The Hospital Corporation of America, a for-profit company more widely known as HCA Healthcare, operates dozens of hospitals and medical centers in Florida, including ten hospitals throughout Florida where registered nurses are unionized.
Nurses at these unionized hospitals — including two within a stone’s throw of Orlando — have been in negotiations for a new union contract with HCA for months, but have struggled to get their employer to address issues they’ve raised about staffing levels and lack of resources to safely and effectively care for patients, according to a nurse Orlando Weekly spoke to.
HCA Healthcare is one of the largest health systems in the United States, self-reporting over $5.2 billion in profits last year, even as the for-profit operator shuttered medical wards and facilities, including a behavioral health facility in New Port Richey. Across the country, HCA has been plagued by complaints from nurses and other healthcare staff alike over short-staffing, a problem described by one union as an “intentional corporate strategy.”
Elisabeth Mathieu, a nearly 30-year registered nurse at HCA Osceola Hospital in Kissimmee, represented by the labor union National Nurses United, told Orlando Weekly that they’re fighting for a contract that can protect not only their own safety on the job, but that of the patients they treat at the hospital, too.
She and other off-the-clock nurses rallied outside of their hospital Thursday morning, while nurses at Sanford’s HCA Lake Monroe rallied to raise awareness of their concerns the day before.
“At the end of the day, what we are doing is to advocate for them, advocate for our patient,” said Mathieu, who had just gotten off a 12-hour night shift. This advocacy, she said, is “a way for us to be able to have enough staff to give them the best care.”
“I want them to know we're fighting for them, and I want them to fight for us by telling HCA: Take care of your nurses,” she added. National Nurses United is a labor union that represents nearly 225,000 registered nurses nationwide, including about 350 nurses at HCA Lake Monroe Hospital and more than 650 nurses at HCA Florida Osceola Hospital in Kissimmee.
Nurses at both local hospitals — HCA Osceola and HCA Lake Monroe — first voted to unionize in 2010, representing some of the union’s earliest victories in a state where only about 6 percent of the workforce has union representation. Nurses at 17 HCA hospitals across six states, including Florida, are currently in negotiations for new union contracts.
Mathieu, a local nurse who serves on the bargaining team for her union — and who therefore gets to face off against HCA management in contract talks, face-to-face — has been working at her hospital for nearly 30 years.
She works 12-hour shifts as a nurse in the emergency department, and although she readily admits that understaffing has been a chronic issue, she believes in recent years, it’s gotten worse.
Mathieu attributes this, in part, to fewer unit secretaries on staff, who function as a “receptionist for the unit and assists the patient care team while maintaining a clean, organized, and safe environment,” according to an active HCA job listing (not at Mathieu’s hospital).
This increases nurses’ patient load and spells out less support for nurses, said Mathieu. “We also used to have more CNAs [certified nursing assistants] or more [patient technicians] to help us with patient care,” she added.
This, she explained, leaves nurses responsible for tasks that patient techs and CNAs are more commonly asked to do, such as taking patients to the bathroom, feeding patients, and repositioning patients in bed.
Hospital staff, including CNAs, represented by the 1199 Service Employees International Union (SEIU), similarly warned hospital executives of understaffing at HCA Osceola and unsafe conditions during their own contract negotiations at the hospital last year.
Heather Cox-Faith, a RN at HCA Lake Monroe Hospital in Sanford, told Orlando Weekly in March that she sees this, too. “It’s burning people out so quick that they’re leaving, or they're going to other hospitals, or they're jumping off to an agency and just traveling,” she said.
Unlike in California or Oregon, there is no universally agreed-upon standard for nurse staffing ratios in Florida, or on a national scale, despite research linking poor staffing levels to worse patient outcomes.
The difference between having adequate staffing, and not, can literally mean life or death, but the hospital industry has been fighting efforts to establish staffing mandates.
