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Howard Brown Health Workers Say They’re Facing Understaffing, Burnout As They Push To Unionize

Non-nursing staff at Howard Brown Health are looking to join the Illinois Nurses Association union in an attempt to address a variety of issues they say they're facing at the LGBTQ-affirming health care organization.

Howard Brown Health Clark, 6500 N. Clark St., in Rogers Park on Feb. 17, 2022.
Colin Boyle/Block Club Chicago
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CHICAGO — Howard Brown Health employees have launched a campaign to unionize to address what they say is a toxic work culture at the LGBTQ-affirming health care organization.

The Illinois Nurses Association, which represents Howard Brown nurses, announced its intent in February to organize the rest of the organization’s staff under its union. Since then, employees have come forward, saying there’s chronic understaffing, burnout and a retaliatory work environment — issues they hope can be addressed through collective bargaining.

Howard Brown Health is a federally qualified health center that employs several hundred people across its 12 clinics, the Broadway Youth Center and its three Brown Elephant resale shops. The organization was founded in 1974 with a focus on serving LGBTQ people and other communities that are vulnerable. It serves about 30,000 patients annually.

Howard Brown Health offers a variety of services, including primary care, dental services, pediatric care, counseling and HIV case management, testing and outreach. The organization has been on the front lines of the coronavirus pandemic, giving out more than 70,000 vaccinations and nearly 100,000 COVID-19 tests, said President and CEO David Ernesto Munar.

Block Club spoke to several Howard Brown employees, who said they’re disillusioned with the work culture. The employees, who asked to remain anonymous for fear of retaliation, said the organization’s struggles are affecting its quality of care.

Munar said the organization faces challenges with understaffing, burnout prevention and employee satisfaction, and these challenges have been exacerbated by the pandemic. Managers have been asked to gather their teams’ concerns, ideas and solutions so the organization can have their input moving forward, he said.

“As an organization, we have challenges and concerns that must be addressed, regardless of workers’ unionization decision,” Munar stated. “Improving the responsiveness and coordination of internal programs, crowded facilities, burnout prevention and employee engagement/satisfaction are but a few priorities.”

In response to the unionizing efforts, Munar said Howard Brown Health plans to negotiate in good faith if the campaign is successful.

“Howard Brown respects the rights of workers to organize and self-determine if collective bargaining is in their best interest” Munar said. “If employees vote to form a bargaining unit, Howard Brown will bargain in good faith.”

Credit: Colin Boyle/Block Club Chicago
The Howard Brown Health Halsted in Northalsted on March 28, 2022.

‘Stressed And Out Of Their Depth’

Current and former employees across the Howard Brown Health system said they’ve been burned out by long hours, understaffing and high turnover.

Amber Matthews, a former sexual health educator for Howard Brown, said these issues were apparent where she worked at the sexual health clinic at 4025 N. Sheridan Road.

Matthews offered basic STI testing and assisted providers in the exam room, she said. But she said the clinic was frequently stressed from low staffing at other Howard Brown Health clinics over her 20-month tenure.

So many primary care providers quit or had been fired at other health clinics that the Sheridan Clinic was often left trying to fill gaps in coverage created by their absence, Matthews said.

“So many patients in the Howard Brown system were without primary care providers because their old provider had left and they had not yet been assigned a new one,” Matthews said.

Without a primary care provider, patients were visiting the sexual health clinic for things like HIV management, PrEP prescriptions and other issues, Matthews said.

“We’d end up picking up a lot of the slack because the patients had no other options,” Matthews said. “But that’s totally unideal because you’d have 15 minutes to review all their history, figure out where they were at. … People living with HIV can face a lot of complex issues, especially at Howard Brown, where they might be homeless, need services for drug use or are performing sex work.”

This left the sexual health clinic’s providers feeling “stressed and out of their depth,” Matthews said.

Workers also said Howard Brown is experiencing a “significant shortage” of mental health providers. Howard Brown is not accepting new mental health patients, and call center employees have been instructed not to bring up mental health services unless callers are registered as a medical patient first, employees said.

Howard Brown has 45 behavioral health staff, Munar said. But the organization has struggled to recruit mental health providers to keep up with the increased demand for those services.

“Demand for mental health services during the pandemic has spiked, and recruiting additional counselors that align with Howard Brown’s affirming frameworks is a challenge,” Munar said.

However, the organization has an on-site crisis team to help patients with urgent mental health concerns that require immediate care, Munar said.

One worker familiar with scheduling said most providers are booked out months in advance, especially on the North Side, where there are so few providers they’re currently booked three to four months in advance.

