to travel further for obstetrics care. Our research finds Ascension is closing obstetrics services at higher rates than the national average and that closures are disproportionately in Black and Latine communities, counties with higher infant mortality rates than the national average, and in low-income neighborhoods reliant on Medicaid.

Protecting and Retaining California’s Nursing Workforce: California’s Registered Nurse Workforce is Robust and Growth is Accelerating

There is no shortage of registered nurses in California; rather there is a shortage of nurses willing to work in unsafe environments. Industry reports of shortages of registered nurses have dominated recent headlines. However, California has an adequate supply of nurses. There are more than one-half million RNs with active California licenses, yet only about 325,600 are currently working in California as RNs.

Medicare’s Hospital at Home Program is Dangerous for Patients

National Nurses United's report on Medicare's Acute Hospital Care at Home (AHCaH) program explains how such programs cannot provide acute hospital-level care in a patient's home because it lacks the ongoing, in-person assessment and treatment by health care professionals, which is a hallmark of acute-level care. The report states that the AHCaH program fails to provide the appropriate level of services, equipment, and infrastructure to provide timely acute hospital-level care and it is vulnerable to fraudulent billing practices.

Protecting Our Front Line: Ending the Shortage of Good Nursing Jobs and the Industry-created Unsafe Staffing Crisis

In this report, National Nurses United describes how the hospital industry has driven registered nurses from the bedside. As the largest union and professional association of registered nurses with nearly 225,000 members working at the bedside in nearly every state in the nation, NNU proposes steps that Congress and the executive branch must take to keep RNs at the bedside, encourage licensed RNs not currently providing direct patient care to return to the bedside, and improve patient care in U.S. hospitals.

Read the press release

Workplace Violence and Covid-19 in Health Care

How the Hospital Industry Created an Occupational Syndemic

This report details stark evidence gathered by National Nurses United of how the dual failures of health care employers to protect nurses and patients from Covid-19 and workplace violence synergistically interact to amplify the harms caused by each individually. Data are presented and analyzed from seven surveys conducted by NNU in 2020 and 2021 with collectively more than 83,000 responses from nurses and other health care workers in every state.

Deadly Shame: Redressing the Devaluation of Registered Nurse Labor Through Pandemic Equity

“Deadly Shame” provides contextualization and history for why moral distress and moral injury are happening to the most trusted profession in the United States. The white paper discusses how the “care work” of registered nurses, a woman-dominated profession, is devalued by employers and government. In our capitalist system, which treats health care as a market commodity, “employers have taken advantage of every opportunity presented during the pandemic to maximize profits,” stated “Deadly Shame.” Immorally, the corporate health system treats nurses and other health care workers as expendable.

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Fleecing Patients: Hospitals Charge Patients More Than Four Times the Cost of Care

With the Covid-19 pandemic continuing to explode across the country, a NNU's new study documents that hospitals jack up charges by as much as 18 times over their costs, a substantial contributor to the growing health care crisis for patients and families.

Overall, the 100 most expensive U.S. hospitals charge from $1,129 to $1,808 for every $100 of their costs. Nationally, U.S. hospitals average $417 for every $100 of their costs, a markup that has more than doubled over the past 20 years.

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Sins of Omission: How Government Failures to Track Covid-19 Data Have Led to More Than 3,200 Health Care Worker Deaths and Jeopardize Public Health

National Nurses United’s (NNU) updated report Sins of Omission, reveals continued failures by local, state, and federal governments to track and report data on the Covid-19 deaths and infections of nurses and other health care workers as well as widespread resistance by the hospital and health care industry to provide this critical information. The March report, Sins of Omission: How Government Failures to Track Covid-19 Data Have Led to More Than 3,200 Health Care Worker Deaths and Jeopardize Public Health, is an update to NNU’s September 2020 report of the same name.

Read the press release

Preying on Patients: Maryland’s Not-for-Profit Hospitals and Medical Debt Lawsuits

In the state of Maryland, all hospitals are operated as not for profits. In exchange for being exempted from paying most federal, state, and local income, property, and sales taxes, not-for-profit hospitals are required to provide subsidized low-cost or free medical care, otherwise known as “charity care,” to qualifying individuals. The state of Maryland also uses what’s called an “all-payer system” for reimbursing hospitals for the medical treatment they provide, meaning that a state commission sets the uniform rate formula by which hospitals are paid. Built into that formula are also monies intended to help hospitals cover the costs of providing charity care, what’s commonly called “charity care rate support.” In other words, Maryland’s not-for-profits hospitals are obligated to provide charity care but actually do not bear these costs. The state’s generous hospital financing system makes the high number of these medical debt lawsuits all the more egregious.

Retaining Effective and Sound Programs for Excellent Care and Treatment (RESPECT) for Veterans

The Veterans Health Administration (VHA) faces a dilemma between its mission, “Honor America’s Veterans by providing exceptional health care that improves their health and well-being,” and the limits that appropriated funding levels impose on its work. This paper compares care provided by the VHA with care available in the private sector based on the assessments and reports required by the Choice Act as well as scientific studies and medical literature.

Taking Neighbors To Court: Johns Hopkins Hospital Medical Debt Lawsuits

This report presents findings on Johns Hopkins Hospital’s practices in suing its patients for medical debt. Many of these lawsuits seek to recover only the amount outstanding after insurance coverage is applied, including Medicare and Medicaid.

Johns Hopkins Hospital: Reality vs. Reputation

On his deathbed, Johns Hopkins set forth instructions and funds for the creation of a hospital that would serve this purpose: "to treat the poor without charge" no matter the patient’s "age, sex, or color."

Foundations of Care: Upholding the Legacy of Hopkins’ Nurse Pioneers

Direct-care nurses who practice at Johns Hopkins Hospital, located in East Baltimore, Md. have written this report to bring attention to patient safety concerns that they and their patients face every day.

Nurses at Risk: Insufficient Protections at Johns Hopkins Hospital Compromise Nurse and Patient Health and Safety

During the summer and fall of 2018, nurses at Johns Hopkins Hospital (JHH) surveyed their colleagues about health and safety in their units. This report outlines the results of the survey and draws on the scientific literature to underline the impact and importance of nurses’ health and safety.

Breaking the Promise of Patient Care: How Johns Hopkins Hospital Management Shortchanges Baltimore and Puts Patients and the Community at Risk

This report, looks specifically at Johns Hopkins Hospital, asks whether Johns Hopkins Hospital is doing enough for Baltimore and its citizens, and the state of Maryland more broadly, when compared to the rich array of tax exemptions Johns Hopkins Hospital receives as a not-for-profit organization.