Certified nursing assistants play a crucial role in providing health care for hospital patients. But that hasn't stopped one of Colorado's newest hospital systems, Intermountain Healthcare — which resulted from the 2022 merger of Intermountain Healthcare with the Sisters of Charity of Leavenworth (SCL) Health system — from handing pay cuts to CNAs across the state through a new, percentage-based program.
Sources at the four metro Denver Intermountain hospitals say that not only are the pay cuts unnecessary and unfair to those they affect, but they could contribute to ongoing CNA staffing shortages — and reduced care for patients.
Sources at the four metro Denver Intermountain hospitals say that not only are the pay cuts unnecessary and unfair to those they affect, but they could contribute to ongoing CNA staffing shortages — and reduced care for patients.
Hospitals typically use a pay incentive system to encourage hourly employees — such as nurses and CNAs — to work shifts that fall outside of usual business hours, usually nights or weekends. According to sources at Intermountain Health, SCL Health formerly offered a fixed dollar amount differential to all hourly employees; the hospital system would pay all hourly employees an extra $4.50 an hour to work night shifts and an extra $2.75 per hour to work weekends.
But an email sent to employees by Intermountain Health in March notified them that the fixed dollar amount system for hourly workers would be replaced by a percentage-based system. As a result, hourly employees now make a differential that is a percentage of their base pay; that percentage is 12 percent for night shifts and 7 percent for weekend and evening shifts.
For some CNAs, that's essentially a pay cut. According to one CNA working in the Intermountain Health system, who asked to remain anonymous, her two-week paycheck that used to come in at around $1,200 was only $800 after the system changes went into effect in May. So experienced CNAs, she says, are "making less, but still have the same amount of — if not more — work to do."
One registered nurse working at an Intermountain Health hospital in Denver, who also asked to remain anonymous, says she will actually get a pay raise as a result of the differential system change. But she feels like she has done nothing to deserve it, and CNAs have done nothing to warrant their pay cuts.
"It's completely unjust," the nurse says. "I can't do my job without them."
She describes CNAs as "the first line of defense for safety for the patient," noting that they spend the most time with patients and are usually the first to know if something is wrong. They report any irregularities to the nursing staff, who can intervene before it's too late. "They're not expendable; they save people's lives," says the nurse, who has been an RN for nineteen years.
"I think, historically, when there are low employment rates and we all have to take on more patients — so, instead of a CNA having maybe fifteen patients, they would have 25 or 30 — historically that will lead to worse patient outcomes," the nurse adds, noting that her hospital is "always short on CNAs" and calling the position "the hardest job with the least amount of pay."
Both she and the CNA say that their hospitals have had a shortage of CNAs since the onset of the COVID-19 pandemic in 2020, and that CNAs, nurses and health-care workers as a whole continue to feel burned out.
The state has taken steps to address staffing shortages. "Certified Nurse Aides are a valuable asset to our health-care system," says a spokesperson for the Colorado Board of Nursing. Steps to address the issue include "allowing temporary certifications for those CNAs demonstrating adequate training."
The email that Intermountain Health sent to employees in March cited two reasons for the change in the pay structure.
The first, according to the hospital system, is "more equity," explained as follows:
"Our compensation team completed a thorough review of both differential options: fixed dollar amounts vs. fixed percentages. Fixed dollar differentials do not keep differentials in alignment with base pay increases and require ongoing market review and adjustments to stay at market competitive rates. Shift differential percentages help to keep differentials aligned to the market. This means as your base pay increases, so will your shift differential."
The second reason is "alignment and harmonization."
"Currently, the Peaks Region is managing 36 unique shift differentials," said the hospital giant. "This complexity has led to errors in processing appropriate payments and is an administrative burden. Transitioning shift differentials to percentages aligns pay practices across all regions and provides a simple, easy to understand model for caregivers regardless of role or facility. The model also still aligns to market, meaning each region within Intermountain Health will have competitive differentials for their respective market."
Asked about the email and new pay system, Intermountain Health sent a statement to Westword: "We do not share specific information about compensation plans publicly. If we do consider changes to compensation, it is done with great discernment to ensure the least amount of impact for our employees.
"In July 2022 we invested $71 million to increase pay for employees. That investment occurred in part to prepare for anticipated changes like aligning shift differential pay," the statement continues. "Additional pay increases are planned for July 2023 for eligible employees. Pay is one aspect of an employee’s total compensation, which also includes health insurance, life insurance, retirement plans, and education and tuition assistance. Nationally, a shortage of healthcare workers has been a challenge for all hospitals. We have taken several proactive and innovative steps such as providing scholarships and tuition assistance, partnering with local school districts and community colleges, and creating educational pathways for our own employees to grow in their careers."
