Hospital Fined $127K for “Persistent” Understaffing of NICU

Nurses all over the country have been going on strike to demand lower nurse-patient ratios and safer working conditions. Dozens of nursing unions have used this tactic to get hospitals to make concessions. But what happens when the hospital fails to hold up its end of the bargain after the strike is over?

That’s what happened at New York City’s Mount Sinai. In a first-of-its-kind ruling, the facility was ordered to pay nurses $127,000 after an arbitrator found that it failed to meet contractual requirements related to staffing requirements in the neo intensive care unit, which nurses and administration agreed upon after a January strike. This led to a “persistent pattern” of understaffing in the NICU.  

Following the demonstration in January, the New York State Nurses Association and the hospital worked out new contracts that included lower nurse-patient ratios and equal nurse-to-management ratios. But that didn’t happen.

Failure to comply with the new staffing requirements led the nurses to seek arbitration to hold the hospital accountable.

“We hoped the administration would see this victory [the nurse strike settlement] as a warning to begin increasing the nursing staff throughout the hospital. Instead, units like the NICU continued to be critically understaffed, sometimes by up to eight nurses per shift,” Matt Allen, RN, a labor and delivery nurse at Mount Sinai, told Medscape Medical News.

Allen added that NICU nurses were repeatedly asked to work “dangerously understaffed shifts.”

“They saw it as disrespectful that the hospital wasn’t holding up the ratios they agreed to,” he said.

The independent arbitrator ruled that the 46-bed unit was routinely short on nurses from mid-January to mid-April. Nurses in the ward were asked to care for extremely ill babies and are supposed to care for no more than two patients at a time. As for the sickest infants, the nurse-patient ratio was supposed to be one-to-one. Other nurses in the ward aren’t supposed to have any patients, so they can jump in and assist as needed.

The arbitrator found the hospital violated those terms by understaffing the NICU by as many as six nurses at a time. That left the unit with some two dozen nurses and an average of 52 patients a day.

“This is about life and death for some of our patients,” Meghan Hurlbut, a NICU nurse, told Politico.

After the ruling, the hospital was forced to pay $127,000 to nurses on the ward.

However, the hospital told Medscape that the NICU is appropriately staffed.

“Hospitals everywhere have grappled with nursing and other health care worker shortages, and these are not challenges unique to any health care provider and have been well documented across the city, state and country,” Mount Sinai spokesperson Lucia Lee said.

“We are confident that Mount Sinai is appropriately resourced to provide excellent care as we continue to recruit top caregiver talent and maintain the highest standards of clinical quality for our patients,” Lee added.

The historic penalty was an “unfortunate consequence” of the agreement made between the hospital and the nursing union at the end of the strike. But the ratios set in the agreement do not reflect the fact that the NICU is divided into two sections in which slightly fewer than half of the beds are designated for neonatal intensive care, and the rest are designated for intermediate/continuing care, the statement read.

“Intensive care patients are always staffed at a 1:1 – 1:2 ratio, while those in intermediate/continuing care are staffed 1:3 or 1:4, based on the clinical needs of the baby,” the hospital statement said.

Allen added that the ruling convinced other departments at the hospital to monitor their own ratios. “The hospital administration is finally taking notice,” he said.

The arbitrator, Timothy S. Taylor, calculated the fine based on the average daily base pay of NICU nurses, which comes out to $643 per shift, and the number of nurses short on a given shift. He then gave the hospital a 20 percent discount because he said the penalty amount “does not reflect the extraordinary financial efforts Mount Sinai Hospital has made to address staffing and meet ratios.”

Robert Chersi, the hospital’s director of finance, said the hospital spent over $1.2 million on travel nurses and nearly $592,000 on overtime pay between Jan. 1 and April 30 to properly staff the ICU.

“If you’re five, six nurses short, you feel that,” Hurlbut added. “You just feel like you’re constantly playing catchup.”