Nurses treating patient while wearing PPE

The Dangers of Health Staffing Companies

“Kill you, pay me” 

The battle cries of once-voiceless warriors for the working class are now blaring into the ears of the majority of United States citizens. As millions wake to the true political fight in this country, the one of progress for the many vs. the concerns and desires of the powerful few, a real opportunity for positive change swells. While more people in the United States work to produce more profit than ever before in our history, wages for average workers have remained flat for the last 40 years. This is despite the fact that the needs and costs for workers have grown and changed greatly in the past four decades. 

As a society develops, so do the needs of its citizenry. Where at one time, access to running water and indoor plumbing were considered a luxury, as an economy grows, what was once luxury becomes necessity. After all, how can a modern business be expected to thrive if its workers arrive for their shifts smelly and unkempt (work from home maybe)? Who will want to buy from an establishment which employs those with such poor personal hygiene? How will such an enterprise fare in attracting additional high-caliber workers to continue to grow the business? Furthermore, how can workers be expected to be alert and ready to perform their expected 40 plus hours of labor if they’ve spent so much of their free time retrieving water to do their cooking and cleaning? The point here should be clear: as a society develops so do the basic needs of its workforce.  

Recently, I found myself in desperate want of such development. In February of 2020, I accepted a new position. This was my second “real” job out of college. That just means second job that offered healthcare benefits. My first job was a paper route at age 10. At age 30, I have been “employed” more than half my life.  

In my new role, I would be recruiting for a healthcare staffing company. When I accepted the position, I was very aware of the ugly side of for-profit healthcare, but with the interest beginning to accumulate on my student loans and this being the highest paying job offer I had received, I convinced myself to take the role for the short term in order to pay down debt and gain experience as recruiter. Again, I accepted and started this job toward the end of February, right before the madness of 2020 began.  

First, a little bit about the staffing industry. Most workers are intimately familiar with temporary or contract work. Jobs like this have unfortunately become the norm as companies continue to seek new and innovative ways to cut labor costs while still boosting productivity and profits. The staffing industry is a big help to businesses in this regard. Many of these companies are very young, and growth in the industry has largely coincided with recent recessions and economic crashes. Since I’m writing this in the midst of yet another economic crash, you can expect growth in this industry to continue. 

As it was explained to me, the staffing company exists to service businesses seeking to hire temporary employees. It holds all employee documentation and serves as an employee’s official employer of record. The workers, however, will fulfill their assignments by working at a secondary company. This arrangement offers the outside or secondary employer access to labor with reduced costs and risks. Staffing companies allow their customers to avoid certain liabilities and to save money by withholding full benefits or other guarantees that they might otherwise be obligated to pay a direct hire. An employee starts on a contract, and the contract can be extended or ended at any time, at the discretion of the secondary employer.  

In a country with strong social safety nets, it could be argued this sort of work arrangement may be mutually beneficial to employer and employee. Perhaps a potential hire would like broad exposure to a variety of entry level positions before deciding on a career path. Here temporary contract work may be ideal for all parties. Or maybe an employer is looking to fill role with an extremely high turnover rate, and finding the right candidate is nearly impossible through interviewing alone. In this circumstance, maybe only “on the job” experience can inform the employer if their new hire will be a long term fit and should be offered a company pension plan, top rate insurance and a hefty salary (as if those were commonplace anymore). Yes, I do think there is a place in this world for staffing companies (publicly owned ones especially). However, in the healthcare field, during a pandemic, this sort of relationship between employers and employees is flatly unacceptable. 

For context, it’s important to understand that my company is actively hiring nurses and other certified healthcare professionals to work on the front lines of the COVID crisis. Our healthcare staff work in ICUs, psych wards, prisons, nursing homes and all other sorts of medical facilities which are directly battling the virus. And while these nurses and healthcare professionals are offered “crisis rates” for these roles, they are not eligible to use company provided health insurance for at least a month, if not longer, depending upon their start date. This means nurses are putting themselves at risk for the benefit of sick and dying patients but are not even being offered health insurance on day one. Sure, they may be earning an extra $10-$30/hr for the risk, as they should, but if they were to get sick and have to pay hospital expenses, the extra hourly rate would certainly not cover an extended stay for COVID-19, which without insurance averages between $51-$78 thousand dollars . 

