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Nursing Unions Say For-Profit Health Care Is Driving Omicron Staffing Crisis

Nurses argue for-profit health care artificially deflates staffing levels to protect hospital employers’ bottom lines.

A registered nurse takes part in a rally outside the Kaiser Permanente Oakland Medical Center on January 13, 2022, in Oakland, California, in response to a California Department of Public Health decision to let asymptomatic, COVID-positive health care workers return to work without isolating or testing.

As the Omicron wave crests in the northeast, burned-out nurses across the country are again turning to collective action, including rotating walkouts and demonstrations, at dozens of hospitals across more than 11 states and the nation’s capital. As some hospitals teeter dangerously close buckling under the strain of a record high number of COVID-19 patients, nursing unions are urging a competent and comprehensive pandemic response — and calling out the role of for-profit health care in the burgeoning crisis.

Registered nurses (RNs) are protesting ever-worsening conditions for both patients and health care workers, including dangerous under-staffing and weakening of federal COVID safety standards amid the Omicron peak, with the United States, as of Monday, averaging over 790,000 new daily cases. The tally is likely an undercount, as many states did not release new data because of the Martin Luther King Jr. Day holiday.

Last week, RNs with National Nurses United (NNU) held a candlelight vigil outside the White House to commemorate colleagues who have died from COVID-19. They set out 481 candles to represent the 481 RN COVID-19 deaths in the U.S., which has the highest known COVID death toll in the world. According to NNU tracking data, more than 4,700 U.S. health care workers have died after being infected with COVID.

Some hospital systems remain close to collapse as they struggle to provide care for 156,505 COVID-positive patients, according to data released Monday from the U.S. Department of Health and Human Services, surpassing records set during last winter’s Delta surge. The surge has meant some hospitals are halting non-urgent procedures and relying on National Guard personnel to fill in critical staffing gaps. Last week, President Joe Biden deployed 1,000 military medical personnel to six states where hospitals are overwhelmed.

RNs across the country are pointing to the hospital capacity crisis to push back against state and federal COVID safety protocol rollbacks, including at the Centers for Disease Control and Prevention (CDC) and Occupational Health and Safety Administration (OSHA), that further weaken COVID isolation guidelines and protections for health care workers.

The CDC’s weakening of isolations guidelines has led to many hospitals and health care facilities compelling COVID-positive doctors and nurses to return to work. Hospital and clinic administrations have argued that such moves are the only way to keep their doors open amid skyrocketing hospitalizations.

Nursing unions have criticized the Biden administration’s focus on protecting employers’ interests, which they say has hampered his administration’s pandemic response from being able to quickly adapt to new and predictable variants. While NNU President Zenei Triunfo-Cortez applauded the U.S. Supreme Court’s 5-4 decision last week to uphold a Biden administration order requiring COVID-19 vaccination for health care workers at facilities receiving federal money, she said in a statement that vaccine requirements for health care workers must be just one part of a more competent and comprehensive federal pandemic response.

Triunfo-Cortez said the recent Supreme Court ruling “should be a signal to the Department of Labor and [OSHA] to take the next necessary step — extending the Emergency Temporary Standard (ETS) issued last June until adopting a permanent standard based on it for health care workplaces.” Despite the emergence and rapid spread of Omicron in the U.S., the Labor Department allowed its ETS, which imposed mandatory requirements for health care employers on infection control protections, to expire last month.

State and federal officials have called the expiration and similar moves necessary to keep hospitals staffed amid the Omicron surge, but many RNs are calling this argument a distraction, noting that the for-profit health care system artificially deflates staffing levels to protect hospital employers’ bottom lines. They are renewing calls to end the for-profit health care system altogether and move to a single-payer system. Under a single-payer system, NNU argues, hospitals could, and likely would, have been staffed-up such that facilities could safely weather the temporary loss of employees who were out sick.

Profit-driven hospitals’ continual failure to invest in safe staffing is what’s creating the kind of dangerous working conditions driving nurses away from the profession at a time when they are needed most, unionized RNs say. “Nurses will tell you we are failing because we have let the interests of corporations and our hospital employers dictate our country’s response to this virus. Their goal is profit, not saving lives,” Triunfo-Cortez said during a press conference last week.

NNU conducted a survey of thousands of RNs across the country from October to December, 2021. Of those who responded, 83 percent said at least half of their shifts were unsafely staffed. Sixty-eight percent said they have considered leaving their position. Immediately increasing staffing levels and growing the pool of available nurses is what’s needed to prevent rising burnout and resignations, the nurses’ union argues.

Elizabeth Lalasz, an NNU union steward and registered medical surgical nurse at the Stroger Hospital in Chicago, Illinois, the flagship hospital of the Cook County Health System, tells Truthout that after her union struck last June, hospital management agreed to hire 300 additional nurses. That’s the kind of collective action that she says is necessary amid the Omicron surge.

