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Brian Lehrer: Brian Lehrer on WNYC. We're going to talk again to the head of the New York State Nurses Association in just a couple of minutes. Nancy Hagans was on the show as the nurses' strike was beginning in New York City at a couple of hospitals last week. Well, now, as you all know, that strike has been settled and we're going to talk about what they've won and why it matters both to the nursing profession and to patients here.

We're going to try to get specific about Montefiore, about Mount Sinai, and some other places. To remind you of the background, roughly 7,000 nurses have now returned to work at Mount Sinai and Montefiore Hospitals. This comes after a 3-day strike, led to successful negotiations with the hospital management. Last week, when the strike was beginning, we took calls from nurses and other hospital staff who told us why this strike was necessary in their opinion. Take a listen one more time to a few of those calls.

Doctor: I'm a doctor. I work in one of the major New York hospitals. It's one in which a strike was averted. When we have sometimes a nurse caring for 10, 12, 14 patients at a time, depending on how many nurses might be on break, you can imagine that over the course of an 8 to 12-hour shift, a lot of the things that we need in order to make good, safe decisions about head care for our patients might not be done in a timely manner, and it is not the fault of the nurse, it is the fault of the staffing ratio. They're asked to do impossible tasks.

Speaker 1: I would love to see somebody follow the money because hospitals are lucrative and they do have the means to staff accordingly. However, I feel that the nurse's goodwill and desire to care for people is often exploited and under-attended to. I think it's about time for hospitals to really put their money where their mouth is, with regard to nursing care.

Speaker 2: Safe staffing has been an issue before the pandemic exacerbated after the pandemic. Nurses just are so flexible that if there aren't phlebotomists, if there aren't nursing assistants, they have to pick up the slack, so not only are they doing the nursing work, but they might be doing other support work as well.

Speaker 3: I've just left the picket line and I'm now taking a little bit of a break because it's been very cold, but the nurses are just amazing. They are out there. We are there for the patients and we are really stand fast to how we really want to make sure that our patients are taken care of, and the way that can be done is by having patient ratios. We've asked for that. It's been written in our contracts in the past, but nobody has been able to uphold it.

Brian Lehrer: Voices of nurses and other hospital personnel at the beginning of last week as the 3-day nurses strike at Mount Sinai and Montefiore was beginning. We're going to open up the phones again. New York City nurses, anybody listening who is on staff at Montefiore and Mount Sinai, how have things been since you returned back to work or any of the other hospitals, as well that settled in the days just before there were new contracts at all the hospitals or many of the hospitals? Have you observed any changes yet? 212-433-WNYC 204-339-692. Help explain to everyone else if anybody's listening, not on your shift right now.

Nurses work round the clock, so even at 19 minutes before 11:00 in the morning. Normal workday hours for a lot of people in a lot of jobs. You might be off right now and be able to report to us some of what's changed, if anything, since the negotiations and strike at two of the hospitals and the settlements. 212-433-WNYC, 2-124-339-692, or tweet @BrianLehrer and with us now to discuss the strike. Follow up is Nancy Hagans, president of the New York State Nurses Association, the union representing the nurses. She was last here on the morning the strike began. Nancy, congratulations, if that's the right word, and welcome back to WNYC.

Nancy Hagans: Thank you. Good morning. How are you today?

Brian Lehrer: I'm okay. Thank you very much. What were the patient-to-nurse ratios before the strike and what changed in terms of any numbers that you can share to help people understand what you want?

Nancy Hagans: Well, before the strike, our nurse could carry up to 20 patients in the emergency room. A nurse could carry up to three to four patients in an intensive care. Right now, our issues are going to be 1:1, 1:2 in the emergency rooms. It's according to the patient security, how sick the patients are. I just wanted everybody to know we appreciate everybody's support, but the work just began just because we were able to achieve those numbers and our contracts but we want to continue to do the work. Now, this is when the hard work begins because the hospitals will have to oblige and they have to be accountable and take the sensibilities and hire more nurses in order to achieve that goal.

Brian Lehrer: Do you think anything would have changed yet, or is it too early to see it based on what you just said?

