Congenital short staffing at Rochester General Hospital compromises patient safety, a report issued this week by the hospital’s nurses union claims.
The Rochester Union of Nurses and Allied Professionals this evening will hold a candlelight vigil at RGH to highlight what it says are the hospital’s staffing and patient-safety concerns. The vigil comes as the 15-month-old union and the hospital reach the one-year point in still largely unresolved first-contract talks.
The RUNAP report claims that staffing of a majority of nursing shifts at RGH has fallen dangerously below levels demanded by state law and often fails to meet levels cited in a plan the hospital itself submitted to the state Department of Health.
In a statement, RRH calls it “disappointing” that the union “decided to publicly disparage the excellent care that our doctors, nurses, other providers and the rest of our staff, deliver to the Rochester community.”
According to the report, spreading nursing care too thin for nurses to adequately attend to patients increases patient risk of death by 7 to 15 percent.
To ensure adequate care in critical-care settings like intensive care units, a very high nurse-to-patient ratio is needed, says Phoebe Sheehan, a cardiac care ICU nurse. In her unit, many patients require one-on-one care. Even for patients in less dire condition, ratios should never go higher than one nurse to two patients. Still, she says, nurses in the unit have at times been tasked with tending to three patients.
In what she believes is a money-saving move, the hospital tends to put fewer nurses on duty during night shifts, Sheehan says, but adds that patients do not conveniently schedule heart attacks during daytime hours.
“At RGH, we are committed to ensuring we have the appropriate level of staff to meet the needs of our patients” the health system counters.
Among concessions the union seeks is to give nurses involved in care direct input in staffing decisions. It is also asking for salary levels commensurate with wages paid to unionized nurses in Buffalo and Syracuse hospitals.
To compile the report, the union asked nurses in multiple units to tally the number of nurses per patient in shifts worked over a seven-day span between Sept. 24 and Oct. 1. The numbers showed that, on average, hospital units adequately staffed only 12 percent of the time, the report states.
In some units, staffing was slightly better than the general average. According to the RUNAP report, maternity, postpartum and neonatal intensive care units were short-staffed 77.5 percent of the time. The hospital’s four other ICUs were short-staffed 78 percent of the time.
Wage and staffing levels
The 528-bed RGH is the flagship of the five-hospital Rochester Regional Health system flagship and the area’s second largest hospital.
Some 900 RGH nurses voted to form the Rochester area’s first nurses union at the hospital in July 2022, coming years after a nursing-union drive at UR Medicine’s Strong Memorial failed. First contact negotiations for the RGH union kicked off in October 2022. The union and RRH have since held more than 20 bargaining sessions.
After the most recent meeting, held Monday, the hospital and the union remain at odds on key issues, with staffing levels and wage demands high on RUNAP’s list, says Sheehan, a member of the union’s negotiating team.
Stating that RGH is focused on “continuous improvements that ensure the best possible healthcare outcomes for our patients,” RRH denies that there are significant patient safety issues at the hospital.
The hospital’s patient safety record “is consistent with or better than the national average when it comes to key patient mortality rates and the hospital’s readmission rate is in line with the national rate, according to Medicare,” RRH says.
The health system cites Healthgrades’ placement for the past three years of RGH on its America’s 50 Best Hospitals list. It also points to RGH’s inclusion on U.S News and World Report’s Best Regional Hospitals list in 2022 and 2023.
Supporting the union’s patient-safety concerns is the Leapfrog Group, which in a June report gave RGH a D rating. A nonprofit health care rating organization, the Leapfrog Group rated RGH as providing good or adequate care in some areas but below-average care in a number of other areas.
In surgery, for example, Leapfrog gave RGH high marks for avoiding accident cuts and tears, for preventing death from treatable complications and for not leaving surgical tools in patients. It gave the hospital an average grade for preventing breathing problems and ranked it poorly for allowing surgical wounds to reopen and for blood leakage.
In July, the federal Centers for Medicare and Medicaid Services similarly found RGH wanting, giving the hospital one star out of a possible five, the agency’s lowest quality and safety grade.
