Dear administration and staff of University of Utah Hospitals & Clinics: 

As a registered nurse at UUHC I have developed intense respect and pride for this organization that allows me to provide the best possible care for my patients. Being a member of a research hospital and academic institution cultivates a high level of knowledge and skill. This acumen can only be attained through the use of cutting edge technology, surgical ingenuity, educational opportunity, and a patient-first mentality. Consequently, University of Utah Health and its employees are highly regarded in the Intermountain West. 

It is with gratitude and love that I have become deeply concerned about the current state of the UUHC organization. 

In the last two years I have seen tremendous people come together to build makeshift crisis covid clinics, emergency department testing tents, a covid ICU, and dedicated covid units all while managing our normal patient flow. The adaptability of our workforce in action is remarkable! 

It is with this in mind that the darker side of exhaustion has presented itself in staff turnover. Whole units made anew after the loss of dedicated and seasoned staff. Uncountable years of knowledge and knowhow have regrettably left our system. The causes for these losses are many, but consistent among them is that our frontline workers do not feel that their contributions and sacrifices are being met with gratitude. Pizza parties have become a sign of dismissal. “Heroes Work Here” banners are a laugh in the face to the droves of human beings that have suffered to keep this great hospital what it is and to keep our patients safe. 

With quarterly retention bonuses amounting to less than $1 per hour worked, mandatory overtime shifts imposed, temporary incentive pay offered month to month, 20 newly hired travel nurses, and the recent arrival of US Naval nursing support one can’t help but feel that the intent of our organization is to get through this pandemic doing everything possible to not raise the base pay of its employees. Akin to putting band-aids over the wounds of our patients, this is not up to the standards that University of Utah Health has come to be known for.

We are not experiencing a nursing shortage; we are experiencing the revolt of an undervalued workforce. “Heroes work here, they just can’t park here.”

The Bureau of Labor Statistics estimates that 18% of healthcare professionals have left medicine since February 2020 and of those remaining, 31% have considered leaving their current hospital. The ‘national nursing shortage’ is the direct result of the COVID19 pandemic shining a light on just how instrumental healthcare workers are to the health and capability of the healthcare system. The inflated travel contracts that many of our qualified colleagues are taking is the perfect example of highly valued individuals being undervalued, underpaid, and being treated as expendable. This critical loss and lack of healthcare workers cannot be attributed to the individual, but to the organizations that employ them. This problem is not exclusive to UUHC, rather healthcare as a system. A 2007 report from a sample of 237 healthcare organizations indicates that nurse workforce and staffing issues, including turnover, were ranked only 7th in their list of concerns. The bigger topics of import on that list included reimbursement issues, government regulation, quality of care, and uncompensated care. It all boils down to the bottom line.

Nursing Solutions, Inc. surveyed over 3,000 health facilities between 2015-2019 to better understand healthcare turnover rates and causes. NSI highlighted the following causes for staff turnover:

• Desire for career advancement
• Retirement
• Seeking more competitive wages
• Workload and staffing ratios

Understanding that the causes of healthcare turnover are multifaceted, the UUCH system does a fantastic job at addressing many factors that increase retention. However, competitive wages are decidedly not among them.  

We live in a booming market with increasing income disparity.

Utah has been consistently rated the number 1 growing state in the nation as well as number 1 in the nation for its economy. Utah has had the fastest growing job market in the nation for the last 10 years. 

The Bureau of Labor Statistics shows the national mean pay for nurses in general/surgical hospitals in 2020 was $39.27/hr, while the mean pay for nurses at comparable hospitals in Utah is $32.02/hr.

As Utah’s housing market has grown, Salt Lake City is now ranked 18-22% more expensive than the national average in terms of cost of living. With the rate of inflation in 2021 conservatively being estimated at 6% and Utah nurses earning 18.48% less than the national average, the most trusted professional career operates at a  >30% cost of living /income deficit. This figure is the reason that so many healthcare workers in Utah are at an impasse and finding it imperative to seek new employment in order to remain living in this state.

Utah Realtors Association, UtahRealestate, and Realtor.com report that rent in Utah generally increases by 5-7% year over year, but jumped by 12% in this last year. Median home sales price has increased by 9.3% year over year for the last 5 years. However, from 2020-2021, Utah’s median home price increased by 23.6%, and the ZHVF predicts that home prices will increase by 17.2% over the next year. The Salt Lake Board of Realtors recent report states that in order to buy a median priced home in Salt Lake one needs to make $100,000/year. As cost of living continues to increase, a healthcare worker's salary will only afford them a dwelling too far away to commute. Something must be done to protect our remaining staff. Heroes cannot afford to live where they hero.

I am not the first person to recognize that retention costs less than turnover. This is the bottom line.

A 2002 study found that nursing turnover costs ranged from $62,000 - $67,000. In a 2008 retrospective study, the Journal of Nursing Administration applied several consumer price indexes to the 2002 study and adjusted for price variation over time; the updated data indicated the cost to replace a nurse was $82,000 - $88,000. Approximately $20,000 increase over a 6 year period. The majority of this cost comes from overtime, travel nurse contracts, bed closures, and patient deferrals due to staff shortages. These numbers do not reflect current travel nurse surge rates, pandemic nursing demands and burnout, or the 14 years of inflation to meet our current climate. In fact, NSI reports that travel nurse contract rates have increased over 200% during the course of this pandemic and for every 20 travel contracts eliminated, a hospital would save ~$3,084,000. 

I am a sincerely proud employee of UUHC.

As a specialized hospital, healthcare workers at the University of Utah pride themselves on being part of a special place. We are, after all, top 10 in the nation for patient satisfaction - a metric that directly reflects the professionalism and remarkable effort of nursing and other frontline staff. Our hospital accepts patients from surrounding states because of the highly specialized capabilities of the people that work here. Extremely sick people are given a second chance at life here, new surgical interventions and treatments are developed here, and people here care about the work that they do. I was once told by an administrator that UUHC prides itself on being in the middle of the pay scale in the Salt Lake Valley, they do not want to be above or below the average. Why would this elicit pride when we strive to be the best at everything else? 

The University of Utah’s PR department created a podcast, called Clinical, about frontline workers, the horrors we see, the struggles we feel, and the unrelenting spirit that we have. The PR folks also created a series of stories with titles like “Keep Breathing”, “Second Chances'', and “Hospital of Their Dreams”, which all encapsulate the magnificence of the human spirit and experience in healthcare. These stories chronicle the lives, grit, empathy, compassion, tears, fervor, and selflessness of the people that make these hallowed halls everything that these stories intend to share. The connection between frontline workers and their patients is the foundation on which advancements in healthcare grow, the soil that feeds the spirit of healing. 

Our frontline is depleted: overworked and underpaid. We ask to be compensated fairly for our education, professional licensure, experience, and crucial contributions to UUHC. We need a geographically livable wage so that we can live and work here. To this end we ask that you:

• Raise nursing wages by a minimum of 30% before the end of FY22 so that: 
  • Starting wages for new staff match at least the national average  
  • Wages of experienced staff adequately reflect their knowledge, experience, and clinical contributions

Sincerely, the Frontline

Note bene: We acknowledge that there is a history of retaliation against sincere critics of healthcare systems, including UUHC. Bear in mind you may sign with only your initials and credentials/affiliation if desired. We specifically invite all UUHC employees to petition with us. If you are not a UUHC employee but support our requests please indicate this in the signature line or in your comments.

If you are a member of UUHC nursing staff, comment with an example of a time when you as nurse or HCA made a critical difference to a patient’s outcome, safety, or satisfaction.

Thank you all!