Fox Nurses Rally against Understaffing

By WRILEY NELSON
ONEONTA

A.O. Fox nursing staff and representatives from the New York State Nurses Association held a “speak out” rally on Wednesday, December 13 to draw attention to ongoing staffing issues.

About a dozen nurses accompanied by NYSNA personnel and community members gathered in front of the emergency room entrance to speak about their concerns about the state of the hospital’s staffing and administration. Each of the speakers pointed out that A.O. Fox faces a 50 percent vacancy rate in nursing; under normal circumstances, the hospital has a staff of about 100 nurses, but it is currently operating with around 50. Such a severe shortage of labor power poses dire risks to patient health and to the working conditions and safety of remaining staff, they said.

According to a NYSNA release on behalf of the group, the nurses called for a comprehensive plan to recruit and retain new staff, as well as a fair contract that addresses working conditions and provides adequate wages.

“I care deeply about our community and it’s disheartening to see the challenges we face in providing the level of care our patients deserve,” said Diane Earl, RN, CEN. Earl has worked at Fox for more than a quarter-century and owns a home in the area. She has established her life and career in Oneonta and is deeply concerned about the effects of short-staffing on the community as well as on her own working life.

“We’re hemorrhaging staff and the ER is strained,” she continued. “There are patients in beds with unanswered calls, a lack of resources… I care about this community and taking care of people; that’s why I became a nurse. When I go home feeling frustrated and upset because I can’t provide the level of care patients deserve, that’s a horrible day.”

NYSNA representatives have been negotiating a new labor contract for Fox with Bassett Healthcare Network personnel since October. One NYSNA official noted that the parties’ negotiating positions remain far apart and that a great deal of extra work will be necessary before the matter is resolved. In a release, the union said that the hospital has pushed nurses to work longer hours and forgo paid time off to compensate for the vacancies, and that many spaces have also been filled with temporary travel nurses, a practice which is often expensive.

“On a daily basis, the existing staff face a demanding workload not only from understaffing, which limits their time to provide quality patient care, but also from the time required to train new temp nurses as they cycle through the hospital,” the release continued.

Rural healthcare systems around the U.S. are suffering under a political economy in which providing coverage to low-density areas is not prioritized because it simply isn’t profitable. According to the Center for Healthcare Quality and Payment Reform’s Saving Rural Hospitals website, more than 100 rural hospitals have closed in this country in the past decade alone. Another 600, representing more than 30 percent of the remaining total, are at risk of closing in the near future. They lose money delivering services to patients.

The COVID-19 pandemic strained much of the industry to the breaking point; increasing workplace safety risks from infectious disease and a new epidemic of patient violence against healthcare workers—on top of a 63 percent increase in violent attacks on medical professionals from 2011 to 2018—have contributed to a mass exodus from nursing as a profession. As cost of living increases for all workers, many nurses look at the declining livelihood their increasingly aggravating and dangerous career provides and conclude it just isn’t worth it. The National Council of State Boards of Nursing found that 100,000 RNs left the profession during the COVID-19 pandemic and estimated that nearly 800,000 more intend to follow them out the door by 2027. Despite this decline in the supply of nursing labor, wages and benefits have generally not risen to incentivize entry to the profession or even to keep up with inflation. The exodus from nursing leaves more and more work for those who remain, making it more likely that even more healthcare providers will burn out of the field. Without some serious changes in the way the American political economy funds and prioritizes healthcare, the industry will remain in a downward spiral that will leave more and more people, especially in rural areas, without access to care, even if they have insurance.

Bassett Healthcare Network, which operates A.O. Fox, is not immune to the shortages plaguing the entire industry.

“Like hospitals and health systems around the country, [Bassett and Fox are] facing unprecedented shortages of healthcare staff,” said Bassett Director of Public Relations Gabrielle Argo in a brief statement on the matter. “We are allocating tremendous resources toward recruiting and retaining nurses and other clinical staff to our local area as well as finding innovative ways to best meet the needs of our patients. While it is our preference to hire permanent staff, it is necessary at this time to use temporary and travel nurses to bolster our staff so that we can continue to provide the care our patients and communities deserve.”

“The safety and care of our patients, communities and caregivers is always our highest priority,” Argo said. “We deeply appreciate the extraordinary work our nurses do each day to care for our patients and communities. A.O. Fox Hospital is currently in negotiations with NYSNA related to a collective bargaining agreement with RNs. A.O. Fox Hospital leadership is committed to continuing negotiations in good faith with NYSNA representatives to reach a mutually agreed-upon contract agreement.”

Many of the gathered nurses directly addressed the ongoing negotiations at the rally.

