In New Orleans and across the nation, hospital management companies are cutting health care workers’ hours. It's a cost-saving mechanism in response to overall lowered intake volumes. This is a positive sign that attempts to "flatten the curve" are working, as well as an ominous indication that sick people are avoiding care because they’re afraid of being exposed to COVID-19 (a fear that’s now unfounded, as hospitals have successfully isolated COVID patients). But the extremely high flux of patients means hospitals have started to destabilize the work schedule of health care workers, a pattern that is likely to continue as political leaders attempt to manage the rates of infection.
On March 24, the same day Louisiana Governor John Bel Edwards announced that COVID-19 patients would likely overwhelm local hospitals by the first week of April, operating room nurse Hannah (whose name has been changed here to protect her anonymity for fear of professional repercussions) was summoned to the surgery desk. There, leadership told her she faced a choice: She could be redeployed to her hospital’s COVID unit for the next three to six months, or she could refuse and be charged with patient abandonment.
“We were told that refusal would lead to immediate termination without eligibility for rehire and that we’d be immediately reported to the state board,” Hannah said.
Hannah opted to work in the COVID intensive care unit. There, she faced “complete fuckery”: disorganization, inadequate PPE, a four-to-one patient-to-nurse ratio (normal ICU ratios are two-to-one or one-to-one), and the sickest patients she’d encountered in her career.
“There’s a certain aspect of death that comes with our profession, but it was on such a scale… I will not be the same from before and after this,” Hannah said.
Her redeployment ended as abruptly as it started. On April 20, Hannah’s director said she was being sent back to surgery, with one caveat: She and her fellow nurses had to take 48 hours of vacation time over the next month and a half so the administration could avoid layoffs.
“I don’t have that much time off,” Hannah said. “They said, ‘We’ll let you go into negative.’ So then I have to pay that back? What happens if I find another job? I have to pay you for time off? It’s just shitty.”
Hannah’s situation isn’t unique. Across New Orleans, hospital revenue is down, and administrations are cutting workers’ hours. “At every hospital in the city, emergency department (ED) volumes are down to 20 to 40 percent of their normal,” said Justin (whose name has been changed because he fears professional repercussions), an ED physician who’s looking into getting a second job because his hours have been cut. “People aren’t coming in for the things they should come in for. For everyone who works in the ED, it’s been frustrating to not only lose hours, but also have the job be really dangerous at the same time.”
Pay cuts and furloughs don’t just make everyday life exponentially harder for front-line workers. They also set the stage for a second crisis, should COVID-19 cases surge again when stay-at-home orders loosen, says MarkAlain Dery, the medical director of infectious diseases and chief innovation officer for Access Health Louisiana, the largest Medicaid-providing clinic system in Louisiana.
“The surges are going to happen. That’s without a question,” Dery said. “Until there’s a vaccine, you will see upwellings. At that time, hospitals will probably be caught without the help they are going to need. Start furloughing, and there’s going to be mobility. People will float to where jobs will happen.”
Jamie (whose name has been changed because of professional concerns) is one such example. She’s a New Orleans–based travel nurse whose temporary position in a COVID ICU was axed four weeks into a six-week contract. In May, she’ll travel to California for work. She’s glad to have the job, but she does wonder what will happen if or when cases surge again in hotspots like New Orleans: Louisiana currently has the fifth-highest rate of deaths per capita in the U.S.
“A lot of people whose contracts were canceled are scrambling for work now,” she said. “If you cut all your staff and cancel all your contracts, when you do need staff, how much will it cost to have people come back in? It’s a gamble.”
Warner Thomas is president and CEO of Ochsner Health, Louisiana’s largest hospital network and the place where 65 percent of New Orleans’ COVID-19 patients were treated—and Hannah's workplace, which levied COVID-related ultimatums at her. He’s less concerned about staffing in the future and more concerned about adequate testing.
“We’re focused on ramping up testing and targeting hotspots or zip codes where we see more cases,” Thomas said. “We’ll look to a staffing plan, but, once again, it will include potentially redeployment and traveling or agency nurses that help us go through those kinds of peaks, which is standard.”
Because elective procedures were suspended due to the pandemic, Ochsner lost $30 million in March and $80 million in April, Thomas said, and that necessitated tough calls. “We didn’t have a need for travel nurses, so we did eliminate contracts,” Thomas said. “We wanted to preserve jobs, compensation and benefits, so the easiest thing was to make people use vacation time.”
Hospital workers understand they can’t get paid if there’s no money coming in from elective procedures. They also said this situation is symptomatic of a health care crisis that existed long before COVID-19 brought it to a head. Though pay cuts and canceled contracts may be business as usual for hospital administration, workers say this model makes it hard to pay bills and undermines morale at a time when they’re literally putting their lives on the line for work.
“They call you a hero in public, and behind closed doors, they cut your pay or fire you altogether,” Jamie said. “It’s so disheartening to realize we’re numbers on a spreadsheet. And it breaks my heart to think so many people will quit after this, and the patients will suffer.”
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