Ellen Andrews avatar

Healthcare is expensive in Connecticut. The shortage of nurses is a prime driver of those rising costs. Nursing is hard and dangerous work. While the state is working to lower healthcare costs across Connecticut, one state entity is driving up private nursing costs. In the last two years Bristol Hospital, and presumably others, have spent millions of scarce dollars to train new nurses, only to have them leave and take that expertise to the state’s public hospital – UConn Health Center. State law recognizes these lost costs when new police officers move between towns. Doing the same for nurses and hospitals would help keep healthcare costs down.

Healthcare is labor-intensive. According to the American Hospital Association, US hospital labor costs grew 20.8% from 2019 to 2022, rising faster than any other expense. Nurses were the largest share of those rising costs. Because hospitals couldn’t hire enough nurses, spending on contract nurses rose 180% over those years.

Connecticut is not immune to the national nursing shortage. Nurses are the largest share of healthcare workers in our state. Even before the pandemic, the Governor’s Workforce Council estimated that Connecticut needed to graduate, license, and retain an extra 1,000 new nursing school graduates each year to keep up with demand.

Small independent hospitals are bucking the consolidation trend that allows huge, monopoly health systems to jack up prices. Bristol Hospital, one of Connecticut’s remaining independent hospitals, is facing stiff competition from large health systems. The state’s latest report says Bristol lost $63 million from 2019 to 2021.

According to Nancy LaMonica, Bristol Hospital’s Vice President and Chief Nursing Officer, nursing costs are a large part of those losses. Newly graduated nurses need up to a year of additional orientation and training to be ready for work in their eventual hospital unit. That training can include onboarding, orientation, residency, and classes. In the last 14 months, Bristol has lost 11 nurses to UConn Health. Most of those nurses left the Intensive Care Unit where Bristol now has a 50% vacancy rate. When those nurses left, not only did Bristol lose their investment in training, but they also had to replace them, both temporarily with nurses to fill in, and eventually with permanent replacements. Turnover has been so high that Bristol has trouble finding experienced preceptors to train new nurses. LaMonica calculated the total costs to the hospital over the last 14 months at $1,429,635.

According to exit interviews, the nurses left for better benefits at UConn Health. Those benefits include the very rich state employee health plan and tuition assistance for employees and their dependents. Each nurse also received a $10,000 signing bonus from UConn Health to move. UConn also pays a substantial hourly stipend over the base pay levels at other Connecticut hospitals. UConn’s richer benefits are subsidized by state taxpayers. Bristol has increased pay but cannot match all of UConn’s package while keeping prices down to what payers can afford. 

LaMonica says “it disheartens me as a Chief Nursing Officer to lose nurses who we educated and trained in our culture making patient safety and exceptional outcomes a top priority every day at Bristol Health. We remain committed to serving our community with excellence. However, losing contracted nurses to the draw of more attractive benefits and pay in a time where all hospitals post-Covid are desperately seeking nurses and struggling financially, adds another significant mountain to climb.”

All this moving around creates new costs for Connecticut’s healthcare system without adding any value. It can also compromise the quality of care as new nurses have to adjust to new settings. These pay increases escalate insurance premiums and consumer costs – we all pay the price.

In response to similar concerns from municipalities about police officer training costs, Connecticut state law addresses the unfairness. When an officer leaves a town to work in another municipality, after working less than two years, the receiving town must reimburse the first town for 50% of the officer’s training costs. 

If we have any hope of controlling healthcare costs, we need viable independent hospitals like Bristol to remain as options for care in our state. There should be an arrangement to reimburse costs for nurses who leave a healthcare system that invested in them. State policymakers should fix this, but should also address the uneven benefits between UConn Health and independent hospitals that are at a state-created disadvantage in attracting staff.

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Ellen Andrews, Ph.D., is the executive director of the CT Health Policy Project. Follow her on Twitter@CTHealthNotes.

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