In a June statement, RRH chief operating officer Jennifer Eslinger conceded that seven months into negotiations, the union and the system are “still very far apart on topics such as wages and staffing grids.”
Since June, Sheehan says, there has not been much progress. Concessions by RRH have generally come after union actions, such as a recent short-term strike and informational pickets that have drawn public attention to the ongoing talks. RRH dropped a proposal to institute a two-tier wage structure under which new hires would be paid less than current staff, but has not significantly moved on wage or staffing levels.
In a July statement, RRH highlighted raises it has already given nurses, maintaining that meeting RUNAP’s further salary demands would make RGH nurses among the highest paid in the nation.
“If RGH were to agree to everything RUNAP wanted around wages, staffing and benefits, it would cost Rochester Regional Health more than $111 million for just the first year of the contract,” the health system protested.
In light of an expected systemwide $150 million loss this year and further red ink expected next year, conceding to RUNAP’s demands would be “irresponsible” for the health system, RRH officials maintained.
“RRH began to incur substantial costs to recruit replacement nurses so we can adequately care for our community. These are expenses that now cannot be used to invest in our employees, our facilities or our community,” system officials said in an August email, responding to a two-day strike the union had then called to protest lack of progress in first-contract negotiations.
Filling nursing positions
Like virtually all U.S. hospitals, RGH was thrown into crisis mode during the height of the COVID pandemic as it scrambled to treat scores of stricken patients. And like most U.S. hospitals, it had to boost its nursing ranks by calling temporary replacements known as travel nurses. Hired through staffing agencies, travel nurses command salaries as much as three times more than regular staff.
In March 2022, RRH chief medical officer Robert Mayo said the system’s nurse vacancy rate was running as high as 25 percent. Hiring travel nurses to fill the gap was putting a “huge premium” on staffing costs, he said then.
Earlier this year, RRH CEO Chip Davis similarly cited travel nurse costs as a big contributor to the system’s red ink. RRH’s travel nurse outlay had risen from $9 million in 2019 to $200 million in 2020, while its operating income had gone from a positive 1.5 percent in 2018 to a 1.5 percent deficit in 2022, Davis said.
Sheehan concedes that from RRH’s point of view, salary demands and staffing issues are economically tied. But she and other RUNAP members say that puts RGH in a doom loop, where high turnover and nurse-vacancy rates put steady economic pressure on the system to keep expenses low, which in turn leads to short staffing and nurse burnout.
The nurse-vacancy rate remains high, Sheehan believes. She says RGH nurses are quitting “in droves” to take work at other facilities, like unionized Syracuse and Buffalo hospitals and the UR Medicine system, or are moving to travel nursing or simply quitting. Stressed by working conditions, at least a dozen of Sheehan’s colleagues have quit the hospital during her three years at RGH, she says.
Not so, RRH counters, RGH’s nurse vacancy rate has come down significantly.
“We are continuously recruiting full-time nurses and are pleased to have hired 217 new nurses so far in 2023, with another 39 nurses set to begin before the end of the year,” the health system says. RGH’s “current nurse vacancy is just 12% and will drop to 5% in the next week as we bring in additional agency nurses to supplement our needs,” it adds.
Before moving to RGH, Sheehan, 29, worked for several years at UR Medicine’s Highland Hospital. She moved to RGH to work in the cardiac care ICU. Sheehan says she made the move partly because at Highland she had been assigned to work full-time in COVID care but also because she saw the chance to work in the ICU as more professionally rewarding.
“I love my job,” Sheehan says. “The people in my unit are great. My immediate supervisor is great.”
As a union negotiator and as an employee, Sheehan finds relations with administrators not immediately involved in day-to-day care less rewarding. In negotiating sessions with system officials, “I think we’re having a collaborative discussion, but when they come back with a proposal, their position seems to have not moved at all.”
In the past, RRH COO Eslinger has repeatedly stated that the system expects first-contract negotiations with the union to take at least 15 to 16 months to conclude.
Will Astor is Rochester Beacon senior writer. The Beacon welcomes comments and letters from readers who adhere to our comment policy including use of their full, real name. Submissions to the Letters page should be sent to [email protected].