HCA nurses in Central Florida rally for hospital improvements as union contract talks kick off

Registered nurses rallied early Tuesday morning outside HCA Lake Monroe Hospital in Sanford, as their union prepares to head into bargaining for a new contract with hospital management.

Nurses at HCA Lake Monroe, represented by the labor union National Nurses United, are advocating for improvements to staffing levels at the hospital, in addition to other measures to help improve patient safety and patient care, and to address burnout among nursing staff. Contract negotiations officially begin tomorrow.

“We’re out here today to ask HCA to stop putting profit over patients, and to make sure that we have the staffing we need, and to do whatever it takes to make sure that we have the resources we need to do our jobs effectively and safely,” said Nathan Knight, a nurse of six years who works in the hospital’s cardiac-neuro unit.

Chronic understaffing has been an issue at HCA hospitals for literally decades (we’ve got the receipts) but nurses like Knight say it’s only getting worse.

“In the six years that I’ve worked here, I’ve just seen essentially deterioration in the staffing, and in the supplies and the equipment,” Knight told Orlando Weekly.  “That makes me worried, and made me decide that we needed to step up and fight harder.”

National Nurses United (NNU), a labor union of nearly 225,000 nurses nationwide, represents nearly 350 nurses at HCA Lake Monroe Hospital and more than 650 nurses at HCA Florida Osceola Hospital in Kissimmee, where nurses similarly rallied Tuesday morning.

Nurses at both hospitals first voted to unionize in 2010, representing some of the union’s earliest victories in a state where only about 6% of the workforce has union representation.

Most of the nurses who gathered outside the Sanford hospital Tuesday morning had just gotten off a 12-hour shift — or were about to start one. One nurse who joined the rally late admitted she had just a couple of minutes to stand with her colleagues before she had to head in for her own 12-hour shift.

About a dozen nurses stood outside the hospital’s back entrance, facing Lake Monroe, holding signs that read “Put patients over profits” and “Safe staffing saves lives.”

The rallies are meant to put pressure on hospital management as contract talks begin.

Adriana Cuazo, a nurse of 13 years at HCA Florida Osceola Hospital in Kissimmee, said her employer “has the means” to address nurses’ concerns. Short-staffing isn’t just an issue she sees at her hospital — it’s also a concern that’s been voiced by nurses and other hospital staff at HCA facilities around the country.

“They make billions in profits,” said Cuazo, who works in the intensive care unit (ICU). “It’s money,” she said. “They just want to save more money.”

The for-profit Hospital Corporation of America, one of the largest health systems in the United States, reported $5.2 billion in profits last year and routinely forks over millions to their top executives. HCA CEO Sam Hazen received $14.6 million in total compensation last year, a 29% pay cut from the year prior (might as well call him a pauper at this point).

The Tennessee-based company, founded decades ago, also dishes out thousands of dollars on state-level political lobbying in Florida and campaign contributions to both state and federal legislators.

Last year, hospital staff at HCA Florida Osceola Hospital, represented by the labor union 1199 SEIU, similarly shared concerns over understaffing — and the cost of that when it comes to patient care.

“We have this brand-new lobby, which costs millions of dollars, but we don’t even have technology to send medications to every unit on the floor as quickly as possible,” Vaughn Benton, an evening-shift pharmacist, told Orlando Weekly last May.

“There are people who have to physically deliver medications throughout this hospital, because they [HCA] refuse to put money into the things that actually improve safety and quality, as opposed to the things that make them look good,” he added.

The difficulties experienced by other hospital staff aren’t lost on the RNs. “Every single department is short,” said Cuazo, the ICU nurse. “Every single department.”

A report from SEIU published last year found that staffing levels in HCA hospitals in 2020 were 30% below the national average, describing this as an “intentional corporate strategy.”

In a recent survey of HCA nurses by National Nurses United, the union reported 84% of nurses said their responsibilities and assignments had increased in recent years, while 68% said they infrequently or never had enough staffing coverage to take meal or rest breaks.

Cuazo said she’s seen this at her hospital, too. “We are all trying to get things done, and sometimes may not even have time to take a break.”

There is no universally agreed-upon standard for nurse staffing ratios in hospitals, although there is evidence linking inadequate staffing levels to poorer patient outcomes. At HCA Lake Monroe Hospital, emergency room nurse Heather Cox-Faith told Orlando Weekly her department is generally fully staffed, but it’s shortages in other units that can cause issues.

