Editor’s note: This commentary is by Richard Davis, of Guilford, who has been active in health care reform for 30 years. Semi-retired after a 40-year nursing career, he volunteers at the Brattleboro Walk In Clinic counseling people on insurance options.
In his recent budget address Gov. Phil Scott pointed out that Vermont is spending too much money to hire traveling nurses. He has come to recognize something that has been causing economic pain to Vermont’s health care institutions for many years.
When an institution cannot hire enough nurses from the local community and they want to provide optimum staffing, they often turn to one of the national traveling nurse companies to fill vacancies. The overall cost of contracting with these agencies significantly hurts the bottom line of institutions and that means that overall health care costs increase for everyone eventually.
We all pay more for health care because of staffing shortages at local hospitals. The traveling nurses are given housing and food allowances in most cases and the cost of hiring them is not only financial. Traveling nurses are not part of the fabric of a local community and they are often paid higher hourly wages than the local nurses they work with.
According to a 990 IRS filing for fiscal year 2017, Brattleboro Memorial Hospital paid PPR Travel, a national traveling nurse agency, $1,601,807. In the same year the Brattleboro Retreat paid $1,247,719 to Medical Solutions, also a national traveling nurse agency. It would be helpful to know how much of that money could have been saved if local nurses were hired, but it is clear these institutions are paying a lot of money for staffing because of recruitment problems.
When these hospitals are asked why they can’t hire enough local nurses they usually say that there is a nationwide nursing shortage and that this problem is just a reflection of that situation. That may explain part of the problem, but we need to dig deeper to understand that there may be additional reasons for the staffing shortages.
Consider that fact that Vermont is surrounded by states that have outlawed institutions from forcing nurses to work overtime when there are staffing shortages. New York, New Hampshire, Connecticut, Massachusetts and Rhode Island are among 18 states that outlaw mandatory overtime.
A nurse works an eight-hour shift and near the end of the eight hours is told that they have to stay another eight hours because the evening or night nurse called in sick. The nurse is threatened with firing if he or she does not stay an additional eight hours. Who would want to go to work with that threat looming over them every time they simply try to do the job they were hired for?
If Scott is serious about cutting down on the use of traveling nurses he would do well to consider pushing the Vermont Legislature to pass H.313, a bill now sitting in the House Health Care Committee, that would ban mandatory overtime. The bill also establishes safe patient handling programs and would require the Department of Health to adopt rules for safe staff-to-patient ratios.
The mandatory overtime issue is especially relevant to the corner of the state we live in because nurses who live in Brattleboro, or in southern Vermont, can easily find work in New Hampshire or Massachusetts without having to worry if they won’t be able to get their kids to school or miss important appointments because they have to choose between losing their job or working hours they were not scheduled for.
Wages also play a factor in nurse recruitment. While it may not be fair to compare Vermont to Massachusetts when it comes to nurse salaries, Vermont is close to other New England states in level of pay. But keep in mind that according to the Nightingale College website, “The average salary for a Registered Nurse in Vermont is $69,160, which is below the national average for RN’s viewed across all U.S. states. The monthly salary is $5,763 and it breaks down as an average of $31.61 per hour. The average BSN Nurse Salary in Vermont is $79,870, with an hourly wage of $38.40.
In my experience of 40 years of working in various health care settings as a registered nurse, it is often a struggle for nurses to improve their working conditions within health care institutions because they are operated like dictatorships. Management pays lip service to the fair treatment of their workers, but that is often not reflected in the rules that employees must follow.
There will never be equity within those insular institutions run by the top 1% of wage earners, but we can make some progress with little steps as we push for the elimination of mandatory overtime and fight the constant battle for fair wages.