Nancy Hagans: Well, it's an ongoing work. The promise is to continue to hire nurses, and one of the reasons we wanted them to do it, the patients were a top priorities. In order to return and attract nurses, we had to change the ratios. We had to address the wages and we also had to provide good medical coverage for our nurses. We've able to achieve that in our contract.

Now, the hard work begins where labor and management have to intensively work together in other to hire more nurses. We have to be able to attract and bring more nurses to the bedside. We do have different plans to start going to local schools and also encourage the younger people in high school that are attending college right now to go into the nursing profession. [crosstalk]

Brian Lehrer: Oh, you want to make that pitch? Is it difficult? Are people not going into nursing in the first place at the rate that you need for all the openings?

Nancy Hagans: Well, after the pandemics and the way we work, we not only had to care for patients, we had to do the non-nursing functions. As a young person, if you hearing your parents coming home and say, "I'm a nurse and I'm working hard and I'm never taking a break," so we are not going to be able to attract a person. If we have good patient-nurse ratios, if we have better salaries, if we have better coverage, then we could start attracting people to come in the profession and retain them. Hiring somebody is one thing, but able to keep that person in that job is another.

Brian Lehrer: A friend of mine--

Nancy Hagans: That's why I said this is the hard work right now.

Brian Lehrer: Yes. We can take phone calls if anybody out there is considering yourself becoming a nurse. Maybe you thought about it before the pandemic and you were dissuaded by the rigors of the demands on the job during the pandemic, and now you're thinking, "Well, maybe I can still become a nurse. Maybe that's still the best choice for me," or if you know anyone in that position, your own child who's in college now or anything else. 212-433-WNYC, 2124-339-692, or any other questions for Nancy Hagans, president of the New York State Nurses Association after this strike.

Someone I know floated a theory to me yesterday. This is just speculation from the person who's got a business background, but I'm curious to get your reaction. This person was suggesting that the reason that it came to a strike at Mount Sinai and Montefiore in particular, whereas you were able to settle without a strike at the other hospitals, is that perhaps Mount Sinai and Montefiore have a higher ratio of patients who are paid for by Medicare and Medicaid as opposed to private insurance. Some of the other hospitals have a higher private insurance population and private insurance reimburses more so Mount Sinai and Montefiore are more financially stressed than the other hospitals in the negotiation. Again, that's just speculation, just the theory from somebody I know in business, but is that true?

Nancy Hagans: Well, there are a lot of safety net hospital that settled the contract without going a strike. You have Maimonides Medical Center who's a safety net hospital, Flushing Medical Center in Queens, a safety net hospital. As a matter of fact, Mount Sinai is not a saftey net hospital, and Montefiore. What do I mean by that? Safe net hospital, you have a higher Medicare and Medicaid patients. I would strongly disagree with that person. Concern was our patients and how we care for our patients. From day one, we said we wanted more nurses. We wanted to have safe nurse-patient ratios in order for us to continue to care for our patients. That's what we've achieved, and the hard work starts now.

Brian Lehrer: It might be interesting for people to hear even more about what you mean by safety net hospitals because people might consider the public hospitals the actual public hospitals, Elmhurst Hospital, Kings County Hospital that are New York City public hospitals as the safety net hospitals. The ones you are negotiating with, including the ones you just mentioned, Flushing, Maimonides, those are private hospitals. What's the difference between a private safety net hospital and a public one?

Nancy Hagans: Those hospitals are considered nonprofit hospital. The nonprofit, the Brooklyn Hospital, the safety net. Safety net means that your patients, the patients that are coming in are not as high as commercial insurance patients. Most of the patients are Medicare and Medicaid patients. That's how the hospitals get reimbursed mostly. They do have usually it's over 50% to 60% of the patients they are Medicare and Medicaid patients. That's what would consider to be a safety net hospital.

Brian Lehrer: Let's take a phone call from--

Nancy Hagans: They rely on the state and the federal funding.

Brian Lehrer: Got it. Whether or not they're public hospitals, it's defined by their populations.

Nancy Hagans: Correct.

Brian Lehrer: Sounds like you're saying.

Nancy Hagans: That's the reason we put patients over profits because most of these hospitals consider themselves a nonprofit hospital, but we wanted them to put the patients before profits.