“Sometimes people are in the ER for over 24 hours, and you’re talking critical patients that should be in intensive care, which is the sickest of the sick,”said Cox-Faith. “But if there’s no beds or no nurses in the ICU, then they’re being housed in the ER.”

Cuazo said that she was embarrassed and “ashamed” to admit to her hospital’s staffing problems. She knows how it hurts patient care and staff’s ability to provide support to patients’ families. “We don’t have time anymore to be with the families like in the past,” she said, growing emotional over the phone.

She described how today, it’s families apologizing for taking up her time, when she knows they shouldn’t be apologizing at all.

It’s her job, and she wants to be there, but she simply doesn’t always have the time when hospital staff are stretched thin. “I feel bad because it shouldn’t be like that,” said Cuazo. “I should have the time to listen to you, and I don’t have that anymore.”

Just two states in the country — California and Oregon — have established mandatory nurse-to-patient ratios, which experts say can help reduce burnout, support proper patient care, and prevent unnecessary deaths and errors on the job.

The difference between having adequate staffing in medical facilities and not can literally mean life or death, but the hospital industry has been fighting efforts to establish mandates.

California’s staffing ratio mandate first went into effect two decades ago — in what was largely celebrated as a victory at the time for the nurses’ unions — while Oregon passed their own staffing ratio law just last year.

Industry lobbyists have poured millions of dollars into fighting similar efforts elsewhere. When Minnesota state lawmakers tried to establish staffing ratios in 2023, the Mayo Clinic threatened to pull billions of dollars from the state in planned investments.

HCA, when reached for comment, denied the nurses’ accounts of understaffing. “Our staffing is safe and appropriate, and we are proud of the quality care we provide, which has been recognized by independent third-party patient safety ratings organizations like Healthgrades,” said Trip Farmer, a spokesperson for HCA’s North Florida Division.

“We value our nurses and are hopeful that we can quickly reach an agreement on a new contract that is fair and reasonable for both sides.”

He dismissed the nurses’ rallies Tuesday as a stunt by the union. “Today’s activity is no different than similar actions NNU has taken against health systems across the country,” said Farmer.

And sure, nurses and other hospital staff have rallied before. But they say it’s because the issue hasn’t gotten better. Since the pandemic, they say it has broadly gotten worse.

“I really like what I do,” said one RN. “Believe it or not, I still have hope that something is going to change.”

“It’s burning people out so quick that, you know, they’re leaving or they’re going to other hospitals, or they’re jumping off to an agency and just traveling,” said Cox-Faith, referring to the growing and more lucrative path of contracted travel nurses.

The newer nurses, said Cuazo, “think it’s way too much, and they don’t last.”

The union argues the industry isn’t facing a nursing shortage, but rather a shortage of nurses who are willing to put up with subpar working conditions. “The hospital industry is crying false tears over the lack of nurses willing to stay in direct care when these untenable working conditions are entirely of their own making,” the union wrote in a 2021 statement.

Nurses at HCA’s Osceola Hospital and Lake Monroe Hospital aren’t alone in their fight for contract terms to address their concerns around staffing. According to the union, over 10,000 HCA nurses across the country will enter bargaining for new union contracts this year — including nurses at 10 hospitals in Florida.

Tuesday’s rallies in Central Florida came just a day after nurses at eight other HCA facilities on Florida’s Gulf Coast similarly staged demonstrations to kick off bargaining with management.

Knight, one of the nurses at HCA Lake Monroe, said he decided to pursue a career in the nursing industry after caring for a friend who was dying of cancer.

He’d previously worked in aviation, and struggled to find work locally after his company went out of business during the Great Recession. Today, he describes nursing as his calling.

Cuazo, the longtime nurse at HCA’s hospital in Kissimmee, said she’s motivated to stay on the job — despite her experience of deteriorations in staffing — because she feels needed there. “I really like what I do,” said Cuazo. “Believe it or not, I still have hope that something is going to change.”

Knight said fighting for workplace improvements through a union makes a difference. “I’ve seen the power of working together to make things happen for the betterment of our floor, for our hospital, for our patients,” he shared. “It makes a difference.”

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This article appears in Feb 28 – Mar 5, 2024.