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]

5 hours ago, klone said:

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. 

It's my comment based on my 37 years of nursing experiences, and 10 years active in the union. Rarely did I encounter nurse management as someone like you. Even during the initial wave of Covid. I'm glad you understand the issues and willing to step in. I stand by my comment. 

[JBMmom, MSN, NP]

10 hours ago, klone said:

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. 

I know I've mentioned this before, but if your approach was the norm and not the exception, nurses everywhere would be so much better off! And so many managers and executives don't realize it, but patients and whole organizations would surely benefit as well. If only a true collaboration between nurses and managers existed in more environments- how can we "klone" you?!

[JKL33]

On 11/2/2022 at 4:51 AM, brandy1017 said:

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

Skip them and notify CMS.

Jake-o is too busy looking for drinks in the nurse's station. They are a non-governmental, made up quasi-regulatory body with voluntary participation.

[bsd058]

On 10/30/2022 at 4:24 PM, brandy1017 said:

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!

So, my point of writing it into the criminal code was not applicable to only cases where a patient is harmed. If the ratios were written into the code, then it would become a crime simply to go over those ratios, even if no one was hurt. There would be an incentive for the hospital to abide by those ratios at all times. You can’t blame scheduling on a nurse when no one was harmed. The simple act of not scheduling enough nurses or not having enough on duty would become a crime, and in my opinion, would make the hospital system be proactive, since serious fines and/or imprisonment could happen if they exceed those. It would decrease risk significantly. If it was a crime to exceed the ratios (obviously there are other things to take into account, I’m not suggesting the wording be so simple), admin would likely be incentivized to do otherwise, since “no harm, no foul” doesn’t necessarily come into play in all cases. The increased risk to the patient itself BECOMES the crime—not the resulting harm that inevitably comes about when taking into account larger numbers (when taking into account all of the hospital systems across an entire state—not just the one that wasn’t in compliance).

[Doris Carroll, BSN]

Management feels they are acceptable risks. It would never pass in any state to make short staffing a criminal offense, although research does correlate less nurses with increased adverse outcomes. This is why we need a federal staffing bill or states to pass their own staffing legislation, putting hospitals on notice with severe penalties and staffing committees with more leverage. Oregon just announced proposed ratio legislation for 2023, very detailed. https://www.oregonrn.org/page/SafeStaffing-legislation

[FAB_RN, BSN]

How about making average nurse-to-patient ratios reportable information? Given the choice, are you going to take your loved one to the hospital where their nurse will have 4 to 5 other patients to take care of, or 3? 
 

Nothing makes hospital policies change faster than the threat of losing revenue!

 

[Doris Carroll, BSN]

7 hours ago, FAB_RN said:

How about making average nurse-to-patient ratios reportable information? Given the choice, are you going to take your loved one to the hospital where their nurse will have 4 to 5 other patients to take care of, or 3? 
 

Nothing makes hospital policies change faster than the threat of losing revenue!

 

It is reportable by law in several states. the staffing plan. 

[Tommy5677]

Boards of nursing are the ones who should be going after the hospitals. Afterall, their priority is patient safety and I'm saying that loosely. They often go after nurses that don't deserve it and I know because I went up against a board unjustly accused and won, something that doesn't happen very often. How did it happen? I caught them lying and they knew it. I had to defend my license and believe me, it's like being on trial. I think some of them relish it. I know of one case, I'm sure there are many, where  a board of nursing threatened nurses for refusing unsafe assignments. Some of them are as rogue as the hospitals.

If patient safety were really priority they could go after the hospitals and get away with it. That includes going after nursing administrators and managers, most of whom will side with management and hang you out to dry. Their job is to protect me, the licensee from things that deliberately put my license and wellbeing at risk. It's also their responsibility to protect the patient but they somehow believe that protection only comes through disciplinary action against nurses themselves. I'm just so glad that after more than 40 years I'm this close to full retirement. THIS CLOSE. But then again, I'm not working for a hospital.

[brandy1017, ASN, RN]

The New York Times just did a great expose on Ascension's greed and systemic understaffing of its hospitals across the nation.  I can't post it as it's under a paywall but a highly suggest people consider reading it and thinking twice about working for them!  I just hope this leads to CMS taking real action against them to fix the safety and staffing issues their greed has created and no it wasn't because of covid!

The article is called Profits over Patients How a Sprawling Hospital Chain Ignited Its Own Staffing Crisis.  I also discovered that Tersigni who had resigned as CEO of Ascension Health is still making millions now the head of its Investment division.  Managers given bonuses to lay off workers and not hire staff.  Bragging about record profits from keeping low staffing and this before covid.  Disgusting!

It's time for new management, a complete takeover, or divide it up as it has turned into a monstrosity of a monopoly.  But it also really shows the need for government intervention and mandatory national patient staffing ratios in my opinion.

[Doris Carroll, BSN]

2 hours ago, brandy1017 said:

The New York Times just did a great expose on Ascension's greed and systemic understaffing of its hospitals across the nation.  I can't post it as it's under a paywall but a highly suggest people consider reading it and thinking twice about working for them!  I just hope this leads to CMS taking real action against them to fix the safety and staffing issues their greed has created and no it wasn't because of covid!

The article is called Profits over Patients How a Sprawling Hospital Chain Ignited Its Own Staffing Crisis.  I also discovered that Tersigni who had resigned as CEO of Ascension Health is still making millions now the head of its Investment division.  Managers given bonuses to lay off workers and not hire staff.  Bragging about record profits from keeping low staffing and this before covid.  Disgusting!

It's time for new management, a complete takeover, or divide it up as it has turned into a monstrosity of a monopoly.  But it also really shows the need for government intervention and mandatory national patient staffing ratios in my opinion.

Yes it was a damning piece against Ascension. Anyone can go to NursesTakeDC FB page to read entire article. https://www.nytimes.com/2022/12/15/business/hospital-staffing-ascension.html?smid=nytcore-ios-share&referringSource=articleShare

[Tommy5677]

When it comes to an understaffed nursing department and patient safety, where are the boards of nursing in this? Oh wait, they're all about punishing nurses for things that happen as a result of chronic understaffing. I forgot. Yes, boards of nursing threatened to go after nurses refusing unsafe work assignments during COVID (I believe it was for failure to provide adequate PPE). I'm not sure but I believe it happened in Texas. Can you imagine? A board of nursing threatening nurses for refusing unsafe assignments? I can.

[summertx]

On 11/8/2022 at 11:43 AM, Tommy5677 said:

Boards of nursing are the ones who should be going after the hospitals. Afterall, their priority is patient safety and I'm saying that loosely. They often go after nurses that don't deserve it

If nurses had a guarantee that their license wouldn't be on the line going in to work such as the 4 nurses taking on 46 patients, then maybe the nurses would have stayed. If I didn't like a shift, I wouldn't necessarily not clock in, but you best believe I'm calling out if my license is threatened.