Brian Lehrer: Yes, although every hospital in New York State under New York State law has to be a non-profit hospital, New York Presbyterian, NYU, whatever big hospital you want to mention, they all have to be non-profits. When you say put patients over profits, where does that actually come into play in a non-profit-only system?

Nancy Hagans: Well, it comes to say that hire more nurses. We need nurse-patient ratios regarding of your zip codes, regarding upper immigration status. Every patient is a VIP, every patient from New York Presbyterian to the Brooklyn Hospital, Interfaith Medical Center should have the same ratio, the same quality of care.

Brian Lehrer: Here's a caller, Tan, originally from Brooklyn, but now in Austin, physical therapy student. Tan, you're on WNYC. Do you go to University of Texas down there?

Tan: I do not. Funny enough, they do not have my program, so I go to St. Augustine.

Brian Lehrer: Okay. What do you want to say?

Tan: Long-time listener. [laughs]

Brian Lehrer: Glad you're on.

Tan: One thing is, I have a friend who is currently a nursing student and is doing their undergraduate there in Iowa. Right now, they're also a nursing assistant. He is the only nursing assistant at the moment where he has a ratio-- Just the other day I talked to him, he had a ratio of 1:25, where he was the only nursing assistant on staff and the hospital told him that they were going to hire more, but they never did within the last two to three months. He actually told our friend group that he felt like dropping out already and that he wants to pursue something else because of just the understaffing. It's pretty much a problem all over the US.

Brian Lehrer: Affirming that experience, and the pressures that come with it. Let me go right to another call. Darrell in the Bronx, you're on WNYC. Hi, Darrell.

Darrell: Good morning. Longtime listener. My question is, just as the man stated earlier, this is a nationwide shortage of nurses. You have nurses, like you said, this person who are LPNs, who are already going through nursing and going for RNs. One of the things is a lot of employees don't want to hire, especially Montefiore don't want to hire LPNs unless they get experience, would probably need to be two things. It need to go through New York State. Two, we need to go federal to tell the feds that this is a national problem about nursing.

Brian Lehrer: Darrell, thank you very much. Nancy, do you want to react to either of those first two calls?

Nancy Hagans: Well, we are encouraging the hospitals to hire the associate degree nurses because a lot of hospitals are not hiring associate degree nurses. The LPNs practice is different than the registered nurses under the New York State education. However, we are encouraging the hospital to attract more people, to hire the two-year nurses with the associates degrees. That is something that we are pursuing and we continue to pursue with every hospital.

Brian Lehrer: Two-year degrees or the LPNs, the four-year degrees or the RNs?

Nancy Hagans: No, the two-year-- You have RN that have an associate degree. They don't have a bachelor's degree because the hospitals want to maintain certain standard. They would only hire nurses with a bachelor's degrees and they all add associate degree nurses that are great nurses that are looking for jobs. Then, hospitals should start hiring them [crosstalk] to continue their education.

Brian Lehrer: Got it. I know one of the victories of this strike was an increase in health benefits for some of the nurses. One way that I read it in some of the news reports was that they maintain their health benefits. Could you describe that a little bit? What kinds of new or improved health benefits? It's ironic that we're talking about nurses not having enough health insurance. What kind of new or improved health benefits will nurses under this contract now be receiving, or is it just a matter of not having to give up what you had?

Nancy Hagans: We didn't have to give up anything that we had. Then we did make some changes for mental healthcare because a lot of time the co-payments were much higher, so we were able to enhance that. Overall, we kept what we had.

Brian Lehrer: Chris in Northern New Jersey, you're on WNYC with Nancy Hagans, president of the New York State Hospital Nurses Association. Hi, Chris.

Chris: Hi. Thank you for having me. What I would like to say is that I hope that with these changes, there's also more scholarship or tuition reimbursement for nurses that would really encourage the RN to get their bachelor's degree and the LPNs to get their associate degree. Because most of us also in the medical field are living paycheck-to-paycheck with the wages that we have.

