Illinois Nurses Speak Out for Patient Safety: Hospital Retaliates

[Doris Carroll]

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

 

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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

[Doris Carroll, BSN]

It is a nonprofit as many hospitals are, especially a religious hospital. Unclear how many beds but this graphic says much how they are closing beds, with the belief they will eventually close. Not because they're losing money...

[brandy1017, ASN, RN]

3 hours ago, Doris Carroll said:

It is a nonprofit as many hospitals are, especially a religious hospital. Unclear how many beds but this graphic says much how they are closing beds, with the belief they will eventually close. Not because they're losing money...

If you read old news articles Ascension has a history of closing inner city hospitals, while at the same time opening up new ones in the suburbs.  They closed one in Detroit after promising to keep it open if allowed to open a new one in the suburbs, then reneged on it and claimed they couldn't keep it open as it was losing money.  They closed an inner city hospital in Washington DC recently and when the board protested just fired the board and replaced them with yes people.  They were in the process of closing an inner city hospital where I live but amazingly due to community pressure and help from the union and it is not even one of the union hospitals, they backed down. 

Now they have opened several micro hospitals by me that from a couple nurses that have worked for one are very understaffed, not equipped to deal with serious emergencies, were meant to be able to transfer critical patients to the other larger hospitals, but since they don't staff it doesn't always work out that way.  I was told of issues with worrying about running out of oxygen and of telling a patient it would be best if they left the ER on their own and went to another hospital ER as they weren't able to handle the acuity of the patient's situation.  But these micro hospitals are being advertised as if they are full service.  People don't know the difference.

They claim they are Christian and non-profit but the way they operate they would give Wall Street a run for its money!  They even have a for-profit private equity fund with a debt collector.  https://www.statnews.com/2021/11/16/ascension-running-wall-street-style-private-equity-fund/

It is unreal.

[Doris Carroll, BSN]

Thanks for responding. Appreciate your thoughtful response. Quite shameful Ascension...

In 15min NurseLiz will be speaking about this issue...

 

[brandy1017, ASN, RN]

I found a local news article and the union is doing all the right things letting the public know what is going on and involving the local government leaders as well in the fight for patient safety.

https://patch.com/illinois/joliet/3-nurses-suspended-ascension-chaos-st-joes-hospital

I want to just suggest to anyone who has witnessed or is aware of a sentinel event you can anonymously report it to JCAHO and they will investigate, but you need to have a date of the incident for them to do so.  So keep that in mind and write down in a notebook, date planner or calendar if or when something bad happened so it can be addressed.  On top of that make an incident report.  You can file a corporate compliance complaint also although in my experience it was futile.  If you have a union you can reach out to them and also file the assignment despite objection forms re unsafe staffing.

Publicity is a great weapon with these corporations as they don't like bad publicity.   The public and most government officials are on the nurses side.  They still hold nurses in high esteem. 

 

[Doris Carroll, BSN]

5 hours ago, brandy1017 said:

I found a local news article and the union is doing all the right things letting the public know what is going on and involving the local government leaders as well in the fight for patient safety.

https://patch.com/illinois/joliet/3-nurses-suspended-ascension-chaos-st-joes-hospital

I want to just suggest to anyone who has witnessed or is aware of a sentinel event you can anonymously report it to JCAHO and they will investigate, but you need to have a date of the incident for them to do so.  So keep that in mind and write down in a notebook, date planner or calendar if or when something bad happened so it can be addressed.  On top of that make an incident report.  You can file a corporate compliance complaint also although in my experience it was futile.  If you have a union you can reach out to them and also file the assignment despite objection forms re unsafe staffing.

Publicity is a great weapon with these corporations as they don't like bad publicity.   The public and most government officials are on the nurses side.  They still hold nurses in high esteem. 

 

Thanks for posting the Patch article. They have now fired the CNO. And they've given the nurses a "final warning" which does not follow the usual steps in the disciplinary process. It's the step before termination at their facility. As you said the union continues to meet with administration, community leaders and legislators...

[Doris Carroll, BSN]

Nurses can join in the fight to pass federal legislation- S. 1567/H.R.3165 - Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021. Go here to learn the steps you can do to educate, organize and agitate. Learn how you can educate yourselves, other nurses and congressional legislators for these bills.  https://www.nursestakedc.com/legislative-information

These bills will die in committee within the week. Next year we hope to see the bills re-introduced. But- the value of learning this information is that it can be applied to fighting for legislation in your own states. Ask unions what are they doing to support and pass ratio legislation?

Don't be fooled by the ANA, AONL and the AHA-they want to see staffing committees as opposed to ratios. Staffing committees allow the hospital to remain in control, attempting to pacify nurses. Yes, some increases in FTEs can be had, but it is a slow and arduous process. 

Even Dr. Linda Aiken has raised her voice in mandating legislation now in the past few years as her own and others research is ignored by the AHA. Dr. Linda Aiken in 2019–“…There has never been one shred of evidence to show more nurse staffing made things worse, but there have been a lot of studies to show they made things better,” says Aiken. She also notes that all of the fears the hospital industry in California expressed were unfounded. “No hospitals closed, and the public didn’t pay more even though it was an unfunded mandate. The hospitals just shifted their resources…Critics of nurse-to-patient ratios say they take away from nurses’ discretion, but I don’t buy it,” says nurse researcher Aiken. “We can show people are dying unnecessarily. I’ve been doing research for over 40 years, and there has been no other example that improves patient outcomes more than staffing.”https://www.aft.org/news/fed-unsafe-staffing-nurses-are-organizing-change?fbclid=IwAR0ojOPQuRy-E1GKPyTH-KjyUXMQ6ZP63arnOCmGEMCx3x-Pwlqy9q5m1kg

 

[Nurse Beth, MSN]

Doris, congrats on your retirement! And thanks for all you've done for so long to promote better staffing.

