Zoe Berg, Senior Photographer

A patient sat in her own urine and feces for over two and a half hours at Lawrence + Memorial Hospital (L+M). She could not find somebody to take her to the bathroom.

The patient’s daughter called Connie Fields, an administrative assistant at Lawrence + Memorial Hospital, who said that the mother’s assigned patient care assistant, or PCA, was feeding another patient and was not free to help her. PCAs look after a patient’s basic needs, from taking vital signs every hour or two and documenting updates, to assisting with personal care and feeding. But at L+M, a shortage of PCAs and other healthcare workers has raised concerns over employee burnout, patient safety and recent employee contract negotiations.

Fields is the president of American Federation of Teachers Local 5123 (AFT Local 5123), a union representing healthcare employees at L+M. This includes certified nursing assistants, patient care assistants, environmental services workers, patient transporters and “everything that the registered nurses and the technicians are not,” Fields explained.

“It’s embarrassing for the patients, it’s inhumane what they’re doing,” Fields said. “Well where is the rest of the staff? They’re not here, you can’t get them in the door. They don’t pay enough money.”

A shortage of healthcare workers

Patient volumes at L+M have not dipped below an average of 180 per day since the start of the COVID-19 pandemic. Recent numbers have risen to over 207. But according to Fields, L+M has failed to adjust staffing to address this spike: the hospital staffing is more appropriate for a volume of 150, as “numbers used to be” prior to the pandemic. 

This past Sunday, Jan. 29, one PCA at L+M had thirty patients across multiple units, seven of whom were in for COVID-19, Fields said. 

“I can’t do that for 30 patients in an eight-hour span because I’m not getting to the patients at least every hour,” Fields said.

It is common to have only one or two PCAs working on a floor at L+M. Fields receives reports daily from PCAs concerned about short staffing.

While overtime is not mandated, according to Fields, the incentive system — where workers can make $10 extra an hour — creates a culture of burnout. The hospital constantly being “overloaded,” Fields said, pressures PCAs to continually pick up extra shifts for more money. In an environment of unmet demand, there is no limit on the hours they can work. 

But with multiple PCAs working 90 hours a week to pick up more money, the quality of care provided comes into question. Fields brought up two PCAs at L+M who work 90 hours on average a week, risking burnout by constantly working double shifts.

“The incentives help but they burn people out,” Fields said. “It would be easier if you just raised the bar financially to get people in the door.”

Instead of having workers take on extra hours, the hospital needs to hire double the current staff, Fields added.

The minimum wage for PCAs at L+M is $15.50. Fields pointed to local nursing homes which pay at least $17.80 an hour for the same job. 

L+M hired five new employees this week, upping the union’s membership from 907 to 912. To put these additions in perspective, Fields brought up 12 new employees quitting within the last calendar year. 

“You wouldn’t have had 12 people quit in a ten year span from L+M before,” Fields said. “When you came here, you felt important. Not [like] a number. And I can’t stress it enough, we’re gambling with our patients, our neighbors, our family’s lives.”

For comment on the PCA shortage, L+M referred the News to the Connecticut Hospital Association. CHA represents all of YNHHS’s member hospitals, including L+M. 

Paul Kidwell, senior vice president of CHA, said that Connecticut hospitals are creating new ways to keep hospital workers resilient and enhance retention and recruitment.

“Providing financial incentives, identifying opportunities for career advancement and supporting continuing education are important ways hospitals are supporting the workforce,” Kidwell wrote to the News. “As hospitals confront significant financial headwinds, exacerbated by the need to hire temporary, contract labor, a partnership with the state to support the workforce is now more important than ever.”

Kidwell called for state funding for recruitment bonuses, student loan payment assistance, cash retention bonuses, tuition assistance, workplace violence prevention and other forms of training to support retention and recruitment.  

Shortage of nurses

Dale Cunningham, a registered nurse (RN) at Lawrence + Memorial, recalled similar feelings of burnout among nurses at L+M, especially in the early days of the pandemic. The physical and emotional burden of caring for COVID-positive patients, many of whom were not allowed visitors, took its toll on her co-workers. 

“So, so many patients died not seeing their loved ones,” Cunningham said in an interview with the News. “[Nurses] would just drive home crying.” 

Combined with taxing work conditions — irregular hours, PPE shortages and precautions not to infect their family members at home — L+M nurses, like PCAs, began to quit. Most of those who left were seasoned, experienced nurses, already nearing the end of their career. Yet these now-vacant positions were filled mostly by brand-new nurses, unprepared to deal with a short-staffed, high-intensity workplace. 