Sometimes we have to take extra shift, even though as hard as already it is, we have to take extra shift to make ends meet, which would discourage you to study. I mean, you're already tired. How can you focus big in school? Sometimes you try to pick up one or two classes, but it's really a struggle. Maybe with more tuition reimbursement, more scholarship, a lot of people would be really encouraged to go back to school and finish their degrees.

Brian Lehrer: Chris, thank you. Is that the point you were just making before, Nancy, that's some of what you won in the contract?

Nancy Hagans: Yes, Brian. That is the point that I was making, scholarship and attract younger people to go to nursing school.

Brian Lehrer: Here's Margaret in Manhattan, a nurse at Mount Sinai. Margaret, you're on WNYC. Thank you so much for calling in.

Margaret: Hi, Brian. I was on strike last week. It was fabulous. The energy was so fantastic. Something that really upsets me is that, of course, the corporate structure isn't going to change. That CEOs are going to continue to make millions of dollars while they offered us initially a 4.5% raise and they wanted to take back some of our healthcare after COVID. [chuckles] I find that very distressing. We had a huge victory and we have language in our contract that I hope that other hospitals in the country find out about our language and want it for themselves, but that structure isn't going to change. We're supposedly nonprofit and we pay these executives millions of dollars. It's very frustrating for me. [chuckles]

Brian Lehrer: Margaret, thank you very much. We're going to go right from Margaret to Nicole in Harlem, also about Mount Sinai. Nicole, you're on WNYC. Hello.

Nicole: Yes, good morning. Longtime listener, first-time caller. Through the years or the last few years, I've watched Mount Sinai purchase Beth Israel and then St. Luke's and then Roosevelt. I'm wondering, I mean, have they outgrown their size? They've become a big business. I think the fact that they often call themselves nonprofit, I think is misnomer completely. I just wonder what the point is to pay all the executives such high salaries when they're not in the frontline like the nurses. It seems to me good business is giving good service. I'm very concerned that that is being reduced all the time. Now, my husband was hospitalized at Mt. Sinai. It was a very distressing-- he passed away.

Brian Lehrer: I'm sorry.

Nicole: Since it was a very distressing experience because I had to spend a lot of time there because the nurses were so overworked, although they would try to be very attentive. Families end up spending a lot of time with patients in order to give them some of the basic needs because there's not enough staff.

Brian Lehrer: Nicole, thank you very much. Nancy, I know you have to go in a couple of minutes. Could you address both of the points? The last two callers made, one on the seven-figure CEO pay. Is that more of a symbolic issue or more of an economic one? Because a few executives, maybe if they made less money than they do, that's not going to change the overall finances of the hospital?

I think the executives would say, and they have to be competitive with other institutions. Then beyond that, structurally, has the consolidation, the fact that a hospital like Mount Sinai, and some of the other big ones too, have acquired other smaller hospitals or merged. I think they would say that that leads to efficiencies that allows them to provide more services, rather than last to more people. What's your perspective as president of the nurses union?

Nancy Hagans: Well, I always say, patients over profits and the CEOs, they building up, they making money off our backs, while we go into work all the time and deliver the care. I agree with what everyone has said, and we will continue to pursue, will continue to fight for our patients, for our communities, in order to [unintelligible 00:21:57] safe patient care. The hospitals will have to comply with the language that we have. Like I said, the work just begin. This is now the beginning.

Brian Lehrer: Do you think the merger of some of the hospitals or acquisitions, whatever you want to call it, is good, bad, or neutral for patient care?

Nancy Hagans: It really all depends if they take over the hospitals and deliver patient-nurse ratios if they were to hire more nurses and provide better care for the patient. They have to put patients before profits.

Brian Lehrer: Nancy Hagans, president of the New York State Nurses Association. Congratulations again, not only I think on winning the contract and winning some more concessions than you would have before the strike, but also for drawing so much attention to the plight of nurses, giving us and others the opportunity, the excused if you want, to get a lot of nurse voices on and just to raise the profile of what nurses are going through and have more public awareness of the situation in all our hospitals. Thank you for doing that. Thank you for coming on with us a couple of times during this period.

Nancy Hagans: Thank you for having us. We'll continue to fight for our patients and our communities. Thank you for the support to our members. We really appreciate it. Thank you.

Brian Lehrer: Thank you.

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