Blog#14- 1/29/20
WHERE HAVE ALL THE NURSES GONE?
By Richard Davis
In his recent budget address Vermont Governor Phil Scott pointed out that Vermont is spending too much money to hire traveling nurses. He has come to recognize something that has been causing economic pain to Vermont’s health care institutions for many years.
When an institution cannot hire enough nurses from the local community and they want to provide optimum staffing, they often turn to one of the national traveling nurse companies to fill vacancies. The overall cost of contracting with these agencies significantly hurts the bottom line of institutions and that means that overall health care costs increase for everyone eventually.
We all pay more for health care because of staffing shortages at local hospitals. The traveling nurses are given housing and food allowances in most cases and the cost of hiring them is not only financial. Traveling nurses are not part of the fabric of a local community and they are often paid higher hourly wages than the local nurses they work with.
According to a 990 IRS filing for fiscal year 2017, Brattleboro Memorial Hospital paid PPR Travel, a national traveling nurse agency, $1,601,807. In the same year the Brattleboro Retreat paid $1,247,719 to Medical Solutions, also a national traveling nurse agency. It would be helpful to know how much of that money could have been saved if local nurses were hired, but it is clear these institutions are paying a lot of money for staffing because of recruitment problems.
When these hospitals are asked why they can’t hire enough local nurse they usually say that there is a nationwide nursing shortage and that this problem is just a reflection of that situation. That may explain part of the problem, but we need to dig deeper to understand that there may be additional reasons for the staffing shortages.
Consider that fact that Vermont is surrounded by states that have outlawed institutions from forcing nurses to work overtime when there are staffing shortages. New York, New Hampshire, Connecticut, Massachusetts and Rhode Island are among 18 states that outlaw mandatory overtime.
A nurse works an hour shift and near the end of the eight hours is told that they have to stay another eight hours because the evening or night nurse called in sick.
The nurse is threatened with firing if he or she does not stay an additional eight hours. Who would want to go to work with that threat looming over them every time they simply try to do the job they were hired for?
If Governor Scott is serious about cutting down on the use of traveling nurse he would do well to consider pushing the Vermont legislature to pass H313, a bill now sitting in the House Health Care Committee, that would ban mandatory overtime. The bill also establishes safe patient handling programs and would require the Department of Health to adopt rules for safe staff-to-patient ratios.
The mandatory overtime issue is especially relevant to the corner of the state we live in because nurses who live in Brattleboro, or in southern Vermont, can easily find work in New Hampshire or Massachusetts without having to worry if they won’t be able to get their kids to school or miss important appointments because they have to choose between losing their job or working hours they were not scheduled for.
Wages also play a factor in nurse recruitment. While it may not be fair to compare Vermont to Massachusetts when it comes to nurse salaries, Vermont is close to other New England states in level of pay. But keep in mind that according to the Nightingale College web site, “The average salary for a Registered Nurse in Vermont is $69,160, which is below the national average for RN’s viewed across all U.S. states. The monthly salary is $5,763 and it breaks down as an average of $31.61 per hour. The average BSN Nurse Salary in Vermont is $79,870, with an hourly wage of $38.40.
In my experience of 40 years of working in various health care settings as a registered nurse, it is often a struggle for nurses to improve their working conditions within health care institutions because they are operated like dictatorships. Management pays lip service to the fair treatment of their workers, but that is often not reflected in the rules that employees must follow.
There will never be equity within those insular institutions run by the top one percent of wage earners, but we can make some progress with little steps as we push for the elimination of mandatory overtime and fight the constant battle for fair wages.
Nursing Homes Too
I saw that in my father’s nursing home in Maine. Constant scrambling to maintain the required staff/patient ratios, high percentage of traveling nurses. Lots of low-paid CNAs (and some wonderful ones BTW), and even some of them are travelers due to shortages, but they’re not able to assume above a certain level of responsibility so RNs are still needed on duty.
Salaries vs Conditions
I’ve heard that traveling nurses are a source of friction and a big cost to hospitals, including BMH where they seem to use them a lot. But when you talk about salaries, it’s hard for me to see how nearly $70,000 a year isn’t enough. Is the problem salaries or is it working conditions? If the hospital was adequately staffed and mandatory overtime was banned (absences covered by a floating pool of volunteer replacements, perhaps), then would the salaries be enough? Or is the presence of these higher paid traveling nurses the real problem?
I can see myself in that situation, and I would wonder: why doesn’t the hospital just pay us that money, and let us do the work? Why can they afford agency nurses but not increases to our wages or hire more staff?
An objective cost comparison might be useful. What if hospitals were to review actual staffing needs and then fill those positions with full -timers. What are the costs and benefits of that?
It seems like it could be good all around, as it would add new citizens to our town rather than floaters who just pass through. But for that to happen, there would have to be a commitment toward keeping everyone happy, not just with money but with better working conditions overall. Another benefit might be happier, healthier patients who heal faster in a less stressed environment.
Lobbying for an end to mandatory overtime sounds like a good idea too, but you’d have to hire people to maintain staffing, and if you have to use agency nurses, that will get expensive. Which brings us back to: do you have to use so many agency nurses? That is the question.