Downsizing Threatens Health Care in New York
NYSNA outraged, calls cuts "irresponsible"
Nurses Protest State & City Budget Cuts
New York City, May 5,2003 - Just a year ago, Registered Nurses in the New York area could find jobs at the healthcare facilities of their choice. Because of the growing nursing shortage, many healthcare facilities were offering generous bonuses to new hires and incentive packages to retain "veteran" nurses.
Today, the nursing shortage is even more acute. But a prolonged national economic downturn that's taking its toll on the healthcare industry-combined with years of poor decision-making by many healthcare administrators-has brought about actual and planned layoffs
of RNs and support personnel at a level not seen since managed care forced the consolidation of healthcare networks in the mid-1990s.
Cutbacks and closings
Health care has seen cutbacks over the years, but the pace has increased dramatically in recent months. Some facilities have made an effort to avoid laying off employees who have direct patient-care responsibilities and instead have targeted transport, housekeeping, dietary, clerical, and aides. Others are closing or downsizing units and even entire campuses - eliminating RN and support positions in the process.
As this issue of Report went to press, numerous facilities in New York City, Long Island, and Westchester had already made layoffs or announced their plans, including:
*Bayley Seton Hospital, Staten Island
- Announced plans to close the facility on Dec. 31, affecting approximately 100 RN positions.
*Brooklyn Hospital Center
- Downsized its Caledonian campus from an acute-care facility to a clinic. A total of 152 RN positions were affected, with 36 RNs losing their jobs.
*Mary Immaculate Hospital, Queens
- Eliminated approximately 10 support staff positions.
*Montefiore Medical Center, Bronx
- After laying off 65 support staff the month before, Montefiore announced in April it would layoff additional staff. No details were available as of press time about which positions would be affected.
*Mount Sinai Hospital, Manhattan
- Announced a possible 500 to 800 layoffs, affecting all staff. NYSNA is currently working with the hospital to develop alternatives that avoid RN layoffs.
*New York City Health and Hospitals Corporation
- Mayor Bloomberg announced plans to lay off 4,500 city employees, and possibly up to 10,500 more, if employee unions don't come up with $600 million in givebacks.
*Saint Vincents Catholic Medical Center, Manhattan
- Eliminated 11 advance-practice RN positions.
*Sound Shore Medical Center, New Rochelle
- Eliminated 27 support staff positions.
*Southampton Hospital, Long Island
- Eliminated 39 support staff positions.
*Staten Island University Hospital, Staten Island
- Announced it was closing its Concord campus, eliminating 40 staff RN positions.
*Westchester County Health Care Corporation
- Eliminated 17 RN management and education positions as part of a layoff of more than 100 employees.
NYSNA has not seen an accompanying surge in layoffs and closings yet in Upstate New York, but this could change by the year's end.
Why is this happening?
Hospital administrators claim the faltering national economy is to blame for their financial problems. Budget crises in Washington and Albany have meant deeper cuts in Medicare and Medicaid reimbursement. The cost of supplies continues to rise, as does the number of uninsured patients. Major Manhattan medical centers have seen a drop in elective surgeries for patients from outside the city since the events of Sept. 11, 2001.
"Healthcare providers cannot withstand any further cuts and still maintain the quality and availability of services our communities expect and deserve," according to a recent report by a coalition representing healthcare facility administrators in New York state. One of the coalition's member organizations, the Healthcare Association of New York State (HANYS), claimed New York hospitals have lost nearly $1.5 billion since 1998 and have suffered operating losses for more than a decade.
But have the hospitals caused their own troubles?
For example: Losses resulting from its ill-fated merger with New York University Hospital and an inability to rein in its own excessive spending
left Mount Sinai Hospital more than $70 million in the red in 2002. The Westchester County Healthcare Corporation reported a deficit of $8 million. Yet it spent millions on consultants for a reorganization plan that proved to be ineffective, found $10 million to buy Ellenville Hospital, and gave one of its administrators a $90,000 raise.
Meanwhile, the federal government is investigating the finances of Brooklyn Hospital Center - which reported a deficit last year of $17 million - for irregularities.
Brooklyn Hospital closed its Caledonian Campus prior to obtaining approval from the state - much to the anger of the community.
"Severe financial problems have existed for years at many New York hospitals and were only made worse by the poor economy," said Lorraine Seidel, director of NYSNA's Economic & General Welfare Program. "But hospital administrators are making their employees pay the price by slashing labor costs. The problem is that, in health care, this same labor provides the crucial services that patients need. So, in the end, these cuts harm patients most of all."
