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When D.C. experiences storms or heat waves this summer, the nurses who staff outdoor COVID-19 testing sites risk losing hundreds of dollars in pay. One nurse estimates she lost $1,370 because the Bowser administration closed the government-supported sites twice when she was scheduled to work in late July. For someone who traveled to D.C. just to test its residents and pays $3,900 per month for housing in both the nation’s capital and her home state more than 800 miles away, $1,370 is not nothing. Her contract states that a “client may cancel up to 0 shifts for which [the] traveler will not be paid.”
Shift cancellations are the least of the traveling nurses’ concerns. Another nurse who lost hundreds of dollars in pay due to weather-related cancellations says she missed a critical doctor’s appointment to avoid an unexcused absence. She says the rule of three tardies equalling one absence and three absences resulting in termination is new and not equally enforced.
A third nurse who worked at outdoor testing sites says his hours and pay were retroactively cut when management learned he was not working the full shift in order to take hydration breaks. His contract was terminated when he tried to get paid for every hour he was at the testing site, instead of just the time he spent swabbing people’s nasal cavities.
A fourth nurse, who travels more than an hour into the city, clocks in at 7 a.m. and out at 8 p.m., with three unpaid hours off of work in the afternoon. The schedule does not match what is in her contract, and she says she would have never agreed to the assignment had she known the hours in advance.
Interviews with 11 nurses, along with reviews of emails, contracts, and a tape-recorded meeting, paint a picture of a chaotic work environment, where health care workers say they are told to accept unfair rules and shifting schedules even if they do not jive with the contracts they signed through Maxim Healthcare Services, the staffing company that hired them. Other nurses wanted to share their stories, but declined out of fear of getting fired for speaking out. It’s the kind of workplace where a nurse does not feel comfortable telling a manager her gloves are too small. She does not want to piss anyone off. The nurses are short-term government subcontractors who traveled from states all across the country to help D.C. respond to the coronavirus pandemic. Since starting work at government-supported testing sites this summer, nurses say they saw their hours and pay cut and were made to feel “disrespected” and “dispensable.”
After nurses aired some of their grievances, a division chief at the D.C. Homeland Security and Emergency Management Agency told them there are “worse assignments” and they could be “ass wiping” instead, according to a recording of an Aug. 10 meeting obtained by City Paper. The HSEMA division chief is no longer overseeing the Maxim contract.
“That employee’s actions during that meeting were not acceptable to us, which is why we removed him from the testing part of our operation,” says Department of Public Works Director Christopher Geldart, who serves as operations chief for D.C.’s response to COVID-19.
Geldart says the rest of the nurses’ accusations should be directed to Maxim Healthcare Services, their employer. The city appreciates the nurses’ work but their hands are mostly tied, as their contract is with Maxim. D.C.’s contract with Maxim does not limit scheduled hours as some of Maxim’s contracts with nurses do, Geldart says, and allows for at least six cancellations without pay. The District has to close the outdoor sites during storms and heat waves, because it would be dangerous for workers and patients alike.
“We don’t set the individual nurses’ hours. We set the hours when we’re going to be testing and then Maxim, as our contractor, has to meet those hours,” he tells City Paper.
“If that’s not satisfying to one of their employees, that’s an employee talking to their employer and saying, ‘This is not something I want to do,’” Geldart says. “That’s not really on the District to say whether that person is satisfied with that or not, because that’s not our requirement, which is why we contracted this in the first place. Because we knew we were going to have requirements to do certain things like this and we wanted to hire a professional firm that could handle the professionals coming in to do that.”
D.C. started contracting with Maxim at the beginning of the public health emergency. The $10-million, labor-hour contract was awarded to Maxim “to provide the full spectrum of temporary healthcare staffing support related to COVID-19 crisis,” according to a copy of the contract. “The services will be provided to and managed by DC Health at several sites throughout the District.” One of those sites was the makeshift hospital at the Walter E. Washington Convention Center that the city has not needed to use. There are few mentions of shifts in the 49-page document, including “all personnel should expect at a maximum to work three twelve-hour shifts per week for the entire engagement.”
The contract also specifies that “a dispute between the Contractor and subcontractor relating to the amounts or entitlement of a subcontractor to a payment or a late payment interest penalty under the Quick Payment Act does not constitute a dispute to which the District is a party.”
