Testimony of Anne Goldman of the Federation of Nurses/UFT submitted before the Assembly Committees on Health, Mental Health, People with Disabilities, Higher Education and Labor

Good morning. My name is Anne Goldman, and I am the vice president for non-DOE members of the United Federation of Teachers and the head of the Federation of Nurses/UFT. On behalf of the union’s more than 190,000 members, I want to thank the Assembly Committees on Health, Mental Health, People with Disabilities, Higher Education, and Labor for hosting today’s public hearing on the status of our health care workforce. We thank you for the chance to discuss attrition and vacancy rates, worker wellness, training, education, and workplace conditions for our nurses. 

To become a nurse is to dedicate your life to the holistic well-being of your patients. Nurses care for our most vulnerable individuals in their times of greatest need, treating them with kindness and respect. Yet we do not treat our nurses with the dignity and working conditions that they deserve. This must change. 

We need transparency surrounding the attrition and vacancy rates of nurses. Staffing has become a numbers game. Hospitals announce their new hires but fail to share the number of nurses they have lost to attrition and resignations. There is no complementary exchange of workers in the nursing field, leading to chronic staffing shortages that harm patients and nurses alike. According to records kept by the Federation of Nurses/UFT, NYU Langone–Brooklyn hired 108 new nurses between January 1 and June 30, 2023, while 71 nurses resigned. Hospitals attempt to remedy these staffing shortages by hiring nonunion per diem and travel nurses, but without being fully acclimated to the hospital, these individuals cannot provide the same care as full-time staff nurses. These workers are meant to effectively support the permanent workforce, not replace it. As it stands, the hospitals’ use of per diem and travel nurses is entirely inappropriate. 

We must also examine what leads to high attrition rates amongst nurses. A significant contributing factor is that we are failing to prepare our nurses for the realities of the workforce. Our nurses are thrown into the highest-risk departments, such as the emergency department and the intensive care unit, with limited support and minimal training. The process of transitioning from the classroom – which was virtual for many – to the bedsides of a multicultural, multilingual patient population requires guidance and mentorship. However, nurses receive a bare-bones two-week training, down from a previous six- to eight-week orientation, while balancing as many as seven patients. They have limited interactions with their preceptors, who are too busy to answer questions due to short staffing. They are then expected to exercise sound clinical reasoning and judgment with no bedside experience. If they misstep, they are met with punitive action and blame, which discourages many nurses from remaining in the profession. We must begin placing our newest nurses in lower-intensity units, such as the medical/surgical unit, for their first year of work. This lower risk setting, coupled with safe staffing ratios that enable preceptors to be mentors, will create safe, supportive transitions in the workforce. 

The training provided to our nurses must also include strategies to cope with the challenges that come with the job. Our nurses are frontline workers who experience deeply sad and traumatic things every day. However, there is no preventative mental health care for them. We wait until they are on the brink of collapse and burnout prior to stepping in. And, when nurses finally do reach collapse, it is other nurses who pick them up. At NYU, this work is done by the Lavender Response Team, which is composed of nurses who deliver emotional support to their peers. To respond to their fellow nurses, members of the Lavender Team must hand their own patients off to another overworked nurse and rush to the rescue of their colleagues. We must employ additional staff members who are responsible for delivering mental health care services to nurses, and this care must start from the moment we hire nurses through the end of their careers so that we break the cycle of intervening after it’s too late. In addition, we need to develop resources, including helplines, that are available and targeted to non-bedside nurses and ensure that sessions are accessible to nurses at times when they are not required on the floors. 

Finally, we need to fix the work environment, not just the workers. This starts with better management in hospitals, and we need nurses leading nurses. When you work with a leader you believe in and who understands the most challenging and most rewarding aspects of your job, you are more likely to want to do your job and to do it well. Additionally, a leader who knows what a safe workplace should look like will fight back against threats to that safety. At NYU Langone–Brooklyn, management violated safe-staffing laws 47 times between May and August 2022. The UFT fought back and won an arbitration that ruled that for each missing nurse, the hospital is required to split the average nurse’s shift salary among the nurses who worked that shift. Since the implementation of the safe-staffing law, the hospital has continued to violate the statutory and contractual unit ratios, despite the 200 violations, which are still under investigation, that were filed with the New York State Department of Health. Placing nurses in management roles would not only reinvigorate and retain our nurses, but it would also help to prevent gross violations of safety laws. 

The day will come when each one of us has a loved one in the hospital. When that day comes, I guarantee we will want the best care for them. However, without safe staffing, adequate training and strong managerial support, our nurses will not be able to provide that. We thank you again for grappling with these issues, and we offer our ongoing guidance as you strive to maintain a strong health care workforce.