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.

Nurses and supporters protest staffing at Mission Hospital in Asheville // Watchdog photo by Barbara Durr

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.

Nurses at Mission file forms documenting what they consider unsafe working conditions.

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.

An excerpt from a safety complaint filed by nurses at Mission Hospital // Asheville Watchdog

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 bdurr@avlwatchdog.org. 

17 replies on “Year in Review: Overworked Nurses Say Patient Care Suffers”

  1. As as recent patient at Mission I witnessed first hand how overwhelmed the nursing staff actually is. My mother and sister are both long-term Registered Nurses and I worked as a patient attendant many years ago, myself, so I’m even more aware than most people of what comprises quality health care. Mission hospital, Under HCA, has turned that concept into a bad joke.
    This isn’t complicated. The very concept of “for-profit” health care is an oxymoronic disgrace, one more glaring example of capitalism run amok. Just how long will we put up with this criminal behavior before we do whatever it takes to return to the basic level of human kindness that nurses are trained to administer?
    Travel nurses are paid far more than staff nurses under HCA policy. Think about that? How stupid can HCA be? They’ve also been a publicly owned company since 1992, and I can promise you they pay more attention to their stock holders than they do their nursing staff.
    This is all so wrong…

  2. What is Josh Stein doing about this? I keep hearing he has been sent complaints and evidence and yet I do not see him doing anything to push to have this situation improved. Has HCA bought him too?

  3. I was recently at mission for 8days andv7 nites of pure misery. Bad enough trying to recover from major surgery, without having nurses who didn’t care. I asked my nurses how many patients they had…only 4 ..you can’t take care of 4 patients??? And they want better conditions? I left there with a UTI, I could call the nurses desk,and they would literally pick up and then hang up on you. Guess the nurses was too busy to answer call bells. From what I experienced, the nurses were not over worked. I can say the nurses didn’t know what patient care is.. I will go out of state before I ever go back to mission.

  4. I am a registered nurse who recently visited a friend at mission. There were pills in a cup at his bedside. It took me an hour to rustle up help to get him turned and to address his pain. Lunch would not have happened had I not been there to feed him. Dietary simply dropped it and ran evidently. And, yes, his nurse was a travel nurse, getting big bucks, who had to call a Mission nurse to show him out to change out the hand sanitizer dispenser. The travel nurse’s comment: “Now I can be a bit more useful.”

    Oh, and my friend was transferred to a nursing with Mission telling no one where he had gone. When his niece, who is his caretaker but not his power of attorney came to visit and found a stranger in his bed she stood in the hall and hollered for help. They wouldn’t tell her where he was citing HIPPA restrictions. Eventually a staff nurse surreptitiously let her know where he had been sent to

  5. I and my spouse have been to mission several times in the past 20 years for emergency care and surgery, when Mission was a not-for-profit and then as a for-profit. We have no formal or otherwise complaints to make following our experiences.

    1. Your point appears to be that for-profit medicine works, despite the USA spending double any other modern industrialized country on healthcare. More telling is the fact that US health care outcomes rank last among modern societies.
      Your most recent experience at Mission was likely the result of highly committed nurses and good luck.
      Apart from your satisfaction with your private well-being at Mission, there are cruel financial and health consequences for individuals, families, and businesses you do not address. Those destructive outcomes are not fabricated or simply the whining of irresponsible people (including nurses).
      There are currently three suits by cities and individuals pending against HCA in federal courts for violations of NC anti-competitive business practices statues.
      The consolidation of the medical industrial complex by private equity funds eliminates competition; the result of no competition is always higher prices and poor service.
      As a native North Carolinian, the most telling occurence is the successful establishment of a union in one of the nation’s most anti-union states.

      1. I previously stated:

        “I and my spouse have been to mission several times in the past 20 years for emergency care and surgery, when Mission was a not-for-profit and then as a for-profit. We have no formal or otherwise complaints to make following our experiences.”

        I still stand by my earlier statement because it is true. If we have not had any bad experiences to-date, what would you have me do, make something up, or pile on to someone else’s experience?

  6. How sad for all residents and retirees who counted on good health care at Mission. Health Care is one of the leading drivers
    in choosing where to retire. All of us who came believing that we would have a good hospital to count on as we age have had the rug pulled out from under us. One friend in his 70’s who recently relocated to the area chose Hendersonville over Asheville because Pardee is a far superior hospital to Mission.
    Word spreads. I met a young nurse while visiting a remote area of Maine. She said she had wanted to move to Asheville but had heard terrible reports about Mission and would not consider working there. Multiply these two individuals over and over and the results are a big negative for Asheville remaining a vibrant and growing community. What can be done here?

