“We want to bring Mission back to its greatness,” explained 35-year nursing veteran Kelley Tyler, who works in HCA Mission Hospital’s trauma care unit. “I want to be proud to say that I work there again.”
Tyler was one of around 30 nurses who took their protest of conditions at Mission Hospital straight to the president’s office on the morning of July 10. Their letter was intended for Mission Health CEO Chad Patrick, but was accepted by a vice president instead, Tyler said. The nurses present had either just come off night shift, or had come into the hospital on their day off to join the action.
Among the demands of the letter was a return to staffing assignments on the basis of acuity—the actual sickness and needs of the patients—instead of the current “grid” process for delegating staff simply by number. Tyler told The Urban News that the response she received was that “acuity” was the basis for staffing now. But her own experience says otherwise.
A year prior to the changes at Mission, Tyler’s trauma unit was a 36-patient unit staffed by 13-14 registered nurses and five nursing assistants. That translated into three to four patients per nurse on a busy day, with a nursing assistant for every six to eight patients. That staffing allowed for more attention to patients who had increased sickness levels.
The current situation has seen the bed number increased to 44, while the number of nurses has dropped to 10 with only three nursing assistants. “Now if you’re full,” observed Tyler, “you have 10 nurses.” That means there can be no surge to cope with difficult cases.
Eighteen-year veteran nurse Jill Rabideau, who also attended the morning protest, tells a similar story. “Back in the day, we had a system that would allow us to classify patients based on their acuity or how much (attention) they needed. That has gone to the wayside.” The grid system may look “good on paper, but it’s not good in practice,” she declared.
“You don’t have that little bit of cushion when things go wrong,” the veteran explained. “We’re not an assembly line….If you were to go and see our staff, people just look broken.”
According to the nurses’ letter to management, Mission is experiencing “dangerous short staffing that puts patients at risk,” and the group demanded additional hiring. The under-staffing extends to psychiatric care units, they claim, leading to “increased incidents of workplace violence” and injuries to both staff and patients. Dealing with the COVID-19 pandemic without adequate PPE was also cited as a problem, increasing the risk of “exposure and infection” as nurses rush to provide immediate care without backup.
The formerly non-profit entity titled Mission Health (a seven-hospital system in Western North Carolina) was sold in 2019 to the profit-based Hospital Corporation of America (HCA) in a $1.5 billion acquisition. Most of the staffing changes, according to Rabideau, have happened since the acquisition.
Mission’s response to the situation regarding staffing, according to its public relations office, is that the hospital is doing all it can to equip its patient care teams “despite the unique challenges presented by COVID-19.” According to their press release, the hospital is not near capacity, and is “well-equipped to handle any potential surge.”
As for the nurses’ specific complaints, the hospital noted that the RN team has grown by 175 full-time and part-time nurses “across 37 different nursing units,” and claimed the National Nurses United “is trying to use this crisis to advance its own interest—organizing more members.” Calling the current COVID-19 pandemic “unique,” the statement urged that in this “unparalleled crisis, everyone should stand together.”