New York-based Mt. Sinai Hospital owes staff nurses $127,000 after arbitrators determined the hospital system has consistently understaffed the neonatal intensive care unit (NICU). This all stems from the historic NY nurses strike earlier this year. This is the first time a hospital system has been found financially liable for violating the contractual agreements made to end that strike.
In January 2023, thousands of New York nurses went on strike to advocate for safe staffing. The New York State Nurses Association (NYSNA) members at Mount Sinai ratified new contracts as a result, which included the following provisions:
Updated nurse-to-patient ratios with regard to unit type and patient acuity
Ensure adequate staffing so that nurse: patient ratios are not violated during breaks
Staffing committees are required to have equal staff nurse-to-management membership
The contract outlines the penalties Mt. Sinai faces if they cannot provide safe staffing per the agreement. Mt. Sinai leadership is required to send weekly staffing data to NYSNA to ensure transparency regarding staffing levels and vacancies. NYSNA can use that data to file complaints and seek financial compensation.
According to Politico, the Mt. Sinai NICU is a 46-bed unit with an average census of 52 patients. The union contracted ratio is to be no more than 1:2, with two additional resource nurses always available. However, according to staffing reports, the unit was regularly up to 6 nurses short. That left around two dozen nurses to care for up to 52 medically fragile patients.
NICU fragility varies widely depending on a baby’s support needs. For example, the most critical patients may require 2:1 or 1:1 nursing care. As a patient improves and gets close to discharge, it’s not uncommon to see higher nurse-to-patient ratios. A mandated ratio of 1 nurse to 2 patients gives the NICU nursing leadership flexibility to ensure all patients receive high-quality care without compromising nursing needs.
Timothy S. Taylor was the arbitrator for this dispute. He calculated the penalty of $127,000 based on the average daily base pay of $643 and the number of nurses the unit was short on any given shift. To be fair, he also included a 20% discount in recognition of “extraordinary financial efforts Mount Sinai Hospital has made to address staffing and meet ratios.”
According to NYSNA, the fine should be dispersed amongst the approximately 150 nurses affected by this short staffing.
“Mount Sinai is appropriately resourced to provide excellent care for our NICU babies and families, and we continue to recruit top caregiver talent to maintain the highest standards of clinical quality. The ratios included in the agreement with NYSNA ignore the reality that our NICU consists of two sections: NICU East and NICU North. Of the 46 licensed beds, 20 in NICU East are licensed for actual Neonatal Intensive Care, and 26 in NICU North are used predominantly for intermediate/continuing care. Intensive care patients are always staffed at a 1:1-1:2 ratio, while those in intermediate and continuing care are staffed at 1:3 or 1:4, based on the clinical needs of the baby. That said, let us be clear. These penalties are an unfortunate consequence of an agreement negotiated with NSYNA in the waning hours of the strike and do not recognize the superb team care that makes our NICU one of the safest in the nation.”
Over on TikTok, TheNurseErica gave a shout out to the decision, congratulating the NICU nurses who documented the unsafe staffing ratios. One comment reads “This is great news, this is what happens when nurses stick together,” while another said “BOOM! Proud to be a nurse to hear this!!” The reactions are overwhelmingly positive, creating hope for other nurses that are suffering from burnout and unsafe situations.
Safe staffing that enables appropriate, high-quality patient care is a top priority for nurses across the country and the globe. One path forward is holding health systems accountable to their contractual agreements. In addition, nurses will continue to advocate for appropriate working conditions and compensation.