How a US hospital chain caused its own staffing crisis

ChicagoAt a hospital in a Chicago suburb last winter, there were so few nurses that psychiatric covid patients had to wait a full day for beds, and a single attendant was on hand to help 32 infected patients. The nurses were so distraught over being understaffed that they banded together to file grievances every day for over a month.

Some 500 kilometers away, at a hospital outside of Flint, Michigan, similar scenes were unfolding. Chronic staff shortages meant patients languished in dry feces, while robots replaced nursing assistants who normally sat with mentally disabled patients.

Both hospitals are owned by one of the largest health systems in the country, Ascension. It has spent years reducing its staffing levels in an effort to improve profitability, even though the chain is a nonprofit with nearly $18 billion in cash reserves.

Since the start of the pandemic, nurses have left hospitals in droves. The exodus is due to many factors, with the hospital industry blaming Covid, staff burnout and labor markets tightened by acute staff shortages.

But a New York Times investigation found that hospitals helped set the stage for the jobs crisis long before the arrival of the coronavirus. Seeking to bolster their bottom line, hospitals sought to squeeze more work out of fewer employees. As the pandemic flooded hospitals with critically ill patients, their meager staffing turned from a financial strength to a glaring weakness.

More than half of the approximately 5,000 hospitals in the United States are nonprofit organizations. In exchange for evading taxes, the Internal Revenue Service requires them to offer services, like free health care for low-income patients, that help their communities.

But The New York Times this year has documented how large nonprofit hospital chains have drifted away from their charitable missions.

Some have skimped on free care for the poor, illegally saddling tens of thousands of patients with debt. Others have invested resources in prosperous suburbs while diverting money from poorer areas.

And many have reduced staff to skeleton levels, often at the expense of patient safety.

At a single hospital in Northern California, the sprawling nonprofit Providence hospital chain laid off dozens of medical staff in 2017 and 2018, resulting in long waits for crucial care. At a Washington state hospital that is part of CommonSpirit Health, another giant nonprofit chain, years of belt-tightening came to a breaking point in October when an overwhelmed nurse called 911 dispatchers, who sent the department firefighters to help treat patients.

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