New York City Health + Hospitals (H+H) spent $168 million more than projected on temporary staff, despite hiring over 1,660 new nurses in city fiscal year (CFY) 2024, according to a new report released today by New York State Comptroller Thomas P. DiNapoli.

"The COVID-19 pandemic led to a major nursing shortage nationwide and in New York City, but Health + Hospitals has taken important and meaningful steps recently to recruit and retain more nurses," DiNapoli said. "The number of full-time nurses at H+H now exceeds pre-pandemic levels, but temporary staff costs are still elevated. Further hiring and training are needed for H+H to achieve its fiscal targets and provide quality health care to all New Yorkers."

Following the COVID-19 pandemic, nearly all H+H hospitals saw a decline in nurses between February 2020 and June 2023. Woodhull Hospital in Brooklyn, Harlem Hospital in Manhattan and Lincoln Hospital in the Bronx saw a 24.1%, 22%, and 14.5% decline in nurses, respectively. As a result, H+H increased temporary nursing headcount with costs rising as high as $660 million in 2020. From 2023 to 2024, H+H worked to increase its staff nurses, hiring over 1,660 new nurses in CFY 2024, and then reducing temporary nurses by 880 positions. Spending on temporary staff declined from $410 million in CFY 2023 to $298 million in CFY 2024.

H+H still relies on a greater number of temporary staff to meet patient needs than it did pre-pandemic. While collective bargaining agreements have contributed to increased permanent nurse hiring, it will take some time for H+H to train newly hired nurses, and temporary staff costs may continue to exceed its projections. Further, potential hospital closures and continued challenges contributing to a nationwide nursing shortage persist and add pressure on the H+H system to compete for staff.

Nationally, nursing school enrollment is not growing fast enough to meet workforce growth projections of 195,000 new positions a year. One factor impacting the number of nursing school graduates is less nursing school faculty. Nursing schools across the country reported vacancy rates of nearly 8% in 2023.

The city has taken steps to partner with the City University of New York (CUNY) to increase its nurse workforce. H+H estimates it provides clinical training to 1,800 CUNY nursing graduates annually and employs more nursing school graduates than any other health system in New York City. This year, CUNY unveiled a new Nursing Education, Research and Practice Center at Lehman College, tripling its capacity to help address the statewide nursing shortage. While nursing graduates still remain below 2021 levels, new student enrollment grew year-over-year in 2023.

In addition, to increase nursing school faculty, CUNY launched a fellowship program which trains and supports nurses for educator and leadership roles in CUNY nursing programs or other health care settings.

This analysis is an update to DiNapoli's 2023 report, NYC Health + Hospitals: Nurse Staffing Trends.

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NYC Health + Hospitals: Nurse Staffing Trends Update