New Report Exposes Nationwide Staffing Crisis at America’s Largest Hospital Corporation

New analysis of federal data links HCA hospital staffing levels, which lag national average by 30%, to extreme worker burnout, patient care failures

Under-resourcing may boost HCA profits and corporate payouts by billions per year, while driving down standards for care

WASHINGTON – A new report by SEIU, the nation’s largest union of healthcare workers, reveals systemic low staffing – far below industry averages – at HCA Healthcare is contributing to a patient care crisis inside its hospitals. Care Crisis: How Low Staffing Contributes to Patient Care Failures at HCA Hospitals analyzes federal data to demonstrate systemic, chronic short-staffing at HCA hospitals and reveals how it directly impacts the care of patients at HCA hospitals.

Key findings include:

  • Staffing at HCA hospitals is 30% lower than the national average.
  • A recent survey of SEIU nurses and other frontline workers at HCA hospitals found that 80% of surveyed workers reported witnessing patient care being jeoparadized by short-staffing.
  • HCA hospitals have performed worse than average on key patient quality indicators, including death from pneumonia, as well as patient satisfaction scores, which are associated with delay of care.
  • In particular, out of all hospitals nationally in the Centers for Medicare and Medicaid Services (CMS)’s 2021 report, 5% have rates that are reported as worse than the national mortality rate for pneumonia. But among HCA hospitals, that proportion is more than twice as high — 11%. Similarly, CMS found postoperative respiratory failure rates were higher than average at 2% of hospitals nationally, and at 4% of HCA hospitals, a proportion that is also twice as high.

Care Crisis (executive summary) also documents how short staffing allows HCA, America’s biggest hospital chain, to shift billions each year out of frontline care and into huge payouts for executives and shareholders. In 2021, HCA reported nearly $7 billion in profits and distributed $8 billion in payouts to shareholders. Since 2011, HCA has paid out more than $32 billion to investors. 

More than 200 nurses and other workers from HCA hospitals in Florida, Texas, California, and Nevada will rally today, sharing first-hand accounts of grueling burnout and their concerns that patient care and safety are compromised by chronic short-staffing at HCA. They are calling on HCA to invest in safe staffing and better conditions for workers, and to put patient care before payouts to top executives and shareholders.

“HCA continues to turn a blind eye to what’s happening to us and our patients on the ground, trying to sweep the ongoing staffing crisis under the rug – but we will not be silent,” says Monique Hernandez, a registered nurse at Riverside Community Hospital in Riverside, CA. “We are coming together to stand up for safer staffing and quality patient care. We are demanding that HCA put frontline workers and patients first.”

HCA hospital workers are paid as little as $12.50 per hour, providing care on short-staffed units with insufficient equipment, resources, and training. Frontline staff also report facing retaliation for speaking out about their concerns over patient safety and a climate of fear discouraging patient care whistleblowers inside HCA hospitals.

“Chronic understaffing and lack of resources are pushing us to our breaking point. We take care of our patients in dire conditions while on the brink of exhaustion,” says Michelle Harvey, surgical tech at HCA-owned Del Sol Medical Center in El Paso, Texas. “We shouldn’t have to compromise our health and safety to do what we love. Our patients deserve better. We deserve better.”

With the release of this report, frontline nurses and other healthcare workers are calling on HCA to address the care crisis at its facilities by raising staffing to safer levels, improving pay and working conditions for frontline staff, and prioritizing higher quality patient care. 


More than one million healthcare workers across hospitals, home care, and in nursing homes are united in SEIU, the nation’s largest union of healthcare workers. SEIU is an organization of nearly 2 million members united by a belief in the dignity and worth of workers and the services they provide. SEIU is dedicated to improving the lives of workers, families, and communities to create a more just and humane society.

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