“I’m here to speak out for a fair contract that will allow us to recruit and retain enough qualified and dedicated nurses for our community,” said Mackenzie Ranc, RN, a medical surgical inpatient nurse who has worked at Fox since 2014. “The majority of the inpatient unit is comprised of travel nurses with only two full-time day shift nurses, including myself, along with three full-time night shift nurses. Regrettably, everyone else has either resigned or transitioned to per diem, leaving us with a staff of mostly travel nurses.”

“Existing staff are frustrated and burned out,” she continued. “There has been little effort to retain the few nurses that have remained. The workload is demanding; I’ll often have to cover six patients plus working as the charge nurse, which equates to just 10 minutes per hour per patient, which is just not enough to provide proper and safe care.”

Ranc indicated that a one-to-four ratio with a charge nurse who is out of assignment is generally considered a more standard and safe staffing level.

Bassett representatives said they are deeply concerned with the staffing issues and that they are taking steps to rectify the problems.

“Recruitment and retention is one of our top institutional priorities, as it is for many hospitals right now,” Argo said in a phone call on Tuesday, December 19. “We’ve been trying to think of traditional and outside-the-box methods to recruit new talent. In addition to significant sign-on bonuses, we’re working to establish unique programs like Bassett Career Advancement and Retention Experience for Students, which will encourage nursing students to stay in the area.”

Bassett CARES is a workforce development partnership with SUNY Oneonta and Hartwick College that officially started in October. Annually, up to 50 recent graduates who receive a bachelor’s degree or greater at either school and who accept any role at Bassett Healthcare Network can receive up to $25,000.00 in loan repayment stipends. They receive $5,000.00 every six months. All Bassett positions, including healthcare, maintenance, clerical, and administration workers, are eligible. Additionally, Bassett’s website offers signing bonuses up to $35,000.00 for RNs, $20,000.00 for LPNs, and other five-digit bonuses for a variety of additional staff.

“We want to draw caregivers who want to stay in the area, who want to work and build a life and career here,” Argo said. “In the short term, we’ve had to necessarily supplement permanent staff with temporary ones to maintain high-quality care for our patients.”

Still, in the short term, nurses have not seen changes on the ground.

“Our concern is that the hospital is not doing enough to recruit people and to retain the staff they have,” another nurse told “The Freeman’s Journal” and “Hometown Oneonta.” “We’re asking for better working conditions, better wages and better care for the community. Almost all the nurses at night are travelers, who don’t always have the training or experience with the floors they’re on, and they’re never as dedicated to the community or to the hospital. It’s not that we don’t appreciate having them, of course, but we would like to see the administration work harder toward a more permanent staffing solution.”
Nurse Earl was especially concerned with patient health and safety.

“Things are critical right now,” she continued. “You have to factor in the acuity of the patients. If someone is in highly acute condition, you could wind up with nearly the entire shift taking care of them and only one nurse to look out for the rest of the patients. We have a lack of nursing resources, a lack of auxiliary staff and technicians. We’ve been told that they’re hiring additional staff, but we haven’t seen that on the ground.”

In addition to the short-term expenses of hiring and training temp nurses, NYSNA representatives called attention to some of the hospital’s other financial outlays.

“Instead of investing in the local nurses that make the hospital run, Bassett Healthcare Network is spending exorbitant amounts on executive pay,” the NYSNA release continued. “In 2021, 11 executives at A.O. Fox received six-figure salaries, with some experiencing double-digit increases in total compensation from the previous year while the COVID-19 pandemic was raging. The manager of nursing care received an alarming 69 percent increase in total compensation during the same period.”

At press time, Bassett personnel did not have detailed information on compensation for executives or temporary nursing staff. However, they noted that Bassett Healthcare Network recruited 323 new permanent RN and LPN staff members to date in 2023, 33 of which are at Fox. This is a marked improvement over 2022, when 133 nurses were recruited across the network, including 18 at Fox.

Many arguments can be made about the merits of strong executive compensation to attract top talent from around the world, relative to stronger compensation for the healthcare staff on the ground. In an increasingly cutthroat industry menaced every day by rising costs and falling revenues, rural health systems will need strong leadership if they are to survive and prosper. On the other hand, the nurses feel an extra nurse or two in rotation will have a far greater impact on individual patient outcomes than the beefed-up executive compensation that the same money could buy. Hands-on healthcare providers also, of course, tend to come from a lower socioeconomic background than executives do. They are less likely to move in and out of the local area in search of the next step in their career, and are more likely to establish lasting homes and families here. As Diane Earl’s life demonstrates, Bassett and Fox have the potential to recruit lifelong Otsego County homeowners, taxpayers, local business and culture patrons, parents, grandparents, friends, volunteers, and all-around community members by making it economically possible for nurses to establish permanent livelihoods here.

“The patients in our community deserve enough staff to properly care for them,” Earl concluded. “We’ve had to do more and more with less and less for years. I’m calling on A.O. Fox to devote the resources and staff to properly care for them.”