New York State Nurses Association union representatives say they are seeking better pay, health insurance and time off. They say Adirondack Health is giving substantial raises to its executives but not its nurses. They also say higher pay and benefits could counter dropping staffing levels. The hospital is not making any public comment on the bargaining process, according to Adirondack Health spokesman Matt Scollin.

The union had a float in the Winter Carnival Gala Parade on Feb. 11. Members were cheering, throwing candy and asking onlookers to sign their petition to support their side of the contract negotiation. This parade entry marked the kick-off of a flyer campaign the union is holding to gather support for the still-under-discussion contract. The petition had 373 online signatures as of Friday.

Bill Schneider is the chair of local bargaining unit executive committee and a nurse in the hospital’s recovery room. He said nurses’ main concern is attracting and retaining new nurses to work with them. He said safe care comes from having enough staff, and that right now, they’re barely getting by.

“Mainly, I would say, it’s the fact that the hospital is just not willing to offer adequate pay increases and benefit increases,” Schneider said. “Our hospital does a good job of staffing our hospital safely, which we appreciate and we want to see continue. But to continue that, we need to be able to attract and retain nurses.”

Emily Doyle, a nurse and a New York State Nurses Association representative at Adirondack Medical Center, waves to the crowd while driving a float in the Winter Carnival Gala Parade. (Enterprise photo — Aaron Marbone)

Most nurses in Adirondack Health are members of this union, Schneider said. Some in management are non-union. He said there are around 200 to 215 members here.

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Contract expired, was extended

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Currently nurses are working on an extended contract. When the contract expired at the turn of the year, a new one was not yet agreed upon, so nurses and the hospital agreed to extend the contract. This contract has been extended several times now, from bargaining session to bargaining session. This will continue until the bargaining is complete, Schneider said.

There are benefits to extending the contract for both parties, Schneider said — legal protections for both the hospital and nurses, keeping the grievance process in place for employees and other conditions and terms that they both enjoy. But contracts expire for a reason, he added, and he feels Adirondack Health is long overdue for a new one.

Schneider said the typical contract is for three years, but nurses at Adirondack Health haven’t negotiated a new contract in six years. Instead, they’ve agreed to two separate three-year contract extensions in the past six years.

He said six years ago there was uncertainty on how much the hospital would be paid in federal reimbursement rates and the economy wasn’t great. There was a mutual agreement at the time that it was not a great time to negotiate. Then, three years ago, when they were set to return to the bargaining table, the coronavirus pandemic struck. Again, it wasn’t a great time.

In the interim, Schneider said the hospital and nurses have negotiated salary increases, but benefits like vacation and personal time and health insurance have remained unchanged. And the annualized average wage increase during those contracts has been 1.93%, he said.

“That wasn’t even meeting cost of living back then,” Schneider said. The costs of living have only increased with higher prices and inflation in the past few years, he added.

Schneider said nurses “played ball” during what was a time of difficulty, agreeing to “minimal raises” due to financial uncertainty for the hospital. Now, he said, they’re looking for a “fair” pay increase.

“We have been working under a contract that hasn’t had cost-of-living increases, and it’s not unreasonable for nurses to look for respectful salary increases that cover cost of living,” Schneider said. “The hospital’s current contract offer doesn’t even cover cost-of-living increases.”

NYSNA spokeswoman Diana Moreno said the average registered nurse’s salary increased by 3.75% from 2019 to 2022 — an average of 1.25% per year.

“At the same time, the healthcare executives at Adirondack have given themselves substantial raises,” Moreno wrote in an email. “The Chief Nursing Officer’s average yearly increase has been 6.5%, the CFO’s 5%, the COO’s 8.7%, CEO 22.9%, and current officers, directors and trustees 6.3%. The directors and trustees, who by all counts are responsible for attending a meeting every so often, made nearly $1 million since 2015. If Adirondack can afford to pay these people, they can afford to pay the nurses who care for this community.”

Scollin said in an email Wednesday that this figure — $1 million since 2015 — was “wholly incorrect.” The trustees on the hospital board receive zero compensation for their work on the board, he said, and serve as volunteers.

“Our trustees do a substantial amount of board-level work, and it is all volunteer work,” Scollin said in an email. “Their volunteer community service should not be unfairly and untruthfully misrepresented, or permitted to be misrepresented, despite publicly available IRS filings to the contrary.”

Moreno said the union was just working off the publicly available data.

“The information we provided on director and trustee compensation is publicly available information,” Moreno said in a statement Wednesday. “Adirondack Medical Center needs to be transparent about executive compensation. But most of all, they need to shift their focus from their own compensation to offering dignified wages and a fair contract for the nurses who care for this community.”

The figures cited by Moreno come from the union’s reading of the hospital’s IRS 990 form, an annual, publicly available document with financial information on the nonprofit organization. While most trustees to not take any reportable compensation, a few do. But Scollin said those that do are all physicians who work at the hospital and the reported compensation is for “services unrelated to their board positions.”

Scollin said compensation for employees who are also trustees on the board must be reported on the 990 forms.

“They’re just physicians that happen to be on the board,” Scollin said. “Even though the compensation has nothing to do with the work they do on the board of trustees, it’s still on there (the 990 form) because it would be inappropriate and illegal not to say that we paid them money. Because we do, but it was not for their board services it was for their physician work.”