[brandy1017, ASN, RN]

12 hours ago, Doris Carroll said:

Thanks for posting the Patch article. They have now fired the CNO. And they've given the nurses a "final warning" which does not follow the usual steps in the disciplinary process. It's the step before termination at their facility. As you said the union continues to meet with administration, community leaders and legislators...

This is what Ascension does when they are trying to get rid of nurses.  That is what they did when our new manager told the new grads she hired that she was going to get rid of the older nurses and then started writing us up.  The first person she texted the need for a meeting over a concern on her vacation to ruin it since she had her cell phone and proceeded to give her a final warning on a small matter blown out of proportion when she had no prior disciplinary problems.  Of course, It is meant as an intimidation tactic and to block the ability of the nurses to transfer out to essentially force them to leave or make it easier for admin to find a way to fire them. 

The new grads one by one said the manager had told them in their job interviews her plans to get rid of us as I've mentioned in another post.  She came after me next, but I was prepared and able to fight back letting her know I was aware of her targeting senior nurses.  I got off with a "counseling" for not saying my name when calling the emergency dept for help with an emergency situation with a patient.  She was really reaching! But I had to be interrogated with 2 HR people watching me via a computer  lest I roll my eyes and repeat what I had already told her before.  smh.  She even threatened to write up another coworker for simply expressing that she had had a rough shift the day before when they were short staffed when the supervisor had asked how her day was going.  She had simply said today is good but you should have seen it yesterday when we were short to which the manager told her if she ever complained again she would write her up! 

I finally had enough of the BS and filed a corp compliance compliant over lack of critical equipment like heart monitors and oxygen flow meters and her harassment and illegal age discrimination.  We'd be forced to admit tele patients without tele monitors and wait an hour or two for a supervisor to scavenge one and if none were found have to call a Dr to get one of our other patients off of tele for the new admit!  Or there would be an emergency and you'd need oxygen for a patient and look up and see no flow meter in the room and have to run to another wing to find one.  Unreal.  While the director above her blew it all off as missing equipment due to covid and just rumors I think there was some blow back on her because she left soon after. 

[Doris Carroll, BSN]

18 hours ago, Nurse Beth said:

Doris, congrats on your retirement! And thanks for all you've done for so long to promote better staffing.

You're very kind! And congrats on your retirement--but you look very busy still! I'm still working with my former union as a retired member, to re-introduce staffing ratio/acuity legislation in 2023. And busy here in Florida with Labor unions and politics ? (here's my view of the backyard pond...)

[Doris Carroll, BSN]

17 hours ago, brandy1017 said:

This is what Ascension does when they are trying to get rid of nurses.  That is what they did when our new manager told the new grads she hired that she was going to get rid of the older nurses and then started writing us up.  The first person she texted the need for a meeting over a concern on her vacation to ruin it since she had her cell phone and proceeded to give her a final warning on a small matter blown out of proportion when she had no prior disciplinary problems.  Of course, It is meant as an intimidation tactic and to block the ability of the nurses to transfer out to essentially force them to leave or make it easier for admin to find a way to fire them. 

The new grads one by one said the manager had told them in their job interviews her plans to get rid of us as I've mentioned in another post.  She came after me next, but I was prepared and able to fight back letting her know I was aware of her targeting senior nurses.  I got off with a "counseling" for not saying my name when calling the emergency dept for help with an emergency situation with a patient.  She was really reaching! But I had to be interrogated with 2 HR people watching me via a computer  lest I roll my eyes and repeat what I had already told her before.  smh.  She even threatened to write up another coworker for simply expressing that she had had a rough shift the day before when they were short staffed when the supervisor had asked how her day was going.  She had simply said today is good but you should have seen it yesterday when we were short to which the manager told her if she ever complained again she would write her up! 

I finally had enough of the BS and filed a corp compliance compliant over lack of critical equipment like heart monitors and oxygen flow meters and her harassment and illegal age discrimination.  We'd be forced to admit tele patients without tele monitors and wait an hour or two for a supervisor to scavenge one and if none were found have to call a Dr to get one of our other patients off of tele for the new admit!  Or there would be an emergency and you'd need oxygen for a patient and look up and see no flow meter in the room and have to run to another wing to find one.  Unreal.  While the director above her blew it all off as missing equipment due to covid and just rumors I think there was some blow back on her because she left soon after. 

Wow...some people don't belong in management. And nurses in management are -how to put this-not your friend and have long ago forgotten their roots. Rarely did I see those who fought the C-suite for better staffing. ? 

[klone, MSN, RN]

14 hours ago, Doris Carroll said:

Wow...some people don't belong in management. And nurses in management are -how to put this-not your friend and have long ago forgotten their roots. Rarely did I see those who fought the C-suite for better staffing. ? 

That's an unfair generalization. I have been in management since 2013, and the day I forget my roots is the day I leave management. I regularly work the floor alongside my nurses, so that I can see and understand what their needs are. 

[Nurse Beth, MSN]

18 hours ago, Doris Carroll said:

You're very kind! And congrats on your retirement--but you look very busy still! I'm still working with my former union as a retired member, to re-introduce staffing ratio/acuity legislation in 2023. And busy here in Florida with Labor unions and politics ? (here's my view of the backyard pond...)

Gorgeous! So happy for you!