In an email to City Paper, a Maxim spokesperson says they cannot discuss details of the “partnership,” but declined to explain why.
“I can tell you that we are working diligently to meet the scheduling needs of both clients and staff while operating within the parameters set forth in our employment agreements,” says the company spokesperson. “Like many other organizations, we have had to remain flexible and open to making adjustments due to circumstances beyond our control during this challenging time. We deeply value our employee and client relationships and remain committed to doing everything possible to meet—and exceed—the expectations of both.”
Some nurses decided to end their contracts early because of the working conditions, while others are counting down the days until their assignments end. Nearly all the nurses interviewed, including four who worked on a contract basis in New York City when it was the epicenter of the coronavirus pandemic in the U.S., say this is one of their worst assignments yet.
“There are no consequences for agencies or facilities—zero—for them shortening your contract, shortening your hours,” says a nurse who requested anonymity out of fear of retribution. “They are making us feel expendable. I want to stay here and fulfill the contract, but they are making it really hard.”
Roughly 80 travel nurses staff public testing sites like those at Judiciary Square and D.C. firehouses, along with congregate care settings like nursing homes and St. Elizabeths Hospital. They’ve helped D.C. complete more than 260,000 tests. D.C. reached 200,000 tests in early August, and public sites and congregate care settings accounted for more than 71,000, or just over one-third of total tests. According to DC Health’s coronavirus dashboard, D.C.’s positivity rate has been below 5 percent since June 13, right around when officials scaled up public testing sites to include firehouses. Nationwide, only D.C and nine states are doing enough testing to mitigate the spread of the virus.
For all the talk of health care workers being essential during the pandemic, nurses in D.C. and across the country have described feeling expendable to the media. Nurses in some D.C. hospitals were not given adequate personal protective equipment or hazard pay during the pandemic, and nurses who typically work in D.C. public schools were told by Children’s National Hospital to serve in COVID-19 response efforts or risk being laid off. Dozens of school nurses ended up being temporarily laid off. Unlike the aforementioned nurses, nurses working D.C. testing sites report to an offsite employer headquartered in Columbia, Maryland, and do not have a union to fall back on. Whenever they encountered issues, travel nurses were told to speak with their recruiters, who in turn told nurses they were surprised to learn of contract discrepancies and overall treatment.
“The money was not worth it for how they were treating us,” says Rycky Pera, who was contracted to work at government-supported testing sites between June 8 and Aug. 14 for $55 an hour.
Pera, who’s worked as a nurse for nine years, says the “nonsense” all started with the scheduling. When they first got hired, nurses who worked at outdoor sites say they were told to mark 8 hours of work in their timesheets even if they did not work that many hours. (The contracts for those that spoke with City Paper began between late May and mid-July, and end in late September.) Outdoor sites like the one in Anacostia were only open for four hours in the mornings. Every nurse interviewed says management told them to say they worked eight hours instead of the five they actually worked. Several nurses say a government official gave them these instructions during orientation, and all were told by more senior contractors while on the job. Management included a HSEMA division chief, a HSEMA contractor, and a nurse subcontractor who got promoted to manager.
Nurses did as they were told, and their timesheets were accepted. Many rationalized it because their Maxim contract said they’d be working 40 hours per week, and made no mention of working outdoors in the blistering heat. Two nurses say they felt uncomfortable with the arrangement, but logged the hours anyways. On June 15, D.C. expanded free testing to include firehouses, giving nurses the opportunity to work more hours and overtime, but only if they volunteered.
Scheduling got rough sometime between mid and late July, when outdoor testing sites modified or closed at least half a dozen times due to bad weather. Pera says she was short the 40 hours guaranteed in her contract for three weeks during her 17-week long contract. Losing hours also interferes with nurses’ weekly stipends for food and lodging; if a nurse does not work a day, then one-seventh of their stipend is deducted.
“I am paying $1,600 for a hotel. On top of that, I am paying house bills for Florida,” Pera says. “When you are losing hours, it’s not worth it.”
