Illinois Nurses Speak Out for Patient Safety: Hospital Retaliates

Illinois Nurses at Ascension Hospital refuse to clock in with four ED nurses to care for 46 patients. IL Nurses need to complete IL Nurse Staffing Survey 2022 to pass legislation for Safe Patient Limits Nurses General Nursing News

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Illinois Nurses Speak Out for Patient Safety: Hospital Retaliates

We have seen the exodus of hundreds of thousands of registered nurses these last 2 years, after bravely caring for the public during the Covid pandemic, with significant risk to themselves. Many nurses became infected, and some died, due to the failures of a healthcare system that values-whom? Certainly not nurses. And I daresay, not the public either. We have seen hospital administration resume normal practices of staffing dangerously claiming there are no nurses applying. They are partly correct.

And our own nursing organizations have convinced legislators to provide funding to increase nursing graduates, believing adding more nurses to this broken system will ease the staffing issues every hospital faces.1

Don't believe it. I know many of you don't. As a recently retired nurse of 37 years. I have fought for Illinois nurses as a statewide nurse union president and co-chief steward at my state hospital of 1400 nurses. I remain actively licensed as a retired member of the Illinois Nurses Association, the Nurses' Union, working collaboratively with other unions and organizations to bring forth safe nurse staffing Illinois legislation in 2023. To pass legislation to protect nurses- and more importantly, the public. Our last attempt was in 2019, before the Covid pandemic started. It is a fight nurses across the country have fought for over 3 decades, alerting the public and legislators of inherent dangers to them when there are not enough nurses at the bedside of our loved ones. Dangers repeatedly corroborated by two decades of evidence-based research.2 

Case in point: Ascension St. Joseph's Hospital in Joliet, IL. Here is what we know –4 nurses were suspended on Saturday, Oct 22, after notifying nursing and hospital management for weeks of how unsafely staffed the emergency room and ICU were. Their fate will be determined in the next few weeks, with possible termination most likely.

From Becker's Hospital Review, dated Oct 24th: "According to the Illinois Nurses Association, which represents the workers, four nurses were available to treat 46 patients at the time, despite hospital guidelines that recommend the unit be staffed with 10 nurses. The union contends the nurses notified hospital management of the issue and urged that the hospital go on bypass. Hospital management did not address the nurses' pleas, and security personnel escorted the nurses out of the hospital, the Illinois Nurses Association news release read. On Oct. 21, nurses also reported threats of retaliation and termination, according to the union. The union said nurses in the hospital's intensive care unit experienced a similar staffing situation on Oct. 17. "Instead of working with the nurses to help make sure the patient population was adequately cared for, on-site management seems to have decided on an approach to exacerbate, rather than resolve, the problem," Julia Bartmes, Illinois Nurses Association executive director, said in correspondence to the hospital, according to the union news release. The Oct. 21 incident came after nurses and the hospital reached a three-year contract in 2020. The agreement followed a strike that took place amid nurses' staffing concerns. In a statement shared with Becker's, the hospital said, "Ascension Saint Joseph-Joliet is committed to working in partnership with our nurses, while also respecting the terms of our labor contract. In doing so, we are conducting a thorough investigation of recent events. We remain dedicated to our mission of providing compassionate and quality care to the communities we are privileged to serve." 3, 4

After speaking to my colleagues who work at Ascension St. Joseph's, the story becomes clearer. The regular staffing grid for the emergency room called for 10-12 nurses, quite challenging at best. And certainly, Ascension was fully aware of the staffing shortage for that night since it had been posted for 6 weeks with only 4 nurses scheduled.

How dangerous is this? Imagine a patient arriving at the ER with symptoms of a MI. How many nurses does a code blue require? How many nurses are left to care for the remaining 45 patients? Quite shockingly dangerous to patients that Ascension is responsible for.