“The ratio of providers, nurse assistants and nurses to patients — every one of those possible ratios is untenable at this point, and every single provider is booked out months at this point for even the most urgent needs,” the worker said.

“We’ve been on teams that have been extremely understaffed for years, and it’s led to a complete breakdown of services to the point of just not being able to serve the community anymore,” another employee said.

Munar said Howard Brown has experienced staffing shortages while seeing a “sharp increase” in demand for its in-person patient services, but recruiting team members who are knowledgable about LGBTQ health care is a challenge.

In the past 11 months, Howard Brown Health has hired 12 primary care providers, and the organization is hiring to bring on 11 more — six of whom would fill new positions, Munar said.

In cases where providers leave the organization, Howard Brown makes “every effort” to notify their patients and match them with a new provider, Munar said. Howard Brown also offers same-day appointment slots for urgent needs at all its locations.

Munar said the organization is trying to balance the increasing demand for health care services with its staff’s needs and the need for more resources.

“We are working to address wait times for some delayed patient appointments, but do not expect staff members to take on more work that would lead to burnout,” Munar said.

Credit: Colin Boyle/Block Club Chicago
The Howard Brown Health Halsted in Northalsted on March 28, 2022.

Patients Frustrated With ‘Inconsistent Care’

Several employees said they were patients of Howard Brown before they were employed by the organization, and what drew them to working there was the quality of queer-affirming care they had received.

But the infrastructure for many of the organization’s services has dwindled so much due to understaffing and other issues that patients are growing frustrated with their quality of care, workers said.

“There’s been a very noticeable dip in the quality of care that patients are getting here,” the employee said. “Understaffing and overworking means that providers are burnt out and not capable of providing the quality of care they put in under better conditions.”

Many providers who are experts in LGBTQ-affirming health care have left the organization, and Howard Brown is not able to replace them with people who are as qualified, one worker said.

This has led to transgender patients being misgendered by providers, they said.

The organization’s high turnover has also led to patients getting “bounced from provider to provider,” they said.

“Patients would tell me, ‘Please don’t quit your job because every time I come back, there’s someone new, and I just want to see the same person two times in a row,'” the worker said.

Another worker who’s in a patient-facing role said many patients have grown frustrated with the organization’s turnover.

“They’re not happy with the inconsistent care and having to switch providers all the time,” they said. “Especially the trans patients, because trans care requires a lot of specific consistencies that tend to get tricky and inconsistent.”

One transgender patient, who’s been going to Howard Brown since 2017, said he’s been looking for a new health care provider after being misgendered and cycling through multiple providers in recent years.

The patient, who asked to remain anonymous, said he had the same provider his first couple years with Howard Brown Health, but that changed when he started taking hormones for his transition in 2019, he said. Since then, he’s been through four providers.

“I started taking testosterone under that provider and had one appointment with them when they were like, ‘By the way, I’m actually leaving, so you’ll have to find somebody else,’” the patient said.

Without a consistent provider to help manage his hormones, the patient went months without receiving proper lab work, he said. He later learned from his psychiatrist that his testosterone dose was too low, so it was causing mood swings and other side effects, he said.

“… I didn’t realize because I didn’t have a provider to talk about it with,” he said. “Although I asked for a low dose of testosterone, if I had more consistent providers who explained to me how low my testosterone levels were, I probably would have upped my dosage sooner.”

Part of this widespread understaffing is due to the coronavirus pandemic, Munar said.

The pandemic has caused a greater demand for ongoing, in-person primary care than the organization anticipated, Munar said.

“Like many health care organizations, we struggled to fill positions due to widespread staff shortages, and are grateful for all our new colleagues who joined Howard Brown in 2021 and 2022,” according to the organization.

Howard Brown has also taken steps to improve its health care for transgender patients by creating the position of a medical director of trans and gender non-conforming patients, Munar said.

Credit: Colin Boyle/Block Club Chicago
Howard Brown Health Clark, 6500 N. Clark St., in Rogers Park on Feb. 17, 2022.

Growing Disconnect

Several Howard Brown employees also said there’s a growing disconnect between workers and executive leadership.

When employees try to voice concerns through formal complaints, conversations with managers or by bringing them up during the company’s listening sessions, they feel brushed off by upper management, some workers said.

“It’s not uncommon to speak up for something you believe in, [against] something wrong or advocate for a patient and be put on a performance plan,” one worker said.

One former nurse, who worked in Howard Brown’s Sheridan clinic and later its Broadway Youth Center, said he was fired after advocating for patients and team members.