Because of the Intermountain Health pay system changes, the nurse who works at one of its hospitals says that many CNAs there are now looking for other places to work. "I would say about 50 percent of the CNAs I've talked to are actively looking for other positions," she adds.
Despite the challenges, though, CNAs and nurses often continue to work in a hospital out of a sense of duty for their patients. "The administration will take advantage of that and say, 'We don't want to let the team down,'" the nurse explains. "There's a lot of guilt-tripping, but we all buy into it because we're all that kind of personality."
But an email sent to employees by Intermountain Health in March notified them that the fixed dollar amount system for hourly workers would be replaced by a percentage-based system. As a result, hourly employees now make a differential that is a percentage of their base pay; that percentage is 12 percent for night shifts and 7 percent for weekend and evening shifts.
For some CNAs, that's essentially a pay cut. According to one CNA working in the Intermountain Health system, who asked to remain anonymous, her two-week paycheck that used to come in at around $1,200 was only $800 after the system changes went into effect in May. So experienced CNAs, she says, are "making less, but still have the same amount of — if not more — work to do."
One registered nurse working at an Intermountain Health hospital in Denver, who also asked to remain anonymous, says she will actually get a pay raise as a result of the differential system change. But she feels like she has done nothing to deserve it, and CNAs have done nothing to warrant their pay cuts.
"It's completely unjust," the nurse says. "I can't do my job without them."
She describes CNAs as "the first line of defense for safety for the patient," noting that they spend the most time with patients and are usually the first to know if something is wrong. They report any irregularities to the nursing staff, who can intervene before it's too late. "They're not expendable; they save people's lives," says the nurse, who has been an RN for nineteen years.
"I think, historically, when there are low employment rates and we all have to take on more patients — so, instead of a CNA having maybe fifteen patients, they would have 25 or 30 — historically that will lead to worse patient outcomes," the nurse adds, noting that her hospital is "always short on CNAs" and calling the position "the hardest job with the least amount of pay."
Both she and the CNA say that their hospitals have had a shortage of CNAs since the onset of the COVID-19 pandemic in 2020, and that CNAs, nurses and health-care workers as a whole continue to feel burned out.
The state has taken steps to address staffing shortages. "Certified Nurse Aides are a valuable asset to our health-care system," says a spokesperson for the Colorado Board of Nursing. Steps to address the issue include "allowing temporary certifications for those CNAs demonstrating adequate training."
The email that Intermountain Health sent to employees in March cited two reasons for the change in the pay structure.
The first, according to the hospital system, is "more equity," explained as follows:
"Our compensation team completed a thorough review of both differential options: fixed dollar amounts vs. fixed percentages. Fixed dollar differentials do not keep differentials in alignment with base pay increases and require ongoing market review and adjustments to stay at market competitive rates. Shift differential percentages help to keep differentials aligned to the market. This means as your base pay increases, so will your shift differential."
The second reason is "alignment and harmonization."
"Currently, the Peaks Region is managing 36 unique shift differentials," said the hospital giant. "This complexity has led to errors in processing appropriate payments and is an administrative burden. Transitioning shift differentials to percentages aligns pay practices across all regions and provides a simple, easy to understand model for caregivers regardless of role or facility. The model also still aligns to market, meaning each region within Intermountain Health will have competitive differentials for their respective market."
Asked about the email and new pay system, Intermountain Health sent a statement to Westword: "We do not share specific information about compensation plans publicly. If we do consider changes to compensation, it is done with great discernment to ensure the least amount of impact for our employees.
"In July 2022 we invested $71 million to increase pay for employees. That investment occurred in part to prepare for anticipated changes like aligning shift differential pay," the statement continues. "Additional pay increases are planned for July 2023 for eligible employees. Pay is one aspect of an employee’s total compensation, which also includes health insurance, life insurance, retirement plans, and education and tuition assistance. Nationally, a shortage of healthcare workers has been a challenge for all hospitals. We have taken several proactive and innovative steps such as providing scholarships and tuition assistance, partnering with local school districts and community colleges, and creating educational pathways for our own employees to grow in their careers."
Because of the Intermountain Health pay system changes, the nurse who works at one of its hospitals says that many CNAs there are now looking for other places to work. "I would say about 50 percent of the CNAs I've talked to are actively looking for other positions," she adds.
Despite the challenges, though, CNAs and nurses often continue to work in a hospital out of a sense of duty for their patients. "The administration will take advantage of that and say, 'We don't want to let the team down,'" the nurse explains. "There's a lot of guilt-tripping, but we all buy into it because we're all that kind of personality."
