PEF testifies low staffing undercuts state health, Medicaid services
Story and photo by Sherry Halbrook
PEF members Nora Higgins and Kenneth Ferro in February delivered the union’s testimony on health and Medicaid issues in the NYS Executive Budget proposal for 2017-18, stressing the need for improved staffing.
PEF Region 12 Coordinator Nora Higgins, a teaching and research center nurse 2 at SUNY Stony Brook Medical Center, told legislators at the Joint Legislative Public Hearing in Albany how demoralizing it is for nurses and many state employees to always be put in situations where they must “do more with less.”
The shortage of nurses, she said, is partly caused by an unwillingness of new nurses to work for the state and the “multitude of nurses leaving the state” to retire or avoid the risk of losing their nursing license, which is a heightened problem in understaffed state facilities.
The lack of sufficient nurses makes work harder for those who are on the job, and it prompts the state to ignore its own law that prohibits forcing nurses to work overtime except in emergencies. “State agencies continue to violate it with no penalty,” Higgins said. Short staffing also means state nurses may not be allowed to use their leave accruals.
“Since 2009, there have been 4,018 instances of mandatory overtime involving Department of Corrections and Community Supervision nurses,” she said.
Uncompetitive pay affects both the retention and the recruitment of nurses by state health care facilities. The private sector often pays nurses $10,000 to $15,000 more per year, than the state pays, Higgins said.
Factors that drive nurses to leave their state jobs include physical assaults and unreasonably high ratios of patients to care for, at times on different units or in separate buildings. Nurses are too harried to take a meal break, and the more tired they get the greater the danger they will make a mistake, Higgins said.
The actions of the state Justice Center for the Protection of People with Special Needs has become a major factor driving the nurse shortage at state facilities, Higgins said. The center’s investigations hurt morale and may remove one or more staff during investigations, exacerbating short staffing. Replacing them with unfamiliar staff creates a stressful and potentially dangerous situation for both patients and caregivers.
The state should review and upgrade its civil service classification of nursing titles, Higgins said.
“Nurses save lives on a daily basis, keep patients alive, offer comfort to the families and provide care to the neediest citizens, but they are still at the bottom of the civil service titles,” Higgins said. “The key to encourage more nurses to remain in state service or return to working in the state system is to improve working conditions and compensation.”
She urged the legislators to pass the safe staffing bill, impose a penalty for violating the ban on mandatory overtime, improve nurses’ pay and revise the Justice Center’s approach.
Ferro, a member of the PEF Executive Board, said that while areas affected by the Affordable Care Act and the Medicaid Takeover program have grown, other areas of state health and Medicaid services remain woefully short staffed.
Any initial savings from understaffing will be more than offset by service shortcuts that inevitably follow, he said.
Ferro said the state’s budget focus for health and Medicaid is on streamlining processes, eliminating functions, contracting for work, conducting audits and inspections and closing or consolidating state facilities, but such economies have reduced safeguards, such as allowing a licensed professional certification as an alternative to project review by the department.
“It is now the primary approval method used to oversee the health and safety of all NYS hospital patients and nursing home residents. Self-certification projects were supposed to be audited (by DOH), but, to date, we don’t believe any projects have been audited.”
Ferro said DOH no longer makes sure non-clinical projects comply with codes aimed at protecting the health and safety of both workers and the public. Such protections might have reduced the danger posed by Hurricane Sandy when the emergency power generators at New York University Hospital failed and the patients had to be evacuated in the dark at the height of the storm. Other emergencies include fires at Mount Sinai Hospital and in Montefiore Hospital’s Emergency Department. And Ferro said a patient depending on a ventilator died when an emergency generator failed at Eastchester Nursing Home.
Stronger regulatory enforcement of code compliance and more safety and health inspections and audits could save lives and reduce risks, Ferro said.
“PEF believes … the state should increase staffing levels across the board, as this (understaffing and reduction of oversight) is occurring throughout DOH and the Office of the Medicaid Inspector General. The small savings from low staffing levels and lack of a thorough investigation has cost the state millions of dollars and possibly some lives,” Ferro said.
Ferro also reported the restructuring of certain civil service job titles at the DOH and OMIG have reduced career mobility and encouraged an increase in political appointees who lack familiarity and understanding of the programs. In addition, the Executive Budget would allow some DOH contractors in the health insurance program to be hired into state positions without taking a competitive exam if they meet the open competitive qualifications for taking the exam. “Student assistants” working in the health insurance program also could bypass taking an open competitive exam and still be hired as trainees.
“Training occurs from the bottom up in many instances and (the situation) causes morale issues throughout all agencies. PEF strongly advocates that the workforce be given … career ladders and room for advancement,” Ferro said. PEF also opposes schemes to let contractors and interns take state jobs without taking civil exams and scoring in the top three. In addition, PEF objects to a proposal in the budget to create a Medicaid investigator title series as non-competitive. And the union questions the proposed reduction of OMIG personnel by 6 percent. More staff is needed, Ferro said, to protect the public interest.
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