Editor’s note: Virginia Mason Franciscan Health provided comments to the Courier-Herald after print deadline. This article has been updated with those comments, and a followup will be printed in the next physical edition.
Correction: The Courier-Herald erroneously paraphrased nurse Kelly Patton saying the Emergency Department was staffed only with travel nurses. The direct quote was, Patton said, “If there’s a lot of travelers scheduled, [St. Elizabeth] bring[’s] them in and we all stay home. Many times, the hospital is staffed by travelers, and the regular staff is at home.” The article has been updated.
Lower pay. No breaks. High patient-to-nurse ratios.
St. Elizabeth nurses found themselves once again picketing against these work conditions outside the hospital, looking to inform the public about what it’s like inside those white halls and pressure Virginia Mason Franciscan Health to “do the right thing” at the bargaining table, said Kelly Patton, a charge nurse in acute care.
The nurses, represented by SEIU Healthcare 1199NW, also picketed these issues back in 2019, but Patton and several other employees have said that since COVID, conditions have gotten worse, not better. Both these events were informational pickets and not strikes, and all staff members out on the sidewalk with a sign was off-duty.
“Now that we’re over [COVID], we’re faced with the hurdle of retention and staffing,” Patton continued. “We don’t have any. We don’t have the nurses that other hospitals have. And it is not safe. It is strictly not safe.”
Patient safety appeared to be the biggest concern for nurses at the rally, but Patton said hospital administration is more concerned about the bottom line. For nurses, this means doing more with less resources, which increases the probability of accidents and mistakes in patient care.
Patton was particularly incensed about the lack of breaks staff received, since the hospital doesn’t employ break nurses, which would allow staff to eat meals or use the restroom between caring for patients.
“It’s a law. You’re supposed to give us breaks,” she said. “St. Joe’s, St. Michaels have them. I was told, by the director of nursing, ‘That’s because they filed lawsuits.’ Is that what we have to do? Do we have to file a lawsuit? I work 12, 13 hours; I’m lucky to drink water.”
According to the Washington State Nurses Association, nurses are entitled to a 15-minute uninterrupted break every four hours, and an additional 30 meal break for every other four hours worked.
Andrew Shoaf, a former night charge nurse who left St. Elizabeth for a MultiCare-run facility last year, said his new job isn’t “perfect”, but, “it’s better… I get a break every day. Every single shift.”
Shoaf said he “left for a variety of reasons — mainly the decision to keep cutting and cutting and cutting” and the numerous other duties nurses had to take on because of a lack of staff, including additional patient loads, some secretarial work, and hospital resource nurse duties.
“It’s too much liability. They’re heaping liability on us,” Shoaf continued. “It’s not safe.”
Patient ratios, Patton and Shoaf said, have gotten as high as six patients to one nurse.
“Right now, I have nurses crying because of the patient load,” Patton said. “They go up to 1-to-6 quite frequently… it has gotten worse.”
According to a 2002 Journal of the American Medical Association study, “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction”, the odds of a patient death increase by 7% for each additional patient a nurse takes on. Additionally, hospitals with a 1:8 nurse-patient ration experience five additional deaths per 1,000 people than a 1:4 ratio.
According to St. Elizabeth’s 2021 Nurse Staffing Plan, submitted to the Washington state Department of Health, acute care aims to have a nurse-patient ratio between 1:2 and 1:3, depending on the number of patients.
For the Emergency Department, the nurse-patient ratio goal is about 1:4.5.
This issue was supposedly addressed when the nurses picketed back in 2019 and a contract agreed to in early 2020, when Virginia Mason Franciscan Health said it would commit to safer staffing.
“In our 2020 contract, St. Elizabeth administration made a commitment to follow the law and staff safely. This contract was settled pre-pandemic – things have only gotten worse. Staffing is at a critical level and VMFH has made wholly inadequate efforts to uphold their commitment from our previous contract,” said Jane Hopkins, President of SEIU Healthcare 1199NW in a prepared statement. “VMFH is derelict in its statutory obligation to have a devoted committee to address complaints regarding staffing and instead designates just 15 minutes to review such complaints in a general administrative committee. We are seeking a legitimate committee process and accountability in our current negotiations with the hospital. Staffing is only going to get worse unless VMFH makes a serious investment in their workforce.”
Between the lack of breaks and high nurse-patient ratio, Patton and Shoaf said mistakes are more likely to be made, putting patient lives at risk.
“Med errors go up, when you have tired nurses,” Patton said.
“You add on more and more workloads to people, things are more likely to be missed, safety incidents are more likely to happen,” Shoaf added later.
OTHER ISSUES — ICU, TRAVELERS, AND PAY
Another safety issue Patton pointed out is a lack of ICU staff.
“Some days we don’t have ICU nurses. God help us if somebody codes,” Patton said. “That has happened a couple of times — thankfully we’ve had people with ICU experience there to pull it all together before we could transfer them out.”
And if there is staff, it’s not always local nurses; Patton added that some shifts are only staffed with travel nurses.
That’s an issue of its own, Shoaf said.
“They’re not invested in the hospital… they’re a necessary stopgap measure when you have to have the staff,” he continued. “But they cost more; they’re not invested in the long-term health at the hospital. They’re here to fulfill a job and leave.”
According to Patton, the hospital has to hire traveling nurses because permanent staff can’t afford to work at St. Elizabeth on the wages being offered.
“They refuse to give us what other Franciscan hospitals make,” she said. “People apply, but then when they find out how much they’re going to make, they don’t accept the position.”
Grace Drechsel, communications specialist with SEIU Healthcare 1199NW, said nurses at St. Michael, St. Joseph, and Virginia Mason hospitals (all run by Virginia Mason Franciscan Health) make between 12% and 15% more in minimum, middle, and maximum pay.
Shoaf said he received a $20,000 signing bonus when he left for MultiCare and a pay raise, even though he’s now working far less than he did for Virginia Mason Franciscan Health.
But the nurses at St. Elizabeth don’t want to leave for a larger paycheck, Patton said.
“We can work anywhere we want — we choose to work in this community because we want to serve the community,” she continued. “Every single person out here is fighting to stay here, and they’re trying to push us out.”
Renee Espinosa, Vice President, Operations and Chief Operating Officer at St. Elizabeth, denies that nurses don’t receive breaks; says that the nurse-patient ratio in the ICU is 1:2, 1:3 to 1:4 in the progressive care unit, and 1:5 medical surgical department (“If we’re experiencing higher patient volumes, nurses may care for up to six patients, but in those instances additional clinical support is available to support patients as needed”); and says all clinic units are always staffed.
“Our registered nurses are crucial to providing high-quality care to our communities. We respect the collective bargaining process and leadership is committed to finalizing a contract that provides competitive wages and benefits that attract and retain the very best. As we, like other hospitals in the state, grapple with staffing challenges, we are already offering incentive pay, bonuses, and training opportunities for our staff. As we move forward with the negotiation process, patients at St. Elizabeth Hospital can expect to receive uninterrupted, high-quality care,” she said in a prepared statement.
IS IT SAFE AT ST. ELIZABETH?
Between the alleged lack of staffing, absence of breaks, high nurse-patient ratio, and low pay, these issues beg the question — is it safe to be treated at St. Elizabeth hospital?
The short answer is yes, but.
“Yes and no. Because I will miss my breaks and lunch to keep you safe,” Patton said. “Every nurse out here will do that for you, because that’s what we do.”