Dozens of nurses, their families, and even passers-by rallied outside St. Elizabeth Hospital last week to protest unsafe patient conditions, unfair wages, and proposed health insurance premium rate increases for workers at the facility.

The dreary weather on Dec. 4 appeared to do little to dampen their spirits as a picket line formed on Battersby Avenue to chants of, “When I say ‘fix,’ you say, ‘staffing,” and, “We’re here, we’re strong, we’ll fight for patients all day long.” A mobile billboard drove around town, lighting up the streets in support of the nurses.

At the heart of the matter is a contract dispute between CHI Franciscan and SEIU Healthcare 1199NW, the union that represents St. Elizabeth’s 124 registered nurses and 30,000 health care workers in Washington state and Montana.

Negotiations have been active since May 2019, according to Sherry Tomt, an RN at St. Elizabeth, union leader and member of the bargaining team, and Enumclaw resident; they haven’t been going well.

“I feel like they’re not really listening to us,” Tomt said, who attended the rally before heading off to her night shift. “They’re saying, ‘We hope the union comes back to the table and agrees to bargain with us.’ We haven’t not been. We’re asking them to listen to us, to hear what we’re saying, and to take us seriously, because this is important.”

It appears the key dispute is staffing — or rather, a lack of it.

Washington state law mandates hospitals submit nurse staffing plans to the Department of Health; according to St. Elizabeth’s 2019 plan, the hospital has one nurse to every five patients in acute care, one nurse to three patients in the progressive care unit, and one nurse to two patients in the intensive care unit, all for a daily average of roughly 14 patients.

That one-to-five ratio in particular is too large, said Kelly Patton, a charge nurse in acute care at St. Elizabeth.

“A one-to-five ratio is really difficult. You don’t get the care that you deserve at one-to-five versus one-to-four, which is what the nursing guidelines say,” Patton continued, citing a California study. “One-to-four is safe.”

Patton added the hospital doesn’t always follow its own staffing plan for the ICU either.

“There’s times they flirt with that, where we don’t have a second ICU nurse, and there should be,” she said. “That’s really wrong.”

In fact, both Patton and Tomt mentioned, sometimes there’s not enough nurses at the hospital to form a code team.

“They pull from my floor, and there’s times that if they go off for a code, and there’s three of us there — I’m a charge, and there are two other nurses — they have to go off and respond to the code and leaves me on the floor, sometimes by myself or maybe with a CNA, and they can be gone for a couple of hours,” Patton said.

Not only is it a problem for acute care to suddenly be down to just one nurse, but a charge nurse’s job is to be in charge of other nurses, not take care of patients.

“I’m supposed to be their [nurse’s] help. I am their resource. It’s really hard to be a resource when you’re having patients yourself,” she said. “And my patients don’t get the care they deserve sometimes, because I can’t be two or three different people.”

But the odd thing, she continued, is that St. Elizabeth has the staff to be able to bring that one-to-five ratio down, and just chooses not to.

“The problem is, we have a lot of staff — they over hired. Then they cut [staffing] down,” Patton said. “So there’s usually six nurses scheduled, and we only usually use four or five, so people are placed on call. They’re either sent home during a shift or they just don’t work at all, and you’re sitting at home, not making any money. Meanwhile, the nurses who are there are fully maxed out at five patients.”

Having only a few nurses working at a time also means there are no break nurses, or nurses that take over when another needs to use the restroom or eat a meal, Tomt said, which only adds to the stress they’re already feeling on the floor.

“It’s becoming a law that you have to have a break nurse, but I would say nine times out of 10, we don’t have a break nurse,” she continued. “So you have a choice of, do I go to the bathroom or do I eat? And what I tell people is, if that’s your choice, go to the bathroom. If you pass out from hunger, at least you won’t wet yourself.”

These sorts of conditions leads to high staff turnover, which is exacerbated when you factor in the comparatively low pay St. Elizabeth nurses allegedly receive. Getting specifics concerning wages is difficult, since registered nurses are paid more based on their level of experience, but Tomt said St. Elizabeth nurses earn up to $5 per hour less than their counterparts at other area hospitals.

“The hospital is in King County, we live in King County, but we don’t get King County wages. We get Pierce County wages,” Tomt said. “If we don’t pay decently, we can’t recruit staff. If we can’t recruit staff, we are short of nurses. In my department, we have lost over the last couple of years five or six nurses. There’s not that many. In 19 straight days, I worked 15 of them. A couple of them were 14 hour shifts, the rest of them were 12 hour shifts, because there was no one who to cover.”

Tomt is a hospital resource nurse and, like Patton, is charged with making sure other nurses are being taken care of than helping with patients, making her role vital to St. Elizabeth’s operations.

“The hospital resource nurse backs up every department,” she continued. “It’s a big deal.”

Finally, the last sticking point for St. Elizabeth workers is that CHI Franciscan is looking to increase their insurance premiums, up to more than $350 more for employees and their families to be on the same plan, which Tomt says only adds insult to injury.

“They want to raise [our] pay just a little bit, they want to do the 2 percent,” she added. “Well, that doesn’t cover what the health insurance going up, so that’s not an increase at all.”

Increased staffing, lower insurance premiums, and increased pay will cost CHI Franciscan more than a little bit of money, but SEIU Healthcare 1199NW believes the organization can afford it.

In a press release sent out before the picket, the union stated that the CEO of CHI Franciscan, Ketul Patel, was compensated $2.6 million in 2018, a 46 percent increase from the $1.8 million he was compensated the previous year, a spokesman said.

“Executives certainly have more than enough resources to protect patient safety, improve staffing levels and raise job standards,” the press release read. “St. Elizabeth is very financially healthy with a strong profit margin, and CHI Franciscan had $1.4 billion in revenue in 2018.”

CHI Franciscan Vice President for Communications and Government Affairs Cary Evans said the health care system is committed to working with the union and continue safely caring for its patients.

“We value our nurses and are committed to providing a quality work environment with competitive wages and benefits that attract and retain the very best,” Evans said. “We respect the collective bargaining process and as we move forward with ongoing negotiations, patients at St. Elizabeth can expect to receive uninterrupted, quality care.”