Some nurses complained about the cancellations to management, because their contracts allowed “the client” minimal cancellations without pay. A review of Maxim contracts shows slight variances, ranging from zero to six shift cancellations. The contracts also say “there is no guarantee of payment for hours not worked as a result of an act of God or other natural disasters.” Nurses did not foresee this clause being an issue because they usually work through natural disasters and rarely, if ever, work outside.
“I would like to address the cancellation policy of your contracts, I do not control that portion,” wrote the nurse manager who set the schedule in an Aug. 3 mass email obtained by City Paper. “Your recruiter is responsible for explaining any issues you may have regarding this matter. When days are cancelled, they are cancelled. Please refrain from emailing and texting me suggestions on how to create a schedule to accommodate cancellations.”
In early August, management also told nurses they could only log the hours they actually worked. This meant nurses could only get 40 hours of work per week if they tested residents at the firehouses in the evenings, between 4 and 8 p.m., effectively forcing them to accept split shifts and mandatory overtime. The new process was not clearly communicated, so some nurses went at least one week without 40 hours.
The new schedule became a problem for nurses who live more than an hour away in Maryland and Virginia suburbs. They’d have to report to, say, Judiciary Square by 7 a.m. to set up, and then swab dozens, if not hundreds, of residents until 12:30 p.m. Then they’d have to kill time for three hours in D.C., where nearly everything is shut down, and report to a firehouse at 4 p.m., where they would work until 8 p.m. In nursing, split shifts are not uncommon, but employees would generally be paid for the time between shifts. This isn’t the case for nurses working D.C. government-supported sites. The nurse manager offered little to no accommodations, according to the majority of nurses City Paper spoke with. Some requested they be scheduled in nursing homes, where nurses get the full eight hours without working split shifts, evenings, or weekends, and get respite from the heat and humidity.
An Aug. 3 email from the HSEMA division chief suggests that enough nurses had problems with schedules, policies, and processes for him to address personnel concerns in a lengthy message. He also chided nurses with “behavior issues,” writing, “Moving forward, before you make a call or send a text/email, I need you to ask yourself if you are being a professional team player or if you are being selfish. Are you making things better or are you causing drama?” It is unclear what those “behavior issues” were.
“You are also being paid very well for the job that you have been asked to do because we know that the environmental conditions are not ideal,” he continued. “You have also previously been paid for hours that you may not have actually worked. As we refine our practices you have been asked to document your hours AS worked to ensure we are as fiscally responsible with our spending as possible. This translates into filling out your timesheets with honesty.”
Some nurses took offense to the email for its “condescending” tone. “We have been doing this for months. How did they not know this? Now, they are coming at us like we are trying to cheat the system,” says a nurse who requested anonymity for fear of retaliation.
Geldart says Maxim manages billing for its employees. He says Maxim has not overcharged D.C. “We checked the overarching hours to make sure that we’re not being overcharged by a contractor,” he tells City Paper. “We’ve done good accounting—good program management, let’s put it that way—from [the] District’s perspective.”
The new schedule was a problem for employees like Pera, who only took the assignment because she could plan around her two daughters. Pera could not see her kids during an assignment between March and May at a New York City hospital, and planned to fly her kids out to D.C. at least three times based on a contract that said she’d work 10 a.m. to 6 p.m. The schedule was also a problem for Elaina Evans, who took the assignment because the contract said she’d only be working during the day. She could only work Monday and Tuesday evenings because her son needed the car the other days for work.
“I’m not a nurse 24 hours. I’m a mom. I’m a friend. I’m someone’s lover. I have other responsibilities,” Evans says. “I’m a person too.”
“This contract has been one of the worst contracts,” she adds. Evans has been a nurse for more than 30 years, five of which have been as a travel nurse.
The job demanded a lot of flexibility on the part of nurses, which many said they were willing to deal with until management made them feel undervalued. Nurses had to travel all across the city in their own vehicles to test residents after management failed to provide them with government vehicles as promised during orientation. The nurse manager sent assignments for the upcoming week on Sunday evenings, giving nurses little opportunity to swap shifts. Sometimes schedules changed the same day. Nurses learned to check their inbox multiple times a day for last-minute changes.