The nurses utilized the chain of command in their repeated requests for additional staffing. Attempts to transfer to other facilities were futile. One nurse, upon arrival to her shift, finding she had no additional nursing staff, experienced a PTSD episode, and had to leave. Another nurse with 17 years of service, who worked 7 days a week, 10-hour shifts to help cover the constant shortages was emotionally overcome as he spoke out... only to be retaliated with a suspension.

Again, I ask the question, who does Ascension value?

Ascension's failure to provide patient safety in a hospital whose purpose is to deliver nursing care services for the public- safely. That is a public safety crisis created by Ascension. A choice to not staff enough nurses to care for the needs of the patients. 

Let me be clear- Ascension's administrative decision was to choose NOT to staff safely after repeated alerts by those who provide nursing services, that is, Ascension staff nurses. Rather they chose to retaliate, punish and lock out the nurses who were notifying corporate of the breach of public safety and potential harm to patients. 

The nurses' staffing needs are not a surprise to Ascension. The nurse staffing plan for nursing units arises from the direct care staff nurses who work at Ascension. The nurses who serve on the Nursing Care Committee, who base staffing needs on national nursing standards and create staffing recommendations according to IL regulatory Nurse Staffing by Patient Acuity law of 2008. 5

The Problem

Every IL hospital was not under any obligation in the law to meet those nurse staffing recommendations! "Data suggests that current law has not been effective at promoting adequate staffing levels to address the shortage of registered nurses. Illinois lawmakers are considering whether to follow California's lead and adopt safe patient limits, which would establish patient-to-nurse ratios in Illinois' hospitals" 6 Therefore, new legislation was passed in 2021, the IL Nurse Staffing Improvement Act, with the intent to strengthen the legislation from 2008, shows clearly that Ascension has violated it with retaliation and should be strongly penalized. However, this bill remains weak since hospital fines are small if there are violations of the Act.  "Retaliation is prohibited against an employee who expresses a concern or complaint regarding a violation of the Nurse Staffing by Patient Acuity Act or concerns related to nurse staffing"7

Conclusion

What exists in nurse staffing law is NOT adequate to protect the most vulnerable in need of nursing care, as recommended by those nurses who use national nursing standards to address patient care nursing services. Instead, Ascension retaliates and disciplines those nurses to silence them. 

The Remedy

Listen and follow safe nurse staffing as proposed by your own staff according to IL law. But obviously much more is needed.

Secondly, we the nurses in Illinois will push to mandate minimum nurse staffing levels - with regulated accountability to address the need for more nurse staff based on a patient needs component. 

And Finally

All Illinois nurses can assist in passing minimum nurse staffing levels in several ways. One way is by completing a new survey, the Illinois Nurse Staffing Survey 2022. The data collected will support the legislation we intend to introduce in 2023.  Here is supporting research, including studies conducted in IL: Resources for Safe Patient Limits in Acute Care Settings September 2022  Stay tuned for further actions to pass minimum staffing levels. 8, 9

Ascension must cease these current dangerous staffing practices, deliberately putting Illinois citizens, and our patients seeking nursing care services, at risk. Listen to your nurse experts who care for patients according to national nursing standards of care-- your cost-cutting business model is not working. Patients' lives depend upon adequate numbers of nurses to care for them. Their bottom line is money and casting a blind eye to the human condition of pain and suffering. It must be the care for the patients and those nurses attempting to provide safe quality care. You can see what happens when the empathic, Catholic, and Christian teachings take a backseat to monetary gains versus patient outcomes.

I thank the nurses who shared their heartfelt stories and words with me. They will remain anonymous since they risk termination for speaking out about dangerous, unsafe staffing at Ascension St. Joseph's in Joliet, IL.

