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
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
Erin Lee, BSN, RN
25 Articles; 363 Posts
Thank you for sharing ! I know your article is focused on Illinois but this is certainly an issue nationwide. I know I have personally faced retaliation for speaking up, it was a unionized hospital and my union rep was of zero help. I spoke up that the sitter should have never been removed from the room, my charge RN said she couldn't do anything about it and handed me a form to file for virtual sitter, after completing that I told her I would be submitting a SIRS report. Minutes, literally minutes later, my manager was there pulling me into her office & writing me up. During our sit down I expressed retaliation to my manager with my rep there, the rep literally disregarded this concern and told me that my manager had my best interest. Needless to say I left that unit shortly after. It is so sad that we are facing this. I love how you addressed things to do about it if you are in IL. I wish we had some sort of national/federal regulations on safe staffing, because it is out of control, and the standard of care does not vary that drastically from state to state, if at all in many scenarios.