Legislation filed by Republican (yes, Republican) State Sen. Ileana Garcia in the Florida Legislature this year, which sought to establish basic nurse-patient staffing ratios in hospitals, died without receiving a single hearing from state lawmakers, thereby denying healthcare professionals any opportunity to provide public testimony on the idea.
While HCA Healthcare is not specifically listed as an organization that registered to lobby on the legislation, disclosure records show the Florida Hospital Association — a trade group representing hospital operators — and the hospital systems BayCare and Advent Health did do so, meaning they were interested (or worried) enough to keep an eye on it.
While HCA’s profits in recent years have notably dipped, from $6.9 billion in 2021 to $5.2 billion in 2023, this hasn’t stopped the for-profit from spending hundreds of thousands of dollars on political lobbying, campaign contributions and lobbyist compensation.
According to the News Service of Florida, HCA Healthcare was one of the biggest spenders on lobbying in Florida last year, reporting an estimated $913,000 spent on lobbyist compensation.
Campaign finance records show, from April through mid-June of this year, a political committee affiliated with HCA received two contributions of $25,000 from both HCA Osceola and Lake Monroe hospitals, in addition to contributions from their other hospitals across the state.
Today, California and Oregon are the only states with mandatory nurse-to-patient ratios, which nurses say can help reduce burnout, and prevent unnecessary deaths and errors on the job. California’s law first went into effect two decades ago, while Oregon passed their own staffing ratio law just last year.
Mathieu, at HCA Osceola, said she’s fully aware that HCA “has the means” to address nurses’ concerns about staffing, but says they have refused to offer even a counter to their proposal. Cox-Faith, from HCA Lake Monroe in Sanford, similarly expressed cynicism. “I mean, at this point, we could call all night long and tell them we’re drowning,” she said. “I don't see them coming in to help us.”
Mathieu sees high turnover among nurses who come into her hospital, who aren’t aware just yet of what they’re in for. “Nursing is a challenging profession, because you’re not just working with machines.”
You have to be awake, alert and oriented each second you’re on the job, she said. With staffing levels as they currently are, Mathieu added, nurses have less time to dedicate to training and mentoring new nurses, and often have to take unpaid lunches, or go without, since she said they only get 15 minutes for lunch on paid time.
“Together, we can fight,” said Matheiu of the organizing efforts by her union. “Because, at the end of the day, we are at the bedside,” she said. “Nurses feel good about standing up together and fighting for what's right for patients, fighting for what’s right for the co-worker, so all of us together can care for patients in a safer way.”
“I want them to know we're fighting for them, and I want them to fight for us by telling HCA: Take care of your nurses”
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Orlando Weekly reached out to HCA Healthcare for comment on nurses’ concerns about staffing, as well as justification for their spending on political activities.
An HCA Osceola spokesperson shared in a statement that staffing “is safe and appropriate” at the hospital, and that HCA Florida hospitals – including HCA Osceola — have been recognized for “excellence in patient safety” through awards from Healthgrades.
Healthgrades is an online healthcare resource owned by RVO Health, a company backed by personal finance company Red Ventures and UnitedHealthGroup’s Optum, a health insurance company.
“We value our nurses and are hopeful we can reach an agreement that is fair and reasonable for both sides,” the hospital spokesperson continued. “Throughout this process, our hospital will continue to put the health and well-being of our patients, caregivers and colleagues first.”
They did not address Orlando Weekly’s question about political spending.
Here in Central Florida, nurses’ current contract technically expired May 31, but they got a one-month extension on it that is set to expire at the end of the month. Although healthcare strikes are rare around these parts, nurses organized with National Nurses United haven’t been afraid to strike HCA hospitals elsewhere before, and the possibility that it could happen here, if HCA fails to meet nurses’ demands, isn’t off the table.
Of course, any strike by nurses organized with the union would require a democratic vote by union members in support of a strike, plus a 10-day notice submitted to HCA and the Federal Mediation and Conciliation Service, under federal law.
A union spokesperson told Orlando Weekly that what happens next in Central Florida, after the local contract expires July 1, is “for the nurses to decide.”
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