After nearly two years on the front lines of the COVID-19 pandemic, healthcare workers continue to demand extra protections and pay from employers. But healthcare companies say rising costs and lower revenue because patients are delaying care make it difficult to shoulder higher labor expenses.
Experts say this will continue to put pressure on the relationship between providers and staff as workers battle burnout and employers try to balance budgets and find ways to serve patients.
The situation is further complicated by the number of workers who have taken travel contracts that can pay three times their normal salary. This workforce shift puts greater financial strain on employers trying to find employees and inflates labor spending.
These trends don't seem to be abating as new COVID-19 variants emerge, cases rise and the pandemic remains a part of daily life. Instead, another tumultuous year is on the horizon for employers and staff as they continue butt heads over wages, safety and patient care. But amid that conflict, there will be opportunities for employers and workers to collaborate on issues plaguing the industry.
"I see [this] year still being a very tough year," said Ivan Smith, a shareholder at Buchanan Ingersoll & Rooney who specializes in labor and employment law. "There are still a lot of issues with staffing, no question about it. Obviously, a new variant doesn't help with that at all."
Throughout the pandemic, health systems have increasingly turned to hiring incentives and retention bonuses as high as as high as $25,000, often tied to time commitments, to attract and retain workers. This is likely to continue as systems become more desperate for workers, more clinicians leave the field and others turn to travel contracts. Employers are rolling out new hiring programs directed at recent graduates, hoping to tap into the pipeline of new workers.
This disconnect has led to a series of union actions and organizing campaigns by healthcare workers, with massive strikes planned in California and other states, as unionized workers demand better wages, more staffing and stricter infection-control safeguards.
Unionization efforts increased in 2021 and that's going to persist, said Joe Guzynski, executive director of United Nurses Associations of California/Union of Health Care Professionals.
The strain of the pandemic is driving these organizing campaigns, Guzynski said. "There's going to be more and more healthcare professionals who want to organize over the next year," he said. The United Nurses Associations of California/Union of Health Care Professionals organized five shops this year representing occupational therapists, speech-language pathologists, pharmacists and nurses in California and Hawaii.
Unionization will "go through the roof" this year, Smith said. "You have the perfect storm. You have this pandemic. You have work shortages. You have stressed-out workers, and you have the Biden administration, which is a very pro-union administration," he said.
Unions will move into hospitals that aren't unionized and push for negotiations at systems with established unions, Smith said. The strongest hospitals will be those that partner with unions to resolve staffing issues and lobby lawmakers for things like higher reimbursement rates, he said.
The United Nurses Associations of California/Union of Health Care Professionals is seeing a "more conciliatory approach" from its members' employers, Guzynski said. "You're going to see employers coming to the table with an interest in dealing with the shortages by offering incentives and wage increases to not only hire but retain quality healthcare professionals," he said.
Guzynski was one of the chief negotiators of the union's most recent agreement with Oakland, California-based Kaiser Permanente, which was settled days before 22,000 workers planned to go on strike in November. The not-for-profit integrated health system had proposed a two-tier wage system that would have offered lower compensation to new hires compared to current employees, which unions strongly opposed.
The 21-union Alliance of Health Care Unions, to which the United Nurses Associations of California/Union of Health Care Professionals belongs, agreed to contract that strengthens Kaiser Permanente's labor-management partnership and establishes an Affordability and Competitiveness Task Force, Guzynski said. "We think this is an opportunity to renew the partnership and double down on it," Guzynski said.