Evans says she quit once management changed scheduling, while Pera says her contract was terminated after she missed shifts on three different occasions because she felt sick and visited urgent care. In an Aug. 23 email, the nurse manager wrote “DC [H]ealth does not provide sick time or paid time off. All sick pay concerns will be address[ed] by MAXIM.” Favoritism could be the difference between getting fired and staying on. Several nurses say they know of colleagues who missed at least three days of work and have yet to be terminated.
Anthony Koch’s contract was terminated after he told management he was not letting them cut his pay for taking water breaks while he was working at outdoor testing sites supported by the disaster relief organization CORE. According to Koch, management caught wind of the fact that nurses at CORE sites were not testing residents every minute of the full eight hours. He says the nurses alternated every hour because the sun was beating down on them. July saw the most 90-plus degree days of any month on record, with temperatures feeling even higher some days due to high humidity, and nurses were working outside in full PPE. After interviewing a few nurses at CORE sites including Koch, management had Koch log three and a half hours of work instead of eight for four days he was on site, according to Koch. He says he was shorted 18 hours.
“I need this money to be able to make it through school,” Koch tells City Paper. He also needed the money for housing; his rent in D.C. was $1,500 per month.
A nurse who works at the outdoor sites tells City Paper that what Koch did is typical. “We call it ‘cooling time’ or ‘hydration time,’” she says. Another nurse tells City Paper it is impossible to take a quick water break because nurses have to go to a designated area to take off all their PPE. That nurse says he got kidney stones because he didn’t hydrate enough. He’s since quit.
Koch submitted his two weeks’ notice on Aug. 18, after management refused to fully compensate him for his time. They ended his contract that same day. He is now back in Ohio.
“I refuse to work for an employer who threatens, intimidates, and steals wages from front line healthcare workers with accusations of ‘fraud,’” he wrote in an email dated Aug. 18.
“I have submitted my time card in good faith, without misrepresenting my hours work[ed], my availability to work, or the work I conducted within the policies, expectations, and guidance provided to me on site by my supervisor,” he continued.
A District official says they were told by other staff on site that Koch was not following protocol, and would be gone for hours at a time. The decision to end the contract was ultimately Maxim’s. Koch refutes this. He cites an Aug. 18 email where a HSEMA contractor asks him to “document breaks” and tells him “we’ve had no problems with any of your work and would look forward to continuing to have you with our team.”
An audio recording of an Aug. 10 meeting shared with City Paper verifies that D.C. management was fully aware of personnel complaints, but that they viewed it as a problem between the nurses and their recruiters at Maxim. The HSEMA division chief told the dozens of nurses in attendance that the D.C. government contract with Maxim specified no hourly minimum or window of work, but said they’d try to schedule the nurses for as many hours as they could in order to reach 40 hours per week.
During the meeting, the HSEMA division chief also stressed that it is illegal for Maxim to bill the D.C. government for hours nurses did not actually work and such actions could jeopardize the contract altogether. The nurse manager also said during the meeting that some nurses were being disrespectful to her when they aired grievances to her individually.
“What we want you guys to know is what you are doing for us is important. We do recognize that it is hot out there,” the HSEMA division chief told nurses at the start of the meeting. “We also recognize that there are worse assignments that you can have right now. You could be working places where you have to do charting, where you have to do extensive bedside care or ass wiping for a lack of a better word. So I want to make sure you understand that while you may have concerns about what you are doing right now, it could be worse. The situation could be worse. The environment could be worse.”
Some nurses were not afraid to express their frustration at what was said. One could not understand how the D.C. government’s contract could say one thing and the Maxim contract could say another. “If you are signing such a big contract,” she said, “take care of your nurses.”
The meeting further crushed morale, according to the nurses interviewed. Many were left to feel like they should just leave if they were unhappy with the assignment, and D.C. and Maxim would hire another nurse to replace them. One nurse in the room had multiple colleagues test positive for COVID-19 when she was working another contract during the pandemic. Contracting COVID-19 is a risk she is acutely aware of when she swabs hundreds of D.C. residents each week, and when the HSEMA division chief told nurses they could be “ass wiping” instead.
“It’s easy to make these statements when you are not facing it everyday,” the nurse tells City Paper. “How can you be passionate about a mission if people treat you like your life doesn’t matter?”
This story has been updated with additional comments from D.C. government officials. The story was also updated with additional comments from nurse Anthony Koch.