Asheville – The Buncombe County Commissioners, through commentary, an official letter to the state, and a lawsuit, made it clear that they do not want Mission Hospital to be awarded the certificate of need the state has made available for a new 67-bed acute care facility. (See sidebar.) So, it was not surprising to see that the commissioners were not only going to give Mission’s nurses a chance to speak at their meeting, but they were not going to provide any clues for the opposing side to prepare a counternarrative for public comment. Instead, the staff report included the agenda item “Mission Hospital Nurses,” which stated only that, “Commissioners Newman, Beach-Ferrara, and Sloan requested that this item be added to the agenda.”
Chair Brownie Newman introduced nurse Lori Hedrick and any of the many nurses accompanying her in the audience, saying the commission just wanted to acknowledge the important work of nurses as they work through COVID recovery and “changes that have happened at Mission.” Hedrick began by plugging National Nurses United, which nurses voted to join two years ago. She explained how nurses pursue their careers in order to compassionately heal people suffering from illness and injury.
Unfortunately, she said, Mission’s nurses have become less and less able to do that, especially since HCA purchased Mission.
The push to unionize reached a boiling point in the heat of the COVID scare, with grumblings about work conditions and Attorney General Josh Stein communicating with HCA over complaints he’d received about staffing and quality of care. Since HCA and the nurses’ union entered into their contract a little over a year ago, Hedrick has observed a “knowledge deficit” about how unions are supposed to function in this Right to Work state. Because HCA has not educated management about the terms of the contract, she said, the nurses are having to teach each other and “fight for what is right for patients and themselves.”
One thing the contract has allowed is the filing of grievances. Most cases can be resolved informally, but some have been escalated through a four-step process to arbitration. Nurses have resolved grievances through arbitration, including suspension without just cause; requiring nurses to use paid time off for quarantining; not promoting from within; denying tuition reimbursement; and not complying with rules for posting schedules.
Hedrick said there were many other grievances at various stages of the process. At first, HCA refused to pay more for tenured nurses. This was in part due to Mission’s failure to keep records of how long employees had worked for the company. The union helped collect this information, and tenure is now compensated. Nurses’ requests for retention bonuses were also denied. Hedrick indicated HCA had misplaced priorities. Rather than compensating nurses in ways that would spur recruitment and retention, she observed that HCA was the most profitable healthcare institution in the United States, and Mission was the most profitable hospital in the HCA system.
Other victories have included requiring an investigation and furnishing accused nurses with a representative before disciplinary action may be taken and the formation of committees to inform patient care and safety policies with up-to-date, hands-on information. The committees, in turn, have successfully lobbied for higher nurse-to-patient ratios in the intensive care unit and permission for nurses to work extra hours to relieve staffing shortages. The latter, unfortunately, has proven a drop in the bucket in attempting to keep up with staffing shortages. Hedrick said Mission has lost 404 nurses since this time last year. When Commissioner Parker Sloan asked if that wasn’t for the last two years, Hedrick said he would have to more than double that amount for the two-year total.
To illustrate the extent of unsafe working situations, Hedrick said grievance forms are submitted daily by nurses who work through meals and other breaks without time to override the automatic clock-outs. Then, in addition to working extra-hard to cover for nursing shortages, the nurses are also expected to cover for janitorial shortages, cleaning patient rooms and emptying trash. Hedrick said this was unsafe, unhygienic, embarrassing, and demoralizing.
Then, the hospital typically has only five of the required 16 phlebotomists on duty at any given time. It would be foolish, and in some cases, lethal, to try to treat people without blood tests. HCA’s response, she said, is to subcontract the hospital phlebotomists out to skilled nursing facilities and add drawing blood and sending samples to the lab to nurses’ plates.
A nurse only identified as Susan added that the hospital had lost “hundreds of doctors,” many of whom had been working in the hospital 17 years ago when she started. She added that most of the doctors in the emergency department are now working for a “private equity firm company,” and weren’t providing patients with the kind of care the old pros would.
Hedrick, who works with all hospital departments, said she doesn’t know most of the nurses anymore because they’re travelers. She said HCA is offering the travelers a $30,000 bonus to keep working for the hospital when they’re already paid more than tenured staff. Travelers aren’t union members, and neither are LPNs. Hedrick said the hospital’s push to hire more LPNs was motivated by its desire to dilute the union’s power. “They’re offering all kinds of bonuses to new hires that they refuse to offer to those of us who have been there,” she said. Conferring with a nurse in the audience, she added, “Oh, yes. They’re offering very lucrative bonuses to management. The money’s there. ”
Newman asked what the commissioners or members of the community could do to help, and Hedrick said nurses get that question a lot. Members of the public can feel free to boycott organizations that aren’t charged with providing critical care. In this situation, “that doesn’t really feel like the right answer.” Hedrick paused and added, “That is happening,” though.
Commissioner Al Whitesides was among those to thank the nurses for their service and courage. He said, “It’s a downer for me, because I spent 12 years on the foundation board for Mission. If you had told me then we’d be where we are today, I would never have believed it. ” The sentiment was echoed.