The hospital’s 990 form for 2021 — the latest year available — can be viewed at https://bit.ly/3KNwBY0 and the information on trustee compensation can be found on pages 7 and 8.

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Staffing struggle

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Schneider said part of the union’s concern is for patients. Good pay for them means good health care for the community, he said.

He pointed out that the hospital currently has job openings for 16 vacant nurse positions on its website. With only around 200 nurses, that’s a lot, he said.

“The crunch is real,” he said.

The hospital has a mandatory minimum for its nurse-to-patient ratio, which is around 1:4. That’s better than average, he said, and not a complaint, but he added it is a struggle to keep it that way.

The hospital fills gaps by contracting with travel nurses from outside the area. This is expensive for the hospital.

There has also been a bonus program for local nurses with major pay incentives to take overtime shifts.

“The downside to that is that people can only work so much overtime for so long before that leads to burnout,” Schneider said.

He called this a “short-term solution.” To attract and retain new nurses, he believes benefits and salaries need to go up.

He said the union’s position is to convince the hospital that the short-term investment in higher pay and benefits to keep existing nurses and attract new ones will pay off long-term by having to spend less on contract nurses, incentives and training a constant flow of new nurses.

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Compensation competition

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It’s expensive to train new nurses, he said — around $60,000 to $90,000 per person. To train in specialties like the operating room or intensive care unit costs even more. If the hospital spends the money to train new nurses and then they leave for better pay somewhere else, that’s not good for the hospital, he said.

“From a financial sense, it makes a lot more sense to keep your existing nurses happy and keep them at the hospital, because it results in better patient care and lower training costs at the hospital,” Schneider said. “If you compare our salary to other local health care facilities in the North Country, the starting rate for new nurses, we’re the lowest in the North Country region.”

He was hesitant to share exact numbers on the starting rate pay. He said that could violate the ground rules for bargaining the union has with the hospital.

“In terms of the starting salaries, Adirondack Medical Center’s are the lowest in the region — lower than other hospitals such as CVPH, Carthage, Claxton Hepburn, and Elizabethtown,” NYSNA spokeswoman Kristi Barnes wrote in an email. “As the largest employer in the Adirondacks, the hospital should be creating good, family-sustaining jobs for local community residents.”

Schneider said nurses with years of experience also have some of the lowest salaries among their peers in the region, too, and that Adirondack Health has the lowest retention bonuses of the North Country hospitals with which it competes for staff.

Schneider said Adirondack Health hired seven recently graduated nurses last year and most have left — some to other local health care facilities for better benefits and pay.

Schneider said their medical insurance is some of the worst in the region for hospital staff. Some other facilities offer health insurance through the NYSNA union, which he said is better insurance at a lower cost to the nurses.

Schneider said less than half of nurses at Adirondack Health take the current insurance program, “because it’s expensive and it’s not great insurance.”

Currently, Adirondack Health nurses do not have access to NYSNA insurance, but that is one of the things they are bargaining for this year, Schneider said. The hospital would pay for NYSNA insurance, and depending on level of coverage chosen, employees might pick up part of the cost.

The hospital has not agreed to this insurance change because it’s more expensive than the existing insurance, Schneider said.

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Pandemic and future

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Many of these nurses are people who “stuck it out through COVID,” too, Schneider said.

The pandemic has been a difficult time for nurses, he said, full of “change and adversity.” Adirondack Health was spared from the massive numbers of deaths that metropolitan hospitals saw, but at times there were plenty of sick people in hospital beds here, he said.

He said everyone stepped up and put themselves in danger to care for others.

“That’s what nurses do,” he said.

The pandemic also brought new safety protocols that, while necessary, were also time-consuming. When working with COVID-positive patients, nurses suit up in layers of protective gear to keep themselves and other patients safe. This added a lot of steps and time to each interaction, no matter how small.

At the same time, he said many North Country nurses have left the workforce since the start of the pandemic.

Schneider said he’s proud of their work at the hospital, but they are spread thin.

The hospital does have financial struggles, he recognized. Though it got around $7 million in federal money to recoup lost revenue from the pandemic, the medical field has also faced supply chain, inflation and reimbursement issues, too.

“Medicare, Medicaid, insurance reimbursement rates are not keeping up with the costs of care, so hospitals aren’t being reimbursed well enough right now,” Schneider said.

Schneider has been working at the hospital for nine years this spring. He saw the negotiations the last time a contract was negotiated, but just as a staff nurse. Any union member can attend the open negotiations, he said. He’s new to being the chair but has sat on the committee for around five years.

“It’s negotiations. We’re going to find a compromise position. But I’m hopeful that the hospital is going to do the right thing and offer us a real salary increase and a good benefit package,” he said.

There are a lot of people involved in bargaining, Schneider said. Every time they meet they need schedules for many people to line up. They’re meeting a couple times a month now, he said. Those at the bargaining table are in the thick of it now, and while each side is hoping that sooner, rather than later, they will get what they want, Schneider said it will take “as long as it takes.”

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CORRECTION: This article has been updated to include a response from Adirondack Health regarding what they described as a “wholly incorrect” figure from a union representative, and the union’s response to questions seeking clarification about its statement. It was also updated to include additional context regarding the figures cited by the union.

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