Travel contracts and full-time staff. Charge roles. Whole departments that had previously been overstaffed are now running with skeleton crews.
If your hospital hasn't cut yet, don't take comfort in it. By the time a hospital makes a change, it was planned weeks before. The list is prepared, and the people on that list are the last to find out.
It's Happening Right Now
Here's real-time evidence that this is occurring:
UCSF Health (San Francisco) cut approximately 200 positions, including nurses from the ICU, physical therapist staff, and emergency clerks. Unions called it a "heartless" decision—while thousands of workers participated in strikes to protest the decision, citing it was reckless. The system called it debts related to serious "financial challenges."
Kaiser Permanente is laying off 42 nurses from outpatient clinics in San Rafael and Petaluma. While these positions are not travel contracts, they are also not temporary. These are long-term, clinic-based positions that are being eliminated due to budget and volume shifts.
Providence Oregon announced the elimination of 128 additional positions, beyond the 134 they had made earlier this summer—these include nurses, researchers, and support staff. The CEO has already warned that more cuts may come.
This is not one hospital, one city, or one state. This is a national trend.
The Warning Signs
There are signs of a problem everywhere:
Overtime closures
Vacant positions are not being filled
Staffing is being shifted around as everyone's gaps get filled
Supervisors quit and have sailed off into the sunset without replacements
Entire departments were ripped apart from where they were placed based on "planned" restructuring
The Budget Games
Then we have the budget burning games we have witnessed:
Taking away travel contracts while one is on assignment without cancelling
Taking two departments and rolling them into one overnight without any notice
Changing employees' titles so it doesn't look like a layoff
Taking away charge nurse roles, and directing the work of charge onto everyone else
Placing nurses in float pools disguised as being "temporary", and never returning them
These are not efficiency measures. These are not patient care measures. These are budget measures. Nursing is expensive, and when budgets come around, nursing will get cut first.
Why It's Happening in 2025
During COVID, hospitals stretched their resources to the max. They over-staffed for surges, signed travel contracts for inflated prices, and built far more programs than they were able to sustain once the federal money stopped rolling in.
Specifically, that money is now gone.
Supply chain costs are rising. Patient volumes are sporadic. The rate of Medicare and Medicaid reimbursement is reduced. In tandem, private insurance companies are placing more pressure on hospitals. Furthermore, hospitals are still carrying debt from expanded space/renovations during COVID, and financing interest rates are far higher than one would expect.
Most importantly, the executives and members of the hospital board are not taking that financial hit. The nurses working in these hospitals are. This is why there can be layoffs in hospitals that appear to be busy. This is not about looking after the needs of patients—this is about the bottom line.
Who Is Most Likely to Go First
All departments are not cut evenly. The pattern plays out everywhere:
First to go:
Case management, outpatient clinics, procedural units — always the first to lose staff. The leadership convinces themselves that those areas can "manage" with measurably fewer people.
Supervisory roles, charge nurses, and assistant managers get consolidated. They don't go away; they just get passed on to bedside staff.
Educational and support roles — non-direct patient care roles such as educators, unit-based councils, or resource nurses, get eliminated or absorbed.
Who Stays
Critical care, ER, labor and delivery, dialysis. They are too hard to cut because the need is too great and the risk is too high.
Float nurses and cross-trained staff. Their flexibility makes them harder to justify taking away.
This doesn't mean these roles are safe forever. But when the cuts roll, these groups usually hold out a bit longer.
What to Expect After the Cuts Roll
Everything will change.
More hours are cut or reduced
Less pay
Benefits are cut or eliminated
Retirement contributions are cut or eliminated
Your coworkers become competition as they apply for the same handful of jobs
This isn't just short-term agony. It is going to derail careers. Raises disappear because people begin going sideways instead of up. You lose bargaining confidence because you are forced to accept whatever is out there. And each "laid-off" letter solidifies a label you have to carry into every pickup interview.
Hospitals don't care about your mortgage, your kids, or your new car payments. The only thing hospitals care about is a line on their balance sheet.
What You Should Be Doing Right Now
Update your resume. Don't wait until you are unemployed. Have it ready to go.
Lock down internal options. File transfer requests immediately. Start accepting cross-training opportunities. Make it harder to get rid of you.
Note the patterns. Hiring freezes. No-OT or overtime bans. Job or unit "restructuring." These are red flags.
Plan. Know which hospitals are hiring in your area and what specialties are more stable than others. Have your plan before someone decides for you.
My Thoughts
Hospitals will never cut from the top first. Executives keep their bonuses. Capital projects and big ticket items keep happening. Cuts come from the bedside. This is the playbook. No loyalty will ever be rewarded.
The only way to avoid being blindsided is to prepare now. This isn't paranoia. It is reality.
Nurses need to put themselves first. Hospitals never will.
Don't Wait for "The Meeting"
If you are waiting for leadership to tell you that layoffs are coming, you are already behind. By the time that email notification from leadership hits your desk, the decision was made weeks ago.
You cannot control the decisions the hospital makes. But you can control if you are ready.
Talk soon,
Jason from Map My Pay
P.S. If you are seeing even one of these red flags where you work, take notice and do something. No hospital uses "temporary fixes" if they are not getting ready for something bigger.
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