Let your voice be heard

Complete the Survey

SPLsaveslives-small.jpg.c6e23fd495dba42426dad2f86b0f5f12.jpg DorisCarrollprofile-small.jpg.e8bd5e084e7e513f8aa07736b257831f.jpg

References

1AACN Fact Sheet Nursing Shortage
2 Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study 

3 Nurses escorted out of Ascension hospital

4 700+ nurses strike over new labor contract at Illinois hospital

5 https://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=095-0401

6Do Nurse Staffing Standards Work? Evidence from a 2018 Survey of Registered Nurses

7 102ND GENERAL ASSEMBLY State of Illinois 2021 and 2022 SB2153

8Illinois Nurse Staffing Survey 2022

9Illinois Nurse Staffing Survey 2022 Research

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Doris Carroll

About Doris Carroll, BSN

Doris Carroll, past President of the Illinois Nurses' Association (INA), The Nurses’ Union, VP affiliate of the IL AFL-CIO, and delegate with the Chicago Federation of Labor, registered nurse of 37 years, now retired.

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Specializes in Critical Care.

I worked at a small local union hospital taken over by Ascension and they were and still are hostile to the union and the workers, violate the contract and the local management is known to outright lie and treat staff with disrespect.  They cut support staff to the bone and lied and said the union had agreed to it, then tried to intimidate us for questioning it on the union facebook page as they had illegally been monitoring our activity!  The most despicable thing was the HUC's & CNA's that were laid off were let go without severance because it wasn't written in the union contract!  The new Ascension management refused to follow common business practice let alone their so called Christian ethics and give severance to these workers who were paid the least among us!  Therefore I think Ascension should be better known as Descension in my opinion. 

They succeeded in driving out most of their nurses even before covid hit so they were in dire straights then.   I warn everybody to think twice before going to one of their hospitals.  If you read the news or check out glassdoor or linked in reviews you will find these practices are par for the course.  I quit because I couldn't continue working somewhere so unsafe due to greed.

It took over six months and a federal negotiator to reach the last contract, but I doubt they will honor it.  Last I heard things are worse then when I worked there and they are even more short of critical equipment and staffing.  Now I hear they are forcing staff nurses to work on call to save money on travel nurses since when I worked there it was almost entirely down to new grads and travelers as they had driven out most of the regular staff. 

The previous CNO was working as a supervisor there recently and telling them how the other Ascension hospital nurses were all better paid and it was the union's fault that they were paid the least and did not get additional market adjustment raises this year.  Of course, it had nothing to do with Ascension management refusing market adjustment raises.  The same CNO stood by and denied tuition reimbursement to staff on a technicality when she had been a nursing college dean prior to becoming a CNO, so much for valuing nursing education!  The highlight to me was her bragging about her diamond ring and trip to Mexico, probably paid for from the 5K covid bonuses given to management who never stepped foot on a covid wing;  but only 1K bonuses given to a select few nurses chosen by her to be worthy of working enough time on the covid wings, while the rest I heard got an Ascension T-shirt as a consolation prize. smh Unreal.  They were the only corporation in the city that denied hazard pay bonuses during covid as well!

While I value nursing unions, especially the work of the NNU, I don't think it is worth it to stay at a place that treats you poorly.  Now more than ever nurses are in the driver's seat, we know are value and there are lots of other jobs and employers to choose from. 

I hope those nurses in IL that are being suspended for speaking for public safety are vindicated!  It sounds like it is time for the local news media and community officials to be informed if this hasn't already happened and for hospital picketing to be done as well!  I wish them the best!

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

What an awful situation for those nurses, and those patients. I know that many nurses over the past couple years have faced shifts with unsafe staffing and it feels like whenever we have filled out the unsafe staffing forms in our hospital, it's turned back on the nurses about how it could have been done better. But they point out things that are unreasonable, like switching entire assignments around mid-shift, and sometimes moving staff mid-shift, as if floor nurses are making those decisions. We're still getting badgered about not taking our lunch break! Really, I've got three ICU level of care patients with charge responsibilities with all new nurses and travelers and I'm getting emails about how it was my responsibility to call the supervisor and ensure I get a break?! 

