Roy Exum
With the cloud of “union oversight” now dark on Erlanger Hospital’s horizon and the turnover of nurses at the hospital peaking due to consistent managerial abuse, literally double caseloads, and declining benefits, there are many longtime hospital nurses who are past being fed up, and believe me on this, my emails have tripled from nurses begging for help. I have nothing to do with it, other than to open light on the dark secret that our Level 1 trauma center is on the brink of being unsafe for human beings.
That’s right: It will come as no surprise, except to the hospital’s bumbling Board of Trustees, when state and federal oversight for our biggest public hospital soon steps in and blows the whistle on a swirling circus unprecedented in the hospital’s history.
Top doctors are leaving with a flood of the best nurses. Management just ganged up on the in-house doctors – the hospitalists -- and they are getting ready to bolt like a herd of wild elephants. Worse, the hospital’s fiscal year ends June 30 and get ready for a report that will resemble the Wuhan flu on its worst day, with the bloodiest damage to be found under the subset line: pensions.
Several weeks ago I revealed the hospital is in chaos and, despite the Board of Trustees labeling me “a gossip columnist” and immediately giving a grossly-inadequate CEO Will Jackson a now somewhat bogus unanimous approval, Erlanger has sagged further south in just two weeks. Three of the best floor nurses in the hospital, each with over a decade of meritorious service, have just been castigated and fired because they refused to take charge of a floor assignment because it was too darn dangerous. They fear that soon one of Erlanger’s tightly-woven nursing family will kill a patient due to unforgivable and horrid under-staffing.
On the Saturday night the three who stood up to horrible management reported for work, the patient-nurse ratio was 1:8, which is exactly twice what pending federal legislation will allow. There are documented cases where Erlanger’s ICU ratio has been as high as 1:5, when a web search can find no exception higher than 1:2 and that’s rare – every source from the American Medical Association to various hospital standards is staunchly 1:1.
According to several studies, the third-leading cause of death in the United States is “preventable death caused by medical error.” The most conservative number is about 700 per day. Yearly figures range from 250,000 to 400,000 and a white paper recently obtained from United Nurses United reads: “Nurses have witnessed preventable death and disability daily at their patients’ bedsides in hospitals big and small from coast to coast. Despite these warnings, hospitalized patients remain at risk and the consequences are alarming. The long-held perception of nurses that there simply are not enough nurses present to provide the care needed has been validated by dozens of studies.”
The same nurses’ group gives these acceptable inpatient ratios: Medical/Surgical 1:4 (like Erlanger’s West Wing 8, where tonight it will be 1:8); Emergency room 1:3 (where at Erlanger tonight it will again be double, two nights ago it was triple); Coronary Care 1:2 (at Erlanger is either 1:5 or 1:6); Acute Respiratory Care 1:2 (at Erlanger it is 16:2), and on and on the great disparity goes.
According to one floor nurse on the condition of anonymity, “The nurses that were fired were from the 8th floor. I am sure you've read the article about the Erlanger Union hopefully being formed. It stemmed from that situation. Do you know what Jan Keys did for the nurses who stayed on shift and took NINE patients each? She gave them a $25 gift card. She didn't take patients. Honestly, she's been away from bedside too long, she wouldn't know what to do. That was the best she could do at that point? A $25 gift card?”
How does under-staffing continue? “Many nurses continue to turn in their notice. Before COVID happened, staffing issues were already beginning to be a problem,” the nurse answered. “I remember overhearing a nurse director crying to Jan Keys in the director's office, asking Jan to not force her to have her staff do team nursing, taking 12 patients to a team. Jan said that was how it was going to be and she (the director) needed to follow suit. Team nursing was Jan's idea of resolving the short staff issue; a "new" nurse matrix to hide the fact that we (the hospital) needed more nurses.
“The staffing issue has not been fixed yet and it continues to get worse as people leave. There was a time last week where there was just one nurse and one tech for seven patients. It wasn't an ICU or med-surg floor, I think it was Estar or something like that,” she said. “But I am sure you can imagine the dangers of only having two people in an isolated area. There are some shifts where there are no patient care techs, so the nurse has to do all the nurse care and the patient care. I never have a problem with that, unless I have seven patients and they all require total care; I can't get it all done myself. It’s impossible. Unfortunately, this happens often.”
Jan Keys, the administrator who is over nursing and the emergency room, is the focal point of a half-dozen nurses who have told me, “Jan Keys, Ted Nelson, Angie Basham all claim to know what it is like at bedside, they say they support nurses, but during any of this crisis, no one has ever seen our fearless leaders taking patients, only scolding staff for not team nursing and telling their directors to take patients.”
Is one area harder than the other? I mean, should harder work areas have more nurses than others? “Nurses are forced from their home units to fill the needs of other units. A kind of "borrowing from Peter to pay Paul" type theory. Sure, nursing is nursing, shouldn't be a problem, right? But if all your nursing career you've been a cardiac nurse and you put that cardiac nurse on an ortho floor, do you not think that cardiac nurse is going to feel overwhelmed and "thrown to the wolves"?” she said realistically.
“One of the hardest places I have rotated to has to be the stroke unit. Almost all of those patients are total care (they cannot move half their body because of a stroke, require help eating, need to be turned frequently so they don't get pressure ulcers, and even try to escape bed and accidentally fall because they forget they can't walk because of their stroke). Having seven to eight of these types of patients makes for a really, really hard shift. (The national recommendation is 3:1, with the “1” being a full RN.)
