Union contracts covering 22,000 healthcare workers at HCA, the largest hospital corporation in the US, are expiring in the coming months at 30 hospitals in five states as healthcare workers push the company to address chronic understaffing they say burns out workers and jeopardizes patient safety.
A study published in January 2023 by Service Employees International Union (SEIU) found staffing ratios at HCA Hospitals in 2020 were significantly lower than state averages in 19 of 20 states where HCA operates facilities and 30% lower than national averages.
Workers contacted by the Guardian said the corporation had the money to fix staffing issues. HCA spent $8bn on stock buybacks and reported a profit of about $7bn in 2021 and $5.6 bn in 2022, while many HCA workers are paid less than $15 an hour. From 2011 to 2021, HCA paid out $4.9bn in dividends to shareholders and spent $26.9bn on stock buybacks.
In Las Vegas, Nevada, Jody Domineck, a pediatric nurse for 18 years, said among 4,700 members across the three hospitals in town, the primary issues facing healthcare workers are the lack of safe staffing and resources required to take care of patients.
“Working short-staffed means that one kid is having trouble breathing and one kid is in excruciating pain, and I have to decide where to go because there’s only one of me, which means somebody waits,” Domineck said. “It means that I’ve had to walk away from a mom that’s worried about her kid because I have to go check on the other patients because there’s not enough people to do both. It means that at the end of the day, I sit in my car and I cry because I did everything and I know it wasn’t enough for all of them, that our patients deserve more.”
She said the understaffing has driven high turnover and it puts workers’ nursing licenses at risk because of the heightened risk of missing something or making a mistake because each nurse is responsible for too many patients.
“It’s a huge burden and at some point, people can’t tolerate that anymore, they can’t survive under that, so we’ve lost a lot of bedside nurses,” added Domineck. “We’ve seen that HCA made billions in profits last year. We would really like to see them invest that to improve patient care, improve staffing ratios and improve the working conditions for the staff.”
In a survey conducted by SEIU in January 2022 of 1,500 nurses in HCA hospitals, 89% agreed short staffing is compromising patient care at their hospitals. Among HCA workers surveyed in Florida, 47% reported wanting to leave their job due to burnout.
Penny Ceasar, a unit secretary at HCA Florida Westside Hospital in Plantation, Florida, since 2008, described chronic understaffing at her hospital, low and stagnant wages and high turnover that have deteriorated working conditions and patient care.
“The patients complain. They’re waiting 30 minutes to go to the bathroom -now they need their own bed changed. That they’ve been waiting over 30 minutes for pain meds. The weekends are the worst. They’re really understaffed on the weekends,” said Ceasar. “I love my job and all my nurses love their job, but we’ve been burned out. We really get burnt out.”
She argued patient-to-nurse ratios are high to the point where workers can’t take breaks because there is no coverage, that many nurses have left through the Covid-19 pandemic because they can make more money working as travel nurses, and that the hospital hasn’t made efforts to resolve staffing issues and if workers complain, they get disciplined with write-ups.
“We’re so understaffed because the nurses are so overworked. They want to keep calling us heroes and the families of patients ask: ‘Why are they calling you heroes and they’re not giving us the proper staff?’” said Ceasar. “They see it, we don’t have to tell them.”
Bella Panchal, a speech pathologist at HCA-owned Riverside Community Hospital in Riverside, California, since 2018, also claimed her hospital suffers from chronic understaffing and the constant burnout and turnover it induces, especially given the traumatic conditions many nurses worked under during the Covid-19 pandemic. Her hospital lost three workers to Covid-19, and many nurses had to take on the burden of holding patients’ hands as they passed away in hospitals, without family members being able to sit by their side due to Covid-19 lockdown protocols.
“It was horrifying for the nurses,” Panchal said. “A lot of the nurses have PTSD.”
Due to the chronic understaffing, Panchal claimed the workplace culture at the hospital is one where workers often have to skip breaks and work past their scheduled shift unpaid.
“We almost never take a break. If I were to take a break, I wouldn’t have finished my work,” said Panchal. “Unfortunately, with HCA, they want you to work every other weekend, so there’s very little work and life balance and you’re running ragged when you are working, so it’s very stressful.”
She argued HCA needs to invest in improving workplace cultures and conditions and hiring workers as staff rather than on a per diem basis.
“They have the money, they can do it,” added Panchal.
HCA did not respond to multiple requests for comment on this story.