Because of this, L+M adapted to rely on per diem employees — professional nurses working on an as-needed basis. While around seventy per diem nurses served at L+M pre-pandemic, that number more than doubled to 150 in Local 5049, the union for nurses at L+M. 

Cunningham believes the hospital hired these workers, who do not receive employee benefits, as a cheaper alternative to full-time staff nurses. This system has contributed to inconsistent staff counts from day to day. At the Neonatal Intensive Care Unit (NICU) where Cunningham works, the unit is often left unequipped for high volumes of patients. 

The result can be fatal, according to a recently published report by AFT Connecticut, the state union overseeing the local unions at L+M. Taking on just one extra patient can decrease a nurse’s capacity to provide quality care, and a nurse may miss critical information when rushing through patient questioning.

Dale described often being pulled away to do three different tasks, while trying to take down a patient’s history. She referenced a 2018 study, which found that adding one patient to a nurse’s workload increases the risk of a patient dying by 7 percent.

There are dangerous consequences for hospital employees as well. L+M has witnessed an upsurge in workplace violence and staff injuries due to mounting frustration from patients and their families, particularly in the NICU. Patients’ family members, irate over long wait times, may act aggressively toward staff. Additionally, when patients resort to violence, nurses who cannot gather help must handle them alone. 

“You’re putting people in danger,” Dale said. “You have a violent patient, and you can’t restrain them quickly because you’re the only one there, and that’s how increased injuries to healthcare workers have happened.” 

According to Kidwell, Connecticut hospitals are actively bringing stakeholders together to inform statewide efforts to address workplace violence will include “all voices at the table.”

“A safer workplace is a critical priority for Connecticut hospitals and hospitals must continue to be safe places for every patient and healthcare worker,” Kidwell added.

An impasse reached on contract negotiations

Negotiations between Local 5123 and L+M for a new employee contract began in May of 2022, culminating in an impasse.

“After many months of negotiations in good faith with AFT Local 5123, which represents more than 65 clinical and non-clinical support roles here at Lawrence + Memorial Hospital, we have not been able to reach an agreement on a new contract,” Fiona Phelan, Media Relations Manager at L+M, wrote in a statement representing the hospital. “AFT Local 5123 has chosen to stop negotiating and has now declared an impasse. We are disappointed that the union has taken this position, yet to ensure the fair treatment of our valued staff in the Local 5123, the Hospital took the unprecedented step of implementing the last offer we made in negotiations.”

L+M began enforcing their “last offer” contract for Local 5123 members on Jan. 3. On Jan. 18, Local 5123 members held an informational picket to call for livable wages, affordable health insurance and patient safety. 

Local 5123 had never entered an impasse before. According to Fields, the union had “always been able to negotiate in good faith” until the current administration under Patrick Green, president and CEO of L+M. Fields decried the increase of Green’s salary from $250,000 when hired in 2017 to the present $1.2 million. 

L+M’s statement said that employees in Local 5123 received wage increases, participation in a Performance Incentive Plan and, “for many, market adjustments and a lower cost health plan option.” L+M said that this package was “very similar” to a package offered to and “overwhelmingly ratified” by L+M’s registered nurses and technologists. 

Last month, Local 4049 — representing nurses at L+M — and Local 5051 — representing medical technologists — ratified three-year contracts with L+M. While L+M said the contracts were similar to what was offered to Local 5123, Fields said that members of the other unions make around $34 an hour, not in the $15 range like Local 5123 workers.

The new contract offered a 50 cent increase for some healthcare workers, while others got around a 2 percent wage increase. However, Fields noted that 2 percent of $15 is “just over 30 cents.” 

Now, the minimum wage would be at most $15.50 an hour for Local 5123 members. Fields found it “disheartening” that in comparison, nurses were offered an over 21 percent increase in wages throughout the course of their contract. 

The contract left 53 percent of union members without health insurance — members who still cannot afford what was offered. Fields explained that it is difficult for workers making $15 an hour to afford a $60 a week fee for insurance. For employees with a family to support, that fee rises, not to mention the $4,000 deductible, she said. 

Fields said that the state should not have to pay for union members’ health insurance or food assistance because “the hospital doesn’t want to pay a livable wage.” She called for a policy mandating that hospitals make healthcare affordable for their employees.

“[To L+M] it’s ‘how do I keep my profits the same? I have to cheat my lowest paid workers. I have to dangle this in front of them. Like we’re animals.’” Fields said. “They should be ashamed of themselves that they allow this… Someone’s got to raise the bar and realize that healthcare workers cannot afford to live off of $15.”