Essentially, our nurses have to weigh the added risk of facing obscene medical bills on their own if they were to contract the disease before their insurance coverage kicked in. Is this really the type of decision that front line, essential healthcare workers should be facing at this time? I should hope not.  

Of course, all of this information was strangely above my pay grade. Fielding questions about benefits was not part of my job description or training and, as a recruiter, I was instructed to direct all benefits inquiries to a separate Benefits Department. All of this, as you can imagine, was to the displeasure and inconvenience of our temporary employees… the joys of having two bosses, all the answers you need in five separates but still somehow convenient locations!  

But it didn’t take long for me to find all this out. A few months into the job, one of my recruits reached out to share her concerns regarding our insurance plan. This nurse had recently accepted a contracted position through our company. She was in her early 60’s and had been out of work for the last few years while battling cancer. Due to her age and medical history, she was at a much higher risk of developing serious complications or even dying from COVID-19 than most, but she was under financial duress and needed income.  

Without recent work experience on her resume, this candidate was rejected from a number of internal roles for which she would have been more than qualified before taking time off with her illness. Essentially, through no fault of her own, this highly trained and experienced ICU nurse was forced into a position where temporary work through an agency was her only option. After a slew of rejections, this nurse got her first job back in healthcare through us, as a temporary nurse in a long-term care facility.  

The COVID-19 situation in that facility was beyond troubling for her. After contacting the benefits department, she understood she would be paying weekly premiums just to have, and not even use the insurance we offered. To use the insurance, she would have to meet a deductible of over $4,000. And on top of that, as mentioned earlier, she wouldn’t even be able to access her plan for nearly two months after her start date! This was when I began to lose it.  

I reached out to management and our HR department about the situation facing my recruit. In distress, I sought some sort of answer for why we would allow our nurses to work directly with COVID-19 patients while uninsured? This seemed a tremendous oversight to me, one which would surely soon be fixed? To my severe dismay however, this didn’t really register as a problem with upper management. 

In response to my expressed concerns, I was informed that our temporary workers were paid at a premium! Our employees, on average, earned a higher hourly wage than a typical internal employee, and the extra hourly rate was meant to make up for the high-cost insurance, the lacking PTO, the non-existent pension plan and absence of other benefits typically offered to internal healthcare staff. Under normal circumstances, the pay differential between temporary and internal staff members amounts to a few dollars an hour. During the pandemic (and depending on the specialty and location worked) nurses are certainly earning more, sometimes as much as $30/hr more than typical rates in my experience. But when you take into consideration the cost of what an uninsured hospital stay can amount to for Corona patients discussed previously, the potential setback of tens of thousands of dollars is just not covered by “Crisis rates” for hourly pay.  

The worker I mentioned previously earned just over $36/hr. Per her contract in a facility with a known COVID-19 outbreak. Working in Missouri, she was actually earning under the median pay for nurses as of 2018. Sadly, she was not the last to voice similar concerns to me.  

Suddenly, I felt part of confidence game, a game which aimed to convince people that our organization is essential to having healthcare workers in place to deliver the care people need. Without us, the system would fail, and people would die, —This, I’ve realized, is a lie. In fact, without a middleman staffing company, hospitals and other healthcare institutions would be forced to handle their own staffing. Employees working directly for a healthcare provider would then have collective bargaining power to demand better pay and conditions for themselves and their patients. The real reason my business, and businesses like it exist is to keep profits high for owners at the expense of the earning and collective bargaining power of their workforce. 

This new understanding brought with it a particularly devastating depression. At this time, like the rest of the country, I was cut off from my usual social circle and activities. Additionally, my roommate had lost his job and couldn’t make rent. He moved back in with his family, and my more costly bills doubled. Mired in student debt and further burdened with the knowledge of the unemployment crisis and how difficult it was to get this job in the first place, I began to feel trapped, performing tasks which now struck me as nothing but destructive to the lives of healthcare workers and their patients.   

