Editor’s Note: As 2022 comes to a close, Asheville Watchdog staffers take you back and inside their most memorable stories and news events of the year.
When I first wrote about patient complaints at Mission Hospital more than a year ago, it was clear that nurses on the front line were struggling to do their jobs. After that story, I heard from many other patients who told of similar or worse experiences at Mission — long waits for care, patients stashed on gurneys in hallways, pain medicines administered late or not at all, patients waiting hours for assistance to get to the bathroom, and on and on.
It seemed that nurses were bearing the brunt of staffing cutbacks by for-profit HCA Healthcare, which had purchased the nonprofit Mission Health hospital system in February 2019. Since the sale, Mission nurses have unionized and held public rallies highlighting what they described as unsafe staffing levels and declining patient care.
I reached out to the unionized nurses in 2021 to find out what was behind this disturbing trend. Nurses told me of being assigned too many patients — often double or more the recognized standard — making it impossible to deliver the care patients needed. They described going above and beyond their duties to compensate for shortages of other critical positions — Certified Nursing Assistants (CNAs), phlebotomists, housekeeping, and security.
They told me they were documenting what they considered unsafe working conditions on forms created by the union called Assignment Despite Objection (ADO). The ADO forms were shared with nursing managers with the goal that management would address the concerns raised.
As of March 2022, eight months after the union contract was ratified, nurses had filed more than 200 of the forms with hospital management. I asked if they would provide some to Asheville Watchdog so that we could see more precisely how patient care was suffering. The union feared retaliation from hospital management against the nurses who had filed the forms but agreed to a compromise that I suggested: that they redact the nurses’ names and identifying information.
The 45 ADOs provided by the union appeared to raise serious concerns, but I needed confirmation from an outside medical professional. A former RN who had never worked at Mission agreed to review the forms and said she was shocked at what she read.
Mission nurses said they lacked the time even to take vital signs of patients or to administer timely medications. They wrote that understaffed security failed to protect them from violent patients, and that nurse managers were assigning untrained nurses to operate complex equipment.
The forms provided first-hand, valuable input about conditions at Mission Hospital and formed the basis of my March 31 story, “Mission Nurses Overburdened, Patients Suffer.”
In response, HCA denied that patient care had worsened and said that nursing shortages were a nationwide problem. A spokeswoman said Mission was recruiting nurses as quickly as possible, offering signing bonuses and partnering with nursing programs.
Mission, like other hospitals, increasingly relied on traveling nurses, who typically contract for four or 13 weeks and make far more money than staff nurses. But even with the higher compensation, I learned, some traveling nurses at Mission, dismayed at the working conditions, left before their contracts ended or chose not to renew.
It does not appear that much has changed in the nine months since my story. In December, nurses were once again protesting unsafe working conditions at Mission Hospital.
Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Barbara Durr is a former correspondent for The Financial Times of London. Contact her at firstname.lastname@example.org.