For these ED nurses they are 100% right to be reporting that as unsafe staffing, and the situation being known for six weeks with no action by administration is awful. It seems like if nurses try to get information directly to the public we're portrayed as being all about the money, and risk our jobs if there are rules about social media or "representing the organization", but no one else is looking out for patients. Four nurses for 46 patients is just scary. If it's not a problem then administration should have been willing to tell all 46 of those patients that there would be only four nurses that night due to their decision. See how well that goes. 

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Specializes in L&D/HIV/ID/OB/GYN Primary Care Adults/Children.

Agreed. Apparently the CNO was just fired. There are ways to fight back. Create an ADO form-Assignment Despite Objection to document the unsafe staffing. Remember-if we don't document it didn't happen. It means you've taken your assignment despite your objection that it's unsafe. Unions have created this document. If you're not in a union what to do? Create your own ADO using Google Forms. Here's an example from a union -https://ado.wsna.org/ado . Start creating a file folder of emails you sent to the charge nurse, copying the supervisor or director of your assignments. Obviously this can not happen if only one nurse does this. Get your entire unit to buy in, get multiple units to do it. Call your legislator in that hospital district. Make an appointment. Present the folder to them. Call your public health department. File a report anonymously. Organize and educate yourselves. Depending on which state you live in you may have laws to protect you. Whistleblower legislation, staffing legislation. Although social media, marches have helped engage and network with others, it's just not the endgame. You must speak out. Silence=acceptance. Join a union.

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Specializes in Cardiac surgery.

Until these issues are addressed on the federal level both nurses and patients will continue to suffer. What will it take for that to happen? 

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.
5 hours ago, Doris Carroll said:

Join a union.

I understand that in many situations, a union can improve conditions, but even unions can push more individual objectives and not always what everyone agrees on. My union chose to strike a few years ago. At the time they were out with signs that said "safe staffing" was what we were fighting for, but they chose to remove the part we were fighting for with patient ratios and instead just went for the bottom line raises, stating that the raises would fix staffing. Well, it didn't. There were many of us that did not agree with how things went, but the majority of the union won. And now we're in the same pile of crap a few years later with daily mandations and continual short staffing. 

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Specializes in Student Nurse.

It appears in the best interest of the public to have those ratios written into the criminal code. How many have actually been harmed due to a safe ratio not being implemented, even though it’s a part of “hospital policy?” I assume plenty enough. People come to a hospital to give them a better chance at surviving, not to be overlooked and harmed. This is more than a civil issue. When it comes to harming the public through negligent practices, that’s criminal negligence, imo.

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Specializes in Critical Care.
3 hours ago, bsd058 said:

It appears in the best interest of the public to have those ratios written into the criminal code. How many have actually been harmed due to a safe ratio not being implemented, even though it’s a part of “hospital policy?” I assume plenty enough. People come to a hospital to give them a better chance at surviving, not to be overlooked and harmed. This is more than a civil issue. When it comes to harming the public through negligent practices, that’s criminal negligence, imo.

The hospitals will cover it up and pay off the family with an NDA as they did in the Vanderbilt case.  Then when they were exposed, they made sure the DA criminally charged the nurse for her mistake.  Before Vanderbilt's outright deceit and falsified records to the medical examiner were exposed the nurse was fired with a slap on the wrist from the BON and nothing was done to fix the systemic issues that contributed to the fatal med error.  Once they were exposed, the BON pulled her license and she was criminally charged. 

While you may say it is not the same situation as it was a med error that did not involve understaffing, don't kid yourself because this is exactly how many hospitals do business.  It is my opinion that they were instrumental behind the scenes in exacting revenge against her with the criminal charge when their own duplicity was exposed, and they were put at risk of losing medicare funding and their brand was tarnished.  Nevermind that it was by their own hand.  Note that Vanderbilt faced no serious repercussions, nor did any of its Drs or administrators suffer any consequences for the illegal and criminal coverup!  Unlike the nurse who was criminally charged for a medical error.  The DA also worked for Vanderbilt and Radonda's lawyer actually had given a political donation for the DA's reelection campaign, talk about conflicts of interest!