“I worked on the cardiac floor the other week and had five patients (usually it's a 4:1 or 3:1 ratio) and I had a patient with a blood pressure that just wouldn't stay within the defined limits set by the doctor. She kept me so busy that I didn't have much time for other patients. This unit shouldn't be more than 4:1 ratio, yet we don't have the staff to tend to the units properly.”
How can you not fault any of your colleagues from walking away? I mean, really, I asked incredulously. “I’m trying to make this too simple … and I apologize. But we need you to let the hospital know, to let the Trustees know, to let our legislators know … “ and then she told me a story …
“Do you know how much this can eat at a person? Knowing you are entirely responsible for another life, but you don't have time for it? And to watch them decline because you were late on meds or because you missed something due to being overwhelmed. In 2015 we were at an 8:1 ratio. It was bad then, too.
“It was after Erlanger dismissed the travel nurses and we didn't have LPN's... We only had one PCT (patient care tech) for the unit and she was busy in another room. It was later in the shift and I had finally gotten to sit down to chart; a patient called out for the bathroom and luckily for her, the PCT was too busy so I was forced to go into the room. I hadn't been there in a while honestly. I know, it's neglect on my part, but I had just discharged my fourth patient and admitted one, I was trying so hard to keep up.
“The patient that had to go to the bathroom suddenly wasn't moving her left side. I called a ‘rapid’ and she was taken to have a thrombectomy. She was lucky. I was lucky. I went home and cried that night. She could have been left paralyzed for life if I had not gone in there in time, if I hadn't heard the call light go off, or if I was still in another room doing an admission or discharge... it would have been my fault for not catching it. This was five years ago, and it still eats at me.
“I know this happens to other nurses in different hospitals on different shifts in different units. Nurse shortage is not a new thing. I just find it shocking how Erlanger's nurse management has decided to handle it.
“The nurse executives such as Jan, Ted, and Angie seem to have created a nurse witch hunt. They look for any opposing party and try to silence them. I heard that of the nurse directors on the med-surg floors, one is pretty vocal about her staffs' needs and the needs of patients, and the nurse leaders have been trying to dismiss her for quite some time. While I know I can't prove this, it has been talked about on several different units and I pray it's not true because this nurse director is incredible.
“I have taken patients with her before she became director, and even after she became director. She has worked many night shifts when she first took her position because night shift was short, and she would still come in the following day to do her management duty. She has taken patients way before the nurse executives told her she HAD to. She advocates for her staff and for the patients. It would be a shame to watch these terrible nurse administrators push out another incredible nurse and leader.”
So, we have an axis of three who have created utter pandemonium in Will Jackson’s historic nine-month road to ruin. “I don’t have a problem with Dr. Jackson, but in the years I have been here, nothing can compare to how bad it is for every nurse in this hospital.
“I don't want this information to scare off new nurses. We need nurses. We (nursing staff) are an incredibly tight network of people, and soon everyone in Chattanooga will see that as we begin to fight back against the leaders who don't support us.
“I honestly believe if Ted, Angie, and Jan were cycled out, and the nursing voice could finally be heard (and acknowledged), we could go back to taking care of patients. I am proud of the voices that have spoken against the current situation we are in. I cannot wait until the entirety of the hospital, especially Ted, Angie, and Jan see that we are #Erlangerstrong and are a proud #Erlangernurse and we don't need or want them as our leaders anymore.”
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This from another email: “What I don't get is why the hospitalist group is having to pay back their PTO they used over the past five years. Supposedly Erlanger 'overpaid' the hospitalist group for their PTO and because of this, they're requiring the doctors to pay it back, and the doctors suddenly have to decide if they want to do it in one lump sum or over a pay period, and this decision had to be made within a month of being told there was an 'error'. How is it that a five-year mistake only gets a one-month thought process time for doctors? You can expect to see a doctor shortage at Erlanger soon, too, at least in the Hospitalist department, because as far as I know, no other specialty or group is having to pay back anything.” I promise. This has become an out-and-out circus and Will Jackson has been the CEO for what? Just nine months?
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Erlanger spent millions, many millions, for a state of the art Epic computer system but something seems amiss. I have five personal medical providers who are each my trusted-and-true doctors at Erlanger. When I tried to send several some blood work results last week my emails were immediately returned as “undeliverable.” A day or two later I returned an appointment email to my orthopedic doctor, Mark Freeman, and it was immediately bounced back, “undeliverable.” Not long ago I sent Mark a copy of a book he might like. It was returned by the postal service marked “Not known – Return to Sender.” I need to see my blood specialist, hematologist Harsha Vardhana (who may be the kindest man I have ever known) and – lo and behold – same thing – “undeliverable.”
Do you think I have been blocked? I don’t know if I can bear it. I am so over wrought, this shrine of patient care that would turn its somewhat childish back on me as an “undeliverable” in this time of “unessentials.” Hilary Clinton informed me some time ago I was a “deplorable.” I can handle that but an “undeliverable?” Oh mercy, I may just die! (a pun is a pun, even on the kindergarten playground). So, how do I get a “thank you … and happily ever after” to my wonderful healers? Through a florist cleverly concealed inside some bouquet? I’ll come up with something and I’ll make do.
Never expend your tears on those who already cry …
royexum@aol.com