  7. This organization needs to be returned to nonprofit status with an honest administration or all of the extravagant advertising for Asheville will not matter. The area’s housing shortage may turn to a housing glut when those who value good healthcare leave the area. That will be my #1 reason when I move (not if). I recently spent time at the bedside of a good friend on a medical unit. Call bells were not answered for 45 minutes or more because there is only 1 RN for too many patients. Most were travelers. All were doing their best. I observed only one less than positive experience. The RNs were the ones assisting with ADL’s, bathing, assisting with the bathroom, changing beds, nightly routines, etc.. The only thing I noticed CNA’s doing most of the time was taking vitals. How is that cost effective? Housekeeping only emptied the trash. There was no wiping down of surfaces or mopping floors, the floors were sticky! Infection Control?? I asked why there was no basin for my friend to use to brush her teeth since she could not get out of bed and was told “you have to ask for that.” I question that a physician actually laid eyes on my friend daily but I did verify they were documenting daily. Many of the hospitalists are travelers. I suspect care in more “profitable” areas of the facility (i.e. surgical) may be to a different standard. If so, that is unfortunate. Where is JCAHO and the NCDHHS?
    I recently asked friends I had worked with at Mission 20 years ago for physician referrals. They all said unanimously “don’t go to Mission.” Entire surgical practices will not perform procedures there. I have been around healthcare my entire life. My mother was a nurse anesthetist, my sister a nurse, and I have worked in healthcare for 40 years. I am both sad and incredulous. The community also needs to stay aware of exactly how the Dogwood Health Trust is spending money and hold them accountable. An old adage rings true .. “When something doesn’t make sense, follow the money.”

    1. You were likely a valuable patient. Some are profitable; some are not. See the research by the late Professor Uwe Reinhardt of Princeton in his book, “Priced Out”.

  8. We drive nine hours round trip to Duke for anything other than a minor doc-in-the-box issue. We had a series of operations at Mission and the care was indifferent, scatter-shot, etc. At Duke we are in another world, of first-world medical care. Our after-the-hospital satisfaction surveys to Duke say that there wasn’t a person in our hospital room, from surgeon down to housekeeper emptying trash, who didn’t make eye contact, offer to help, etc. We had nursing staff who were off their shift or were by on another day who stopped in to say hello and ask how we are doing. Going to Mission is like going to third-world hospital care.

  9. The unionization has handcuffed administration in a lot of ways and the NATIONAL shortage of nurses chasing traveler pay is the main issue at Mission, not administrators or the “evil, for profit” HCA. Ask any local hospital workers about the nursing shortage, it’s no better elsewhere.

  10. We have lived in Asheville for a year. In this year, my husband has had 3 surgeries. He is considered challenging because of his “issues”. I heard of all the staffing problems at Mission and we were concerned but all 3 times he had excellent care! Nurses and were very responsive and caring as were the surgeons. We have been very pleased. FYI travel nurses get higher pay because they do not get any benefits.

  11. I was hospitalized at Mission for a week recently. I was in the hallway of the ER from Monday afternoon until Tuesday night until they had a bed. My nurses were attentive and caring; but I had to ask my son to bring Kleenex, toilet paper, wash cloths and a towel. One of my nurses was upset when he realized I did not have any pillowcases and was sleeping on a pillow without one. Housekeeping came in only to empty the trash. (In 2020 my mother was hospitalized, also for a week; I was allowed to stay throughout the day; she had a roll of bloody gauze in her sink which was there when she was brought into the room. I called attention to it but finally put on a pair of gloves and removed it myself the next day. They brought her a hamburger and fries for dinner three nights in a row. I changed her bed pads myself; she had one of the new catheters that leaked if she moved. There were multiple times I called for a CNA or nurse; long waiting periods where no one came and I did what I could–a CNA asked me to help lift her, as she was short handed, but I had a back injury that kept me from doing that–me changing her pads was hard enough. One night (visitors had to leave at eight) I was leaving but she needed changing; finally a CNA came in and apologized, as she was in charge of the entire side. They were short staffed for the overnight hours but I couldn’t stay. I felt terrible leaving her.
    Not just housekeeping and nursing staff, but chaplains are in short supply. I also saw a PT once the week I was there despite the need for therapy (got home recommendations were three times a week for an hour.)
    I grew up in Asheville and I can tell you, the Mission I remember and experienced, not just me but other family members, was not at all like the one I have experienced lately. All hospitals have rough days and shifts, but it is consistency that counts. My nurses were attentive and caring, but I could tell they were stressed. I wonder how many of them will stay.

  12. The hospital needs to use the name HCA so people don’t confuse the current hospital as the caring patient focused hospital (Mission) it used to be before the underhanded takeover of a for profit organization. Sadly many retirees came to the Asheville area because of the reputation Mission/St. Joseph’s and are stuck here until they die from medical malpractice under HCA management.

  13. My mother was in mission in August 2022…she was admitted and could walk and talk ….I never left her side …the nurses expected me to do everything….almost impossible to get a gone to answer the bell…but to me, the worse part was her admitting Dr. I’ve never experienced anytime him….Tom all her pain/anxiety medication away from her….the meds that she had been taking for years….some that wod cause withdrawal….gave her medication that could have killed her instantly if given to her with a low blood pressure ..thank God that a traveling nurse explained that to me the night before they released her…it was a nightmare…..she never walked again and a few weeks later her heart Dr called in hospice and I lost her a month later. Now I am not accusing anyone for her death….but I fully feel that her lack of treatment for what was wrong certainly brought it in much earlier! I’ve since gone through her medical records from that trip and have recovered a letter that that Dr. Put in her chart that gave me the chills….it is unreal of the out and out “LIES” he wrote in that letter. I will at later time turn it over to a lawyer…..right now I’m grieving for the loss for the best Mother that God could have ever given me….but, eventually, I will make this letter public….I, nor anyone in my family, will never go to that hospital again. It used to be a wonderful, caring, hospital. Those days are long gone …it is now nothing but a money maker for the HCA group to line their pockets with! MaY God bless anyone that has to go there……

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