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Specializes in L&D/HIV/ID/OB/GYN Primary Care Adults/Children.
On 10/29/2022 at 7:31 PM, FAB_RN said:

Until these issues are addressed on the federal level both nurses and patients will continue to suffer. What will it take for that to happen? 

We need to continue to volunteer our expertise in pushing the federal legislation forward. No one will do it for us. That message should be very clear now. There are many ways that one nurse can make a difference. First see if your congressional senators and representatives are co-sponsors: https://www.congress.gov/bill/117th-congress/house-bill/3165/cosponsors?r=84&s=1. If not email them, then call, then see them in person. https://www.usa.gov/elected-officials Use this to familiarize yourself and review with legislators, nurse colleagues, family and friends. Demand your legislator become a co-sponsor and pass it! From www.NursesTakeDC.com Schedule appointment with nurses and congressional legislators. The legislative session ends with the Nov 8th election. Hopefully, Jan Schakowsky-IL and Sherrod Brown-OH will re-introduce the federal bill in 2023. It has been re-ntroduced for decades. Nurses must do this!! Support organizations that fight for patient safety. Show up in Skokie Illinois for a Patient Safety Advocate Org on Nov 10th. Get tickets now! https://ci.ovationtix.com/34423/production/1141887.. 

Preparing for NTDC federal Legislator visit document HR 3165 S 1567.docx

Vote Yes on HR 3165 and S 1567 Nurse Staffing Ratio bill NTDC June 2022.docx

Safety Advocate.jpg
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Specializes in L&D/HIV/ID/OB/GYN Primary Care Adults/Children.
23 hours ago, bsd058 said:

It appears in the best interest of the public to have those ratios written into the criminal code. How many have actually been harmed due to a safe ratio not being implemented, even though it’s a part of “hospital policy?” I assume plenty enough. People come to a hospital to give them a better chance at surviving, not to be overlooked and harmed. This is more than a civil issue. When it comes to harming the public through negligent practices, that’s criminal negligence, imo.

It's a long-standing cover-up by healthcare systems. They choose to target nurses with criminal charges rather then deal effectively with the root cause- unsafe staffing. 

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Specializes in L&D/HIV/ID/OB/GYN Primary Care Adults/Children.
On 10/29/2022 at 8:07 PM, JBMmom said:

I understand that in many situations, a union can improve conditions, but even unions can push more individual objectives and not always what everyone agrees on. My union chose to strike a few years ago. At the time they were out with signs that said "safe staffing" was what we were fighting for, but they chose to remove the part we were fighting for with patient ratios and instead just went for the bottom line raises, stating that the raises would fix staffing. Well, it didn't. There were many of us that did not agree with how things went, but the majority of the union won. And now we're in the same pile of crap a few years later with daily mandations and continual short staffing. 

I understand. My union did that in 2017. I was told we hadn't properly educated our nurses on the staffing issues. It wasn't an urgent issue that my own nurses were ready to strike on. I was devastated. Then in 2020 I made sure ratios were front and center. We won 200 more positions in a hospital of 1400 RNs. Hospital refused to call it ratios, called it FTE staffing commitment. However, now many nurses have retired or went to travel nursing. Yet our turnover rate is quite low compared to other IL hospitals.  So the way you get your voices heard in your union- you run for office on the local union board-it's run by nurses with organizers to assist. And the the state board. That's how it's done. It's a democracy so majority will rule. 

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Specializes in Nurse Leader specializing in Labor & Delivery.

I'm curious whether the hospital in question is for-profit or "non profit" (yes, a quick Google could tell me, but wanted to know if the OP knows). Also, how many beds does that hospital's ED have? 45 patients - I can't even imagine. The one hospital at which I worked as a house supervisor (this was a for-profit hospital and all managers/directors were expected to take one day shift every other week as house supervisor, which was their way of saving money, not having to hire an FTE), if there were 10 people in the ED at the same time, that was super busy. I can't even imagine 45 patients. Even thinking about it causes a pit of stress in my stomach.

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