The updated incentive program raised the wage bonus for healthcare workers working overtime from $7 to $10 an hour. Although certain groups, such as environmental services workers who clean the hospital environment, still get $7. 

The nurses by contrast “have a nice incentive program,” Fields said. In cases of emergencies, their bonus can reach an extra $50 an hour, compared to a baseline $30 extra for non-emergencies. 

Policy suggestions

Despite the impasse in negotiations, Local 5123 is seeking progressive solutions forward. 

“I’m not just looking to bang pans together and complain that things are no good,” said John Brady, Vice President of AFT CT. “That doesn’t help out nurses that are working on the floor.”

In a recent press conference at the Capitol, AFT CT laid out three key policy proposals: an end to mandatory overtime, a recruitment and retention bill and employee input in setting safe staffing limits. 

Currently, L+M Hospital does not mandate overtime for nurses, a measure which Cunningham and Brady both praised. L+M instead allows nurses to choose when they are willing to come in on their off days. For these nurses, L+M has an incentive program which compensates them with often double or triple the hourly pay. 

Cunningham commended the program for respecting nurses’ personal lives but expressed frustration over how its rules have become increasingly nebulous and unevenly distributed across departments. She recalled L+M hospital at one point offering an extra thirty dollars to employees from some units, but not others.

“They have some secret formula on how they determine what areas get an incentive and others don’t,” Cunningham said. “If you’re called in on your day off, what makes you any different in any department?… My coworkers need me just as bad. My patients need me just as bad.”

Another concern about the incentive program is employer intimidation. Nurses may be scared to refuse “optional” overtime, according to Cunningham, a problem exacerbated by mounting pressures from their employers. 

“They make comments to you like, ‘Don’t you want to stay and help your friends?’” Cunningham said. 

Still, such comments mostly do not amount to real threats. Cunningham remains in favor of L+M’s policy opposing mandatory overtime, and Local 5123 hopes to permanently embed this tenet into their contract. 

Another goal of the union is a recruitment and retention bill, which they believe would help alleviate the issue from the perspective of nurse education, which has also been impacted by faculty quitting their jobs. The bill would help recruit more teachers to nursing schools across Connecticut and combat staffing shortages more broadly. 

Most importantly, AFT CT wants to give nurses greater input in making staffing plans. Currently,  hospitals use a committee of both nurses and management members to create a staffing plan.

Brady deemed these committees “ineffective,” as they are largely dominated by management members. In one instance, a committee meant to plan nursing had no hand in the drafting collaboration, and was only shown the staffing plan right before it was submitted to Connecticut. 

“What we envision is making them truly a part of [the planning],” Brady said. “In a place represented by a union, the union should be able to select who’s on staff and who’s on committee.” 

According to Cunningham, even after hospitals submit staffing plans to the state of Connecticut, they are rarely held accountable for seeing them through to completion. 

Brady’s comprehensive vision for union-driven staffing plans includes committee-wide votes on plan drafts, whistleblower protection for reporters, and a limit to the number of patients assigned to one nurse. 

Oppositely, the Connecticut Hospital Association pointed to harms caused by additional government mandates. They emphasized that they share the same goal as healthcare employees — to ensure high-quality patient and worker care — but believe increased regulations would only undermine nurses’ flexibility and agency, while driving up healthcare costs for corporate staffing agencies.

“Government-mandated ‘solutions,’ like staffing ratios, would worsen the very problems we are all trying to solve together,” CHA wrote in its statement to the News. “It would lead to longer wait times in emergency departments and delayed access to care, putting even more strain on patients and leading to high stress situations.”

Brady emphasized a willingness to discuss and modify these ideas alongside hospital administration, as long as collaboration could yield tangible solutions. At the end of both of their statements, Brady and CHA acknowledged their common goal toward a healthier workplace for patients and employees alike. CHA reiterated its appreciation for healthcare workers’ exceptional care and fortitude in the face of the pandemic.

“We must continue working together to support recruitment, retention, and safety with solutions that achieve our shared goal of a strong, healthy, and supported workforce,” Kidwell wrote. 

Lawrence + Memorial Hospital is located at 365 Montauk Ave, New London, CT.

Kayla Yup covers Science & Social Justice and the Yale New Haven Health System for the SciTech desk. For the Arts desk, she covers anything from galleries to music. She is majoring in Molecular, Cellular & Developmental Biology and History of Science, Medicine & Public Health as a Global Health Scholar.
Samantha Liu covers Community Health & Policy for the SciTech desk and serves as co-chair for the Diversity, Equity & Inclusion Committee. As a Global Health Scholar, she studies English and Molecular Biology.