NEW YORK - Ambulances have been diverted, elective procedures canceled and as many patients as possible have been discharged as Montefiore Medical Center in the Bronx grapples with a nurses' strike that stretched into its third day Wednesday.
With 3,500 nurses off the job, the hospital has called in temporary nurses, and the mayor asked people to dial 911 only when necessary. The emergency room waiting area has been largely quiet.
But conditions deeper inside one of the borough's main hospitals - and in another of the city's major hospitals, Mount Sinai in Manhattan, where another 3,600 nurses are on strike - are even more tumultuous than usual, patients and staff members said, as a crew of temporary and redeployed workers tried to care for people in the nurses' absence.
"It's very chaotic," said Ana Hare, 60, who was being discharged from Montefiore on Tuesday morning after six days in the hospital for treatment of a heart condition. She said she had waited until 11:30 a.m. that morning to get her 9 a.m. medicine, in contrast to the smooth care she had received at the start of her stay.
On the picket line in New York City's largest nurse strike in decades, nurses said they were worried about conditions inside. But they were outside the buildings for now, they said, because they wanted to improve care so they could keep patients safer in the longer term. At Montefiore, a vital safety-net hospital in the northeast Bronx, nurses said one of the main reasons they were striking was that tumultuous was too often the norm.
Ana Villeda, an emergency room nurse, said her work environment often resembled a New York City parking garage, with rolling stretchers stacked several deep. In order to reach patients, nurses have to pull down the rails of the stretchers to squeeze between them.
Because of a shortage of poles for intravenous fluid bags, nurses sometimes have to hang the bags from the walls and curtains. One nurse can have as many as 15 patients, and even more when covering for a colleague who is on break.
"You pile the patients in," she said. "You can have a psychiatric patient screaming while you are intubating a patient, right next to each other. It's so dangerous." Last week, she said, one man with abdominal pain had waited in a chair for three hours before staff members realized he was having a heart attack. "You do the best you can," she said.
Nurses, both at Montefiore in the Bronx and at Mount Sinai in Manhattan, said they were hoping they could alleviate chronic understaffing by negotiating contracts that mandate that managers adhere to minimum staffing levels.
This is the first contract being negotiated since before the pandemic began, and understaffing, long an issue, has grown as a problem as hospitals have failed to replace nurses who have left, either to pursue higher-paying jobs or because of trauma and burnout after several COVID-19 waves. Both Mount Sinai and Montefiore have hundreds of open nursing positions, which managers blame on the national nursing shortage but which the union believes could be filled by increasing pay and improving working conditions.
"What do we want?" the nurses chanted outside Montefiore on Tuesday. "Safe staffing!"
At Montefiore, nurses and managers returned to the bargaining table for continued talks Tuesday morning. At Mount Sinai's main campus on Fifth Avenue, talks had been stalled since early Monday, with each side blaming the other for the inaction.
Both hospitals said they were open for business and that patient safety remained their top priority. An outpatient center across from Montefiore's main campus was busy Tuesday, and patients continued to trickle into both the pediatric and adult emergency rooms.
"Contingency plans remain in place to ensure our hospitals remain open," the hospital said in a statement.
Lucia Lee, a spokesperson for Mount Sinai, acknowledged that the situation was "impossible" but said the hospital was coping, thanks to the support of the staff members who were still at work. "We are weathering through it," she said. "We are trying to be resilient."
The main campus of Mount Sinai is down to about 525 patients, from its typical 1,100, as patients are transferred to Mount Sinai West and Mount Sinai Morningside, where union agreements have already been reached, she said. "This is a strike crisis, and we are responding to it," she said.
One nurse manager at Mount Sinai, who asked that her name be withheld to protect her job, described conditions over the past two days that she felt had been dangerous for patients. She said that managers had been told that more temporary travel nurses would be hired to help cover for the striking nurses but that many of them apparently did not show up and that the working conditions for those filling in were not sustainable.
Across the hospital, nursing managers have been pressed into service as floor nurses, even those who have not dealt directly with patients for a long time, she said. Some don't know how to use all the equipment, so they are leaning heavily on the travel nurses who are there, she said, and the travel nurses are not familiar with all of the equipment, either.
Both hospitals originated from 19th century Jewish philanthropic efforts, and both have undertaken breakneck expansion efforts over the past decade. But they are very different institutions.
Facing Central Park, Mount Sinai draws many patients from both East Harlem and the Upper East Side, but also from elsewhere in the city. More patients have commercial insurance, rather than government-sponsored Medicaid, which means that the hospital is paid better for each patient than hospitals in other boroughs, where more patients tend to have lower-reimbursing Medicaid.
A decade ago, Mount Sinai merged with another network of hospitals that included Beth Israel and the two campuses of St. Luke's Roosevelt, emerging as one of the largest hospital systems in the city. The strike affects only the main Mount Sinai campus.
Montefiore, the largest hospital system in the Bronx, has tried to emphasize that its financial position is very different from those of other hospitals negotiating with the nurses' union. There are strikes at three campuses, including the Moses campus, its main site. Medicaid patients outnumber those with commercial insurance 2-to-1. In a statement last week, a Montefiore vice president, Joe Solmonese, noted that the system had lost $200 million last year, while some of the major hospital systems negotiating with the nurses' union were running at a profit.
But Montefiore has also expanded over the last decade, acquiring several hospitals in Westchester County and the lower Hudson Valley. More recently, job postings at Montefiore have indicated that it is planning to open "a concierge/executive medicine" service, based at Hudson Yards, a pricey neighborhood on Manhattan's West Side, in search of more patients with commercial insurance.
After contracts between the New York State Nursing Association and about a dozen private hospitals in the city expired Dec. 31, eight hospitals have come to tentative agreements or ratified them. All of the hospitals have agreed to wage increases that total about 19% over three years, an offer also on the table at Montefiore and Mount Sinai.
But there remain sticking points. At Montefiore, nurses want the management to address the problem of overcrowding in the emergency department and the practice of boarding patients in hallways for long stretches, said Judy Sheridan-Gonzalez, a nurse on the negotiating committee. They also are asking for hiring bonuses to attract new nurses and better enforcement of patient-nurse ratios.
"We want to be with our patients," said Michelle Gonzalez, a Montefiore nurse. "We want be taking care of our community, but give us the resources that we need to do that."
At Mount Sinai, nurses are asking for nurse-to-patient ratios that have an enforcement mechanism so they cannot be ignored. Currently, nurses may file a protest letter when they are asked to care for more patients than in the last union contract. The management then signs the letter. This happens so frequently that the letters are sometimes referred to as "wallpaper," the nursing manager said.
To deal with the nursing strike, Mount Sinai transferred fragile premature infants out of the newborn intensive care unit. Doctors and physician assistants are pitching in. Some said that for now, staff members appeared to be managing to care for the patients, but not easily.
Olivia Early, who trains hospital workers to operate electronic medical records software, said on Tuesday that the scene inside Mount Sinai the day before had been "chaotic," as patients received care from a visibly stretched staff that included fill-ins from other Mount Sinai sites and doctors thrust into "nurse-like roles."
But despite the scramble, Early said she had seen no lapses in patient care in the wing where she was working Monday. "There's none yet, thank God," she said.
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