The result of all this was a mental breakdown. I reached out to HR about my troubles- I told them my thoughts were getting to a place where I felt a strong need for psychiatric help- but, of course, my own insurance plan didn’t make this option affordable for me —Their solution? Unpaid leave to deal with my mental health issues. Hooray! I was not allowed to return to work until I was cleared by a doctor, which of course, I would have to pay for.  

I took some time. I attempted to find some other work, but with only a few months of recent recruiting experience and an absolutely staggering number of unemployed people to compete with, I managed to get a few interviews, but no firm offers. So, I went to the doctor, started on medication for anxiety and depression, asked for a work release, and went back to my job.  

I told myself, “It doesn’t have to be forever. Things are bad right now though, and you need money coming in. Just do what you have to do to survive…” This attitude lasted a few months. Soon my manager reported some “great news!” He let us know that in 2020 our company had far surpassed their most profitable year on record, and as a sign of gratitude to all the workers who made this possible, we would be offered a new commission structure, effective January 2021.  

So that’s right, in 2020 not only our local office, but the entire company was excited to report its most profitable year on record, but were the low-level employees like myself or our nursing staff going to reap any of the increased profits? Not quite. Instead, recruiters like myself would be given the opportunity to earn more, if we kept producing at this same rate, next year… I guess we’re meant to hope that the pandemic, which is the obvious cause of the increased profits, will still be raging each week next year, when we are graciously allowed the opportunity to “earn” a slightly higher commission on recruits placed. For readers who are not understanding my outrage, let’s take a closer look at the numbers. 

At the heights of the pandemic, our office of four recruiters and one business development manager brought in over $30,000/week in PROFIT! Not revenue, but profit. This mark was achieved consistently when all four recruiters were working through the pandemic. The other recruiters and I were paid right around $45k for 2020 and were told by our manager that he earned just over 60k. If you do the math, you find the company is paying us five employees right around $250k to generate what could amount to around $1.5 million in profits, not revenue, but profits! Next year, if we make them that same $1.5 million, they will be generous enough to pay us a combined $350k!… 

This is the same company that won’t give day one health insurance to nurses working directly with COVID-19 patients, the very same company that heard of my need and inability to pay for mental health services and decided to stop paying me! 

What makes this worse is when you really start to think about these numbers, you see that so much of the cost of healthcare ends up in the form of profits for people who are not doctors, nurses, aides, techs or specialists. The majority of the money funnels to upper-level administrators, salespeople, lawyers and accountants who are all in place to ensure profits, not care. As of 2018, the Co-founders and CEOs at the top of the top of my organization were worth over $7 billion dollars combined. It hurts to imagine the effect 2020 will have on that figure.  

Again, on the verge of a total mental breakdown, I reached out to our company’s HR department. I wrote an email describing my internal battle between ethics and survival. I let them know my thoughts of self-harm were growing, and I pleaded for help with paying for mental health treatment that I had been putting off for months. I hit send. I received a phone call 10 minutes later, and though I had received zero warnings or indications that my performance had been unsatisfactory, I was informed that my employment had been terminated. 

At what point do we ask ourselves, “Is this really the best we can do?” Why are we working so hard to make money for organizations and people who use and abuse us to build their wealth? Am I not to feel insulted when I see the company’s PR line is one of “serving” others and “enriching” the lives of our staff and patients? When a company makes record profits at the expense of quality of life of its employees and consumers, who is really being served? Just whose lives are being enriched by all of this.  

I cannot believe it is necessary to live in a world where the profits of executives and unnecessary third parties outweigh the basic needs of the people who need and deliver healthcare. It is long overdue that healthcare, like water, electricity, paved roads, and public education, be made a public utility to ensure affordability and access to all. When will we rise up and demand our employers direct more profits into the hands of the workers who made created them? When will we understand that moving forward means cutting the profits of the criminals at the top of these healthcare organizations, who are more than fine with the poor and uninsured dying so long as their wealth is maintained?  

The time to speak up on these issues is now. If you work hard and are barely making it, I implore you to understand that your enemy is not found in the poor and working-class people on either side of the political aisle, but in those who have taken more than enough, and who will continue to deny basic dignity for all. Unite with your fellow workers and impoverished community members, understand the strength you have in numbers, and demand and continue demanding for the dignified treatment of yourself, your fellow workers and your community. 

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