Update from Alan Levine on steps to address nursing shortage

From the CEO

NOTE: This message was emailed on Friday, July 29, 2022, to all Ballad Health team members from Alan Levine, CEO and President of Ballad Health.

Dear Colleague:

Earlier this week, I communicated with you regarding some steps we are taking to help deal with the national nursing shortage, and the staffing concerns we face in many of our hospitals due to the nursing shortage. 

Alan Levine

I have received incredibly helpful feedback and questions from some of our team members, and I want to be responsive to what I believe are genuine efforts to help us make the best decisions.

First, let me reiterate that we have taken several steps which benefit all our team members, and we continue to evaluate where changes in the labor market have made it necessary to change the pay for certain team members, particularly in nursing and other areas where we have faced national labor shortages. 

Here’s what we’ve already done

Specifically, some investments we have made include, but are not limited to:

  • We have held flat all team member contributions to health insurance premiums at a time when health care costs have increased by more than $6 million for Ballad Health. By comparison, our team member out of pocket contributions are extremely low relative to our peers. This helps all team members who have the health insurance benefit.
  • We have increased our hire-in wages for bedside nursing systemwide by 22% in the last two years, in addition to annual wage increases, and at the same time, implemented compression adjustments (pay increases) for all bedside RNs, LPNs and CNAs. ALL bedside RNs, LPNs and CNAs in ALL our hospitals have received increases to base pay in addition to annual wage increases. Bedside LPNs have received two special increases systemwide in the last two years, in addition to annual increases, while bedside CNAs systemwide have received three special increases in the last two years in addition to annual increases.
  • We have doubled our on-call pay to $3.00 an hour and doubled annual pay increases to 4%. The increase to on-call pay benefits everyone system-wide who already takes call, and the doubling of the annual pay increase benefits all eligible team members.
  • On July 15, every eligible team member received the second part of a special bonus – $1,250 total over two installations for full-time and $625 for part-time team members. This was the third special bonus paid to almost every team member in the last 12 months. 
  • We have done some pay adjustments in certain departments based upon labor shortages, and we continue to evaluate other areas. In these cases, the pay adjustments are communicated directly to the team members who are involved. 

All Ballad Health team members are valued and contribute to the success of the health system. At no time in modern history has it been more evident that healthcare professionals are heroes who make a difference to the human condition. And, so, I want to be clear with everyone that the targeted adjustments for RNs in our four major inpatient, acute care receiving hospitals (Bristol Regional Medical Center, Holston Valley Medical Center, Johnson City Medical Center and Johnston Memorial Hospital), which we announced earlier this week, were intended to deal with a very specific challenge. 

As we know, the severe shortage of RNs has affected everyone in all our hospitals in a multitude of ways. One of the most serious issues we face right now is that many of our community hospitals are being negatively affected by the severity of the shortage in our receiving hospitals. Our community hospitals are holding patients who would normally be transferred to a major receiving hospital due to the availability of the specialty services needed by the patients in the receiving hospitals. This is placing a strain on the community hospitals, their nursing and support staff, and more importantly, disrupting the continuum of care for our patients – who are the most important part of this discussion.

By far, the worst turnover, highest use of contract labor, and worst vacancies are occurring in our four inpatient, acute care receiving hospitals. There are many reasons for this, all of which are occurring due to the severity of the RN shortage. 

It is critical for our patients, and for the nursing staff in all our hospitals – including our community hospitals – that we solve this problem with a sense of urgency. By prioritizing our immediate focus to reduce the vacancies in the larger receiving hospitals, we will reduce the pressure on our community hospitals, allowing for smoother transfers, decompressing our emergency departments and helping us to provide the level of care we all desire for our patients. 

Over the past few days, I have heard from team members from across the system who have provided me with very helpful feedback, which I have taken seriously. Certainly, we did not intend to send the wrong message to RNs in our community hospitals, and I apologize if our actions came across that way. These challenges are unprecedented, and our attempts to solve them are unproven as of yet. To all our team members, you are important, valued and trusted. I hope, at a minimum, the steps we have taken – and will take in the future – to provide bonuses, withhold increases to insurance premiums, make pay adjustments and more, demonstrate you are not forgotten.

In this case, we are attempting to solve a problem that, if not solved, will harm patients and make the work of all our nursing staff in each care setting even harder than it is today. So, I ask that you bear with us as we address these issues systematically.

Here’s what else we are doing

With the constructive feedback we’ve received over the past few days, I agree with our nurses in the community hospitals who felt that the decision we made left too great a gap in pay for RNs. So, beginning with the pay period starting Sunday, Aug. 14, 2022, the hire-in rates for all our inpatient, acute care non-receiving community hospitals will increase to $24/hour, and an appropriate compression adjustment will be made for our nurses in those hospitals, which includes:

  • Dickenson Community Hospital
  • Franklin Woods Community Hospital
  • Greeneville Community Hospital
  • Hawkins County Memorial Hospital
  • Hancock County Hospital
  • Indian Path Community Hospital
  • Johnson County Community Hospital
  • Lee County Community Hospital
  • Lonesome Pine Hospital
  • Mountain View Regional Hospital
  • Niswonger Children’s Hospital
  • Norton Community Hospital
  • Russell County Hospital
  • Smyth County Community Hospital
  • Sycamore Shoals Hospital
  • Unicoi County Hospital
  • Woodridge Hospital 

I commit to our team members that we will continue to evaluate appropriate adjustments in other job categories where we are finding the labor shortage has affected our ability to retain staff. In these cases, we will communicate directly to our team members who are affected. 

I am extremely grateful for the feedback and open dialogue that has occurred this week. We are listening. While we may not always get it perfect, we are trying to solve the problem I know you are feeling each day. The staffing shortage is, indeed, severe, and it is a national problem. While we didn’t create it locally, we must find a solution that works for our region. Whether you are a team member in a hospital, an outpatient clinic, a post-acute care site, or an ancillary or support department, we are all truly on the same team, and I hope you will continue to provide the feedback to us as we navigate these very unchartered issues.

Alan