Lalasz tells Truthout that solidarity with other frontline workers in Chicago isn’t simply a choice for nurses but a necessity. Nurses realized that if they didn’t support the Chicago Teachers Union in its recent work stoppage across the Chicago Public School system, the city’s hospitals might be more overwhelmed than they already are, she says. “[Teachers] were [originally] asking to be remote until January 18, which would have helped us in the hospitals to bring down the volume of COVID patients,” Lalasz says. “That kind of solidarity, seeing that connection, I think is integral to us seeing how our struggle is tied.”

She also echoed Triunfo-Cortez in identifying the for-profit health care system as the primary driver of unsafe staffing, noting, “When you’re for-profit, what you’re thinking about is that bottom line, like, ‘How can I cut a corner?’” In such a calculation, labor costs for nurses are seen as “expensive” — so those costs are lowered even when it’s unsafe to do so, she says.

RNs Back Single-Payer in California

The fight for both increased staffing and single-payer is heating up in California, where 18 unionized hospitals held actions last week amid Gov. Gavin Newsom and the California Department of Public Health’s (CDPH) decision to let the hospital management force infected but asymptomatic health care workers back to work without isolation or testing.

The moves come as Los Angeles County on Monday reported more than 31,500 new COVID cases — a nearly tenfold increase from a month ago — and as the number of COVID-positive patients in Sacramento County hospitals has reached a record pandemic high.

But even as nurses with the California Nurses Association (CNA) and NNU condemned the governor’s actions, they also held demonstrations in favor of two bills before the California state legislature that would create a state-run, single-payer health care system.

The first bill, the California Guaranteed Healthcare for All Act, Assembly Bill 1400, passed out of the legislature’s Assembly Health Committee in an 11-3 vote. The bill would do away with California’s for-profit health care system, removing private health insurance companies from the picture entirely. All Californians would be switched to a new universal plan called “CalCare” that would cut health care costs by eliminating insurance company overhead and profits while also forcing reductions in provider fees and drug prices.

The bill’s outcome remains uncertain, as it would require passage of a separate funding plan outlining the largest state tax increase in history, estimated at $163 billion, which would need to be approved by voters in an amendment to the California constitution. The bills not only face skeptical Democratic assembly members, but also entrenched opposition from powerful lobbies for doctors and insurance companies. This comes as Governor Newsom unveiled his own $286-billion state budget plan that would allow undocumented people to sign up for Medi-Cal, the state’s health program for low-income Californians.

CNA President Cathy Kennedy supported the single-payer health care proposal, highlighting inequities in health care access exacerbated by the COVID-19 pandemic. “This for-profit health care system has cost lives, all so that a few health insurance executives can line their pockets,” she told the Guardian last week.

Kennedy also took issue with Governor Newsom and the CDPH, telling reporters during a press conference that the decision to allow infected nurses back to work “doesn’t make any sense, and it’s unconscionable. Eliminating the isolation time and sending asymptomatic or exposed health care workers to work will guarantee more preventable transmission, infections, hospitalizations and death. By doing all of this, Governor Newsom and the CDPH are in effect guaranteeing more transmission…. Hospitals are supposed to be centers of healing, not centers of infection.”

NNU’s Triunfo-Cortez likewise pointed out that, at the start of the pandemic, the hospital industry in California petitioned Governor Newsom and CDPH to waive the state’s minimum nurse-to-patient ratio standards, rather than opting to hire additional staff. The waiver was rescinded, she says, after the California Nurses Association pushed back. Yet, nurses in California continue to experience a staffing crisis even with the state’s stronger nurse-to-patient ratio regulations in place.

That’s why passage of the single-payer bills, nurses say, is so critical. Assembly Constitutional Amendment 11, which would establish a concrete package of taxes to pay for the CalCare plan, sets the new proposal apart from the state’s failed 2017 single-payer proposal. Voters, however, would need to pass the tax hikes, which may not happen until 2024.

AB 1400 comes not only amid the Omicron surge, but also as more than 70 percent of the nation’s largest health insurers have ended COVID treatment cost waivers, exposing even insured and vaccinated patients to astronomical bills and potentially even financial ruin if they require treatment.

“We’re here to emphasize, as we enter the third year of this deadly pandemic, that [the current pandemic response] is not sustainable,” said CNA and NNU Executive Director Bonnie Castillo during last week’s press call. “Nurses that have already given our all, we’re running on beyond empty. We need our employers and our elected officials at the federal state and local levels to give us protections based on science, not just what’s good for business. Nurses have been saying all along that if hospital employers, our elected officials in the public, don’t do what we need to do to control this virus, there may not be a nurse to take care of you when you are in that hospital bed. And I want to … [emphasize] that that day is here.”