The nurse, who worked at Howard Brown August 2016-December 2020, said he was fired after a “huge breakdown of communication” with the Broadway Youth Center’s medical director.

The nurse said he was advocating for patients by asking the medical director — a doctor who would see patients at the Broadway Youth Center — questions about patients’ visits to make sure they were receiving the proper care.

“I’m a nurse, so if I see something that I need to advocate for — like if a patient has the wrong type of needles or syringes ordered — I’d be like, ‘Hey, make sure you’re ordering the right thing because this patient could harm themselves by using the wrong gauge of needle,'” the nurse said.

But the medical director didn’t seem to appreciate his questions and was closed off to collaboration, the nurse said.

The nurse requested a meditator to intervene to restore communication between him and the medical director, but the doctor eventually reported him to human resources for insubordination, he said.

Around the same time, there was an incident at the Broadway Youth Center in which one patient became upset after mail they were expecting wasn’t at the center, the nurse said. The patient thought staff had tampered with or stolen their mail, and the situation escalated with the patient threatening to shoot youth center staff while he was being escorted out of the building.

“We do not call the police at the BYC, but there’s typically a safety plan in place,” the nurse said. “In this case, there was essentially nothing said or done, which made staff feel really unsafe.”

The nurse said he didn’t feel like Howard Brown’s response was “appropriate or rapid enough,” so he outlined his concerns in an email to upper management, asking for a staff meeting to go over safety plans.

A few weeks later, the nurse was fired following an investigation into his dynamic with the medical director, he said.

“I believe I was terminated because I was the squeaky wheel,” the nurse said. “I was talking too much or asking for too much. I feel I was retaliated against for questioning too much.”

This retaliatory culture is also exemplified by the halting of In Power, Howard Brown’s medical forensic exam program for LGBTQ survivors of sexual assault, employees said. The program was suspended without an available sexual assault nurse examiner when its only one on staff was suspended after they spoke up to advocate for a patient, the Chicago Reader reported.

Munar said the organization cannot comment on specific personnel, workplace or patient matters, but Howard Brown Health is “committed to fostering a supportive and inclusive workplace environment that values employees and their voices.”

“Howard Brown does not tolerate retaliation and thoroughly investigates all reported breaches of policy, regulatory requirements or patient safety,” Munar said.

Credit: Colin Boyle/Block Club Chicago
Howard Brown Health Clark, 6500 N. Clark St., in Rogers Park on Feb. 17, 2022.

‘A Desperate Attempt At Getting Our Voices Heard’

Workers publicly launched their unionizing campaign, named the Howard Brown Health Workers United, on Feb. 11 by releasing a mission statement declaring intent to form a collective bargaining unit among all non-nursing employees across the Howard Brown Health centers, Broadway Youth Center and the Brown Elephant.

All employees across all Howard Brown Health units would be eligible for the union, except for managers, anyone with independent hiring and firing powers or human resources employees.

“I think unionizing is a desperate attempt at getting our voices heard,” one employee said. “We’ve been trying to get our voices heard for years, but we’re viewed as being hysterical or exaggerating our needs and never being happy. This is a way for staff to join forces and become a collective voice that can finally be acknowledged.”

Nursing staff across Howard Brown previously unionized with the Illinois Nurses Association and won their first collective bargaining agreement in 2019. Now the Illinois Nursing Association is working with employees to expand its representation to all non-nursing staff.

“The nurses love their work, their mission and the patients that they serve, but many have seen their coworkers suffer due to short staffing, long hours, unsafe working conditions, inadequate pay and benefits, inconsistent and unfair labor practices and unsustainable labor turnover,” said Julia Bartmes, executive director of the Illinois Nursing Association. “The same issues that impact the nurses affect their coworkers in equal measure, but they do not yet have a seat at the table or the protections afforded by a collective bargaining agreement.”

A handful of workers said their motivation for unionizing is so employees can help ensure Howard Brown lives up to its mission of providing quality, affirming health care to LGBTQ people.

“We’re doing this because we all really desperately want to work here,” one employee said. “This is an incredibly unique environment where we get to theoretically feel safe in our identities and get to feel out and proud in who we are.”

In an emailed statement, Howard Brown said it “respects workers’ right to unionize” and that it would negotiate in good faith if employees do elect to unionize.

“The effects of two years of emergency response operations have taxed our workforce and systems,” the organization stated. “Whether or not our employees elect to form a union, our imperative is to create stronger clinic teams, support our employees, and bolster operations so we may continue to respond to the needs of our patients.”

Jake Wittich is a Report for America corps member covering Lakeview, Lincoln Park and LGBTQ communities across the city for Block Club Chicago.

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