Nurses, more powerful and visible after Covid, capitalize on new clout in Washington

WASHINGTON — Since the start of Covid-19, nurses have been hailed as heroes. But two years into the pandemic, they want more than their neighbors banging on pots and pans.

Instead, the country’s roughly 4 million nurses are using the attention — and the accompanying political clout — to spotlight their sometimes-oppressive working conditions. Amid the country’s health emergency and ongoing shortage of health workers, they’re scrambling to make sure the moment doesn’t slip away.

It is an opening, advocates say, that nurses have awaited for years, or even decades. And while they lament that it took a pandemic to win Washington’s attention, national nursing groups as well as grassroots advocates say the national conversation about the health worker shortage and work conditions in hospitals represents a unique opportunity.

“It is back-breaking work, and this pandemic just put it out there for the world to see,” said Jean Ross, a registered nurse in Minnesota and the co-president of National Nurses United, the country’s largest professional association for nurses. “Finally, someone is at least attempting to listen to what we’ve been saying for a long time, and that’s very gratifying.”

The recent advocacy groundswell highlights nurses’ unusual position: While doctors, insurers, and drug companies are often the heavyweights in Washington, the current crisis has given nurses more leverage in Washington than at any point in years — perhaps ever.

At the center of their new advocacy agenda is a “National Nurses March” planned for May 12, just steps from the White House. The event’s Facebook group already includes over 200,000 members, and thousands more nurses are expected to attend satellite events planned for state capitals across the country.

And while the pandemic has complicated some lobbying efforts, it’s clear that nursing professional associations, labor unions, and grassroots activists have found success winning lawmakers’ recognition. In the past year, dozens of lawmakers have introduced bills to improve conditions for nurses, including major expansions of guest-worker programs, loan repayment for health workers, and pay increases for some nurses working for the federal government.

But there’s still plenty to fight. The biggest issue, by far, is the increasing scrutiny of travel nurses whose pay has increased dramatically during the pandemic. Travel nurse pay, and the staffing companies that link travel nurses with hospitals, have been the focus of recent inquiries from Sens. Bill Cassidy (R-La.) and Mark Kelly (D-Ariz.). Some states already have caps on wages for temporary health care workers, and other legislatures have moved to enact new caps.

Travel nurses who work in intensive-care units, in particular, have found Covid-19 to be lucrative: According to data from Vivian Health, their weekly wages have more than doubled from roughly $1,750 to roughly $3,500 between early 2020 and early 2022.

Lawmakers have argued that such fees are exorbitant. And, more specifically, they have taken issue with the fact that many of the most lucrative staffing agencies have been acquired by private equity companies.

“In 2020, nurses were labeled as heroes, and now that we’re finally able to make a decent living, we’re labeled as greedy,” said Ashley Hughes, a trauma response nurse in Charlotte, N.C., and one of the march’s organizers. “No one caps doctors’ pay. No one caps CEOs’ pay. So why are we doing this to the backbone of health care?”

More broadly, they say, the concept of a national staffing shortage is a myth. It’s not that there aren’t enough nurses — it’s that there aren’t enough nurses willing to work under the conditions that hospitals and the government writ large have forced upon health workers.

“For decades, we’ve tried to point out: There is really no nursing shortage,” she said. “There is a shortage of nurses who are willing to put their lives on the line with a pandemic, and their futures and literally their bodies, for employers who continually short-staff us and don’t listen when it comes to things like personal protective equipment.”

Beyond the threat of Covid-19, health workers, and nurses especially, have suffered from overwork, intense burnout, and rates of depression and suicidal ideation far greater than in the general population. It’s not just a threat to nurses, either: Hospitals, health workers, and the federal government all agree that staff shortfalls worsen the quality of patient care.

The Biden administration has already made modest attempts to address health worker burnout, setting aside $103 million earlier this year for programs to address it and other mental health issues.

“The Covid-19 pandemic has intensified issues that have long been a source of stress for frontline health care workers — from increased patient volumes to long working hours,” health secretary Xavier Becerra said in a statement then.

Advocates say those efforts aren’t nearly enough. Instead, they’ve called for hard caps on patient-to-nurse ratios, as some states, like California, have already enacted. Sen. Sherrod Brown (D-Ohio) has introduced a similar proposal at the federal level; his legislation would require hospitals to submit detailed plans to the federal government that comply with new limits on patient-staff ratios.

“Too often, nurses are stretched too thin, caring for too many patients with not enough support,” Brown said in a statement to STAT. “We can prevent that by ensuring nurses are adequately staffed, and protecting their ability to go to hospital management, without fearing potential retaliation.”

Many have also called for new anti-discrimination protections in the workplace, as well as better physical protections from, and stiffer penalties against, people who assault health care workers.

“I’ve been assaulted personally by a patient,” said Justin Riney, a travel nurse based in Michigan. “The result was a meeting about what I could have done differently. That’s the problem in health care: I can be assaulted verbally, physically, and the conversation is never: ‘What can I do for you?’ It’s always: ‘How can you change your behavior so that doesn’t happen?’”

Another Democratic lawmaker, Rep. Joe Courtney (Conn.), has introduced a bill that would require employers, including hospitals, to enact new protections against physical violence targeting health workers. The legislation passed the House of Representatives in April, but has stagnated in the Senate.