The basics:

• NJ hospitals balance labor demands with financial challenges
• Staffing, wages and workplace safety remain key bargaining issues
• Statewide nursing shortages are projected to continue through 2037
• Hospitals, unions differ on solutions to recruitment, retention

A strike, originally set for June 16 – by nearly 850 Health Professionals and Allied Employees (HPAE) unionized nurses at Virtua Memorial Hospital in Mount Holly – was averted by down-to-the-wire negotiations. Some 30,000 Garden State healthcare workers are represented by a patchwork of unions, each with their own priorities; and hospitals are finding it challenging to manage a medley of demands. It’s one more burden for Garden State hospitals, which already face higher expenses for equipment and other operating costs, along with a squeeze from lower reimbursements.

The HPAE talks may have been a white-knuckle affair, but Virtua Health Executive Vice President Chief Human Resources Officer Rhonda Jordan told NJBIZ she was always optimistic about a settlement[MD1.1]. HPAE did not respond to requests for comment.

“Negotiations are inherently complex,” Jordan said. “Fortunately, Virtua and HPAE have a long history of collaboration and arriving upon thoughtful, responsive contracts for the member nurses. It’s important to note that we were always aligned in terms of the objectives and priorities – everyone wants safe staffing, fair compensation, and so forth – it was about finding the right way to get there.”

Wages and staffing issues typically receive a lot of coverage, but another key discussion point was “the importance of safe working environments,” she added. “Virtua has comprehensive safety protocols that include weapons screening technology, panic buttons and more. Both parties agreed that safety is of paramount importance; through the negotiation process, we have committed to additional, meaningful plans to address it further.”

Balancing act

Hospitals, however, have cited a number of financial challenges, such as rising medical costs and reduced reimbursements from Medicare, Medicaid and insurance companies. How can a hospital system like Virtua balance the need to avoid a labor interruption with the financial squeeze?

“It is well-reported that many hospitals across the U.S. operate at a deficit,” Jordan acknowledged. “The current economic landscape and the anticipated challenges ahead must always be considered. That said, our nurses are essential to our ability to be the trusted choice for personalized, compassionate care. Therefore, our responsibility is to find solutions that account for all these factors and position our health system, and our nurses, for the long term. It’s about achieving balance.”

Getting there could be challenge, with significant Garden State nursing shortages projected through 2037, according to a recent New Jersey Collaborating Center for Nursing report.

“Demand for care is increasing as the population ages,” agreed Jordan. “People are generally living longer, thankfully, and patients require more complex and comprehensive care services. At the same time, healthcare professions are facing challenges related to burnout, turnover, and retirements.”

She said Virtua is “committed to addressing these matters and supporting colleagues in having long, fulfilling careers. Specifically, we offer a suite of wellness, belonging, and recognition programs to help them feel connected to purpose and one another. I believe these efforts contribute to our recurring appearances on ‘Best Places to Work’ lists from Forbes, Newsweek, and others.”

In late June, Virtua announced it earned national recognition as an exceptional employer on two “best workplaces” lists published by Newsweek. “For the second consecutive year, Virtua is named on Newsweek’s list of America’s Greatest Workplaces in Health Care,” the institution reported. “In addition, Virtua has again made Newsweek’s Greatest Workplaces by State list, which includes all industries. The honors highlight Virtua’s commitment to fostering a purpose-driven, inclusive and supportive work environment for its more than 16,000 colleagues.”

Added Virtua Senior Vice President and Chief Nursing Executive Catherine Hughes, “We are working proactively to get ahead of the nursing shortage. In fact, we have been developing solutions for several years. Our primary driver for remaining well-staffed is our own nursing schools and programs, including our academic affiliation with Rowan University. Each year, we train new classes of talented nurses, many of whom elect to join the Virtua workforce upon graduation. We also have scholarships, tuition reimbursement, and other programs to make it easier for existing, established nurses to pursue further education. We are committed to creating pathways to help grow the next generation of nurses.”

Step toward a solution?

In March, Gov. Mikie Sherrill signed legislation eliminating many practice restrictions for advanced practice nurses. Hughes saw the move as a positive development. “Advanced practice nurses are highly trained professionals who play an important role in caring for patients,” she said. “Removing barriers can help patients receive care sooner, while still preserving the importance of collaboration, quality, and safety across the care team.”

Jordan was also upbeat about developments at the Virtua system. “We recognize our responsibility to the community,” she said. “We are in the early stages of a renovation and expansion project that will serve future generations of Burlington County families and give our Mount Holly staff – especially our nurses – a modern, welcoming facility.”

Other New Jersey hospitals are addressing labor issues. When JNESO – a union that represents more than 5,000 nurses, technicians, and other health care workers in New Jersey and Pennsylvania – recently agreed to a contract at Bishop McCarthy Center for Rehabilitation and Healthcare in Vineland, pay raises weren’t the only issue on the bargaining table. Additional vacation days were also a sticking point that was ultimately resolved.

According to Douglas Placa, executive director of New Brunswick-based JNESO District Council 1, IUOE-AFL-CIO; and Elfrieda Johnson, board president of JNESO, time off is vital to combat a continuing burnout-driven nursing shortage.

Johnson, a registered nurse who also serves as president of the local at Saint Michael’s Medical Center in Newark, has worked bedside there throughout her tenure at the union. She said the pressure on nurses is relentless. “Safe staffing, adequate staffing – making sure that you have what you need to take care of the patient properly at the bedside – that’s the top priority,” she noted.

Not a new concern

A 2023 Rutgers University study highlighted nursing staffing and burnout as major concerns in New Jersey. And Placa said that the research goes back further than many realize — a landmark University of Pennsylvania report raised the issue in 2002; a later JNESO-commissioned study also flagged the same warning signs.

“Universally, working conditions, and more specifically, having resources for our members to work at the bedside, is a top issue,” Placa asserted. “That includes staffing, ancillary staff, equipment, and other items needed to do direct patient care.”

The COVID pandemic also left a lasting mark. “A significant number of experienced nurses retired or left the bedside rather than continue under grueling conditions,” cautioned Johnson. “Then post-COVID, many nurses decided, ‘I’m not going to do this anymore,’ and a large number left. That means we have to bring in new hires, which takes more time to train.”

Placa added that management, having learned during COVID how to operate short-staffed, has largely continued that practice. “The premium on nursing is even more so today than before or even during COVID, because so many healthcare workers have left the field,” he said.

The human resources deficit isn’t going away anytime soon. A 2026 report from the New Jersey Collaborating Center for Nursing projects significant supply-demand shortages through 2037. Both union leaders point to a shortage of nursing educators – and insufficient pay for them – as key bottlenecks.

Can’t do it all

Placa cited an additional issue: loan forgiveness programs to attract candidates. “Nurses do it because they love it,” he said. “But they walk through the door with wholehearted intention and find out they can’t do everything because they’re so short-staffed — and that’s when burnout kicks in.”

The recent legislation Sherrill signed, eliminating many practice restrictions for advanced practice nurses, was just a bandage, according to the union officials. Placa framed APNs as a complement to, not a replacement for, floor nurses.

For Johnson, the union matters now more than ever. “The hospitals have found a way to get the work done with less,” she said. “The union helps us balance that — knowing that no matter what’s going on, your union is not going to abandon you.”