Losing sight of the human cost
One of NYSNA's primary concerns in the event of layoffs and closings is the quality and availability of care in the affected communities. The closing of Brooklyn Hospital's Caledonian Campus, for example, will leave the Kensington neighborhood without 24-hour access to services. "In the event of an emergency where are people in this area going to go for care?" asked James Ferris, RN, NYSNA nursing representative for the facility. NYSNA contends that even if RNs are not directly affected by a layoff, patient care is. "Every position on a hospital unit is important," said Camille Edwards, RN, NYSNA nursing representative at Sound Shore. "If any position is taken away, the entire process is disrupted. If support staff is cut, tasks still need to be performed. And sometimes RNs are the only staff left on duty to handle them."
Already struggling with skeleton crews to provide the best care they can, overburdened RNs at some hospitals are stretched to the limit. "They're facing an impossible situation with now even greater uncertainty," Seidel said. "These cutbacks are intended to address only the bottom line-they don't take into account their toll on human lives."
Fighting for nurses' rights
NYSNA is fighting to protect RNs' rights. Each NYSNA contract includes provisions enabling veteran RNs to fill vacant positions. Because of the nursing shortage, many of the affected RNs have been able to find jobs within their institutions. But they must often take positions on other shifts, or on units they are not familiar with.
Not every hospital administrator, however, chooses to abide by their contract. For example: "Instead of first eliminating all vacant positions and then all probationary positions - as required by their contract with NYSNA - the Westchester County Healthcare Corporation decided to 'pick and choose' which RNs to lay off and where to reassign them," said Sonia Noll, RN, NYSNA nursing representative. In response, NYSNA fought for the nurses' rights by filing an improper practice charge with the state Public Employment Relations Board and submitting the matter to arbitration.
Staten Island University Hospital, meanwhile, "didn't provide RNs with adequate notice that it would eliminate their positions at its Concord site, nor did it give them a fair opportunity to interview for open positions at the North campus," said Laura Kennedy, RN, NYSNA nursing representative. "NYSNA filed a grievance with the hospital to ensure that the nurses receive the rights to which they are entitled."
"Such irresponsible cost-cutting only leads to deterioration of the work environment and, as a result, a decline in patient care," Seidel said. "Hospital administrators need to take a second look at these decisions and ask themselves: What sort of health care do we want for our patients? Nurses are advocates for their patients. To them this is unacceptable, and we're going to keep fighting until healthcare industry management understands it, too."
Nurses Protest State & City Budget Cuts
With a state budget overdue and layoffs and service reductions proposed for New York City, nurses in the metropolitan area are expressing alarm about their patients' future.
In his budget proposal, Gov. George Pataki called for a $2 billion cut in healthcare spending. In a "doomsday" budget announced on April 15, New York City Mayor Michael Bloomberg outlined major cuts in services and layoffs of up to 10,000 city workers.
Since March, NYSNA members have been working to inform the public about the impact of these cuts and urging lawmakers to make a better choice. Carol Pittman, NYSNA's community affairs representative, said NYSNA members are signing letters and postcards urging Gov. Pataki to reconsider his budget cuts.
NYSNA staff members Nancy Kaleda and Harriet Cooper joined a Municipal Labor Committee emergency bus caravan to Albany to lobby key lawmakers. They expressed the need for the state to provide recurring revenue support to the city. Other union leaders on the caravan included Randi Weingarten of the United Federation of Teachers and Lillian Roberts of District Council 37.
NYSNA nursing representative Eileen McEntarfer, RN, presented testimony at a budget hearing before the New York City Council Health Committee on March 18. She expressed nurses' concerns about the possible closing of 12 out of the 30 HHC Child Health clinics, the elimination of city subsidies for the remaining clinics, and reductions in school nurse programs.
"These cuts will mean that many residents of the five boroughs will not seek early intervention," McEntarfer said. "They will reach the emergency departments sicker, requiring hospitalization. There will be more lost work time, more lost school time. Where are the cost savings here?"
In addition to the cuts to the city's Department of Health and Mental Hygiene, the Mayor's budget proposes to cut $10 million in reimbursement to HHC. His "worst case" proposal includes the closures of or reduction in Saturday and evening hours at clinics.
Accountability sessions organized by the Central Labor Council will be held in each of the five boroughs in late April and early May. These meetings will provide an opportunity for nurses to discuss the budget crisis with lawmakers. At least one NYSNA member nurse will attend each session. Members also are expected to participate in a City Council speak-out on health care. HHC nurses who are interested in getting involved in this campaign may contact Carol Pittman at 212.785.0157, ext. 201.
"NYSNA will continue its fight to support quality health care in the city's public hospitals," said Kaleda. "We intend to be in the forefront of this battle for as long as it takes."
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