Roy Exum: Erlanger's Poor Staffing Situation

I have never heard of a CRRT but when I found out that such an intensive care machine is used to facilitate a “continuous renal replacement therapy,” I was actually scared that some poor soul in the throes of acute kidney failure at Chattanooga’s Erlanger Hospital could die. Granted, kidney failure in a critically ill patient is a terrible thing but when one nurse is charged with operating two CRRT machines at the same time, the effects of understaffing can indeed be just as lethal.

On Tuesday night last week, a medical ICU nurse alerted me another RN in the unit was tasked with the impossible; since then two different sources have told me to operate one CRRT machine is enough to rattle the nerves of the best ICU nurses – operating two at the same time is “idiotic” (the nicest word that was used.)

Instead of a regular dialysis treatment (3 or 4 hours) the CRRT is rapidly becoming an ICU mainstay because the complex therapy is far gentler with its 24-hour cycle.

Dialysis, of course, is used when our kidneys shut down and cannot naturally cleanse our blood. As anyone might expect the process and the one patient requires close and constant monitoring. As one veteran ICU nurse confided, “That patient is somebody’s husband, dad, golfing partner. You try to block that from your mind,” she said, “until you hear that soft voice: ‘Thank you so much…’”

Since Erlanger’s nursing woes have been brought to light last month, two of the biggest antagonists in a horrifying story of mismanagement and abuse have been removed and the hiring of Rachel Harris over the nurses has meant even more to the weary. But today’s problem is that the patient-nurse ratios may be the worst in the Southeast, with COVID-19 now bearing down even harder.

An Erlanger nurse has just written me about the staffing shortages – knowing others who braved “instant firing and professional blackball” by contacting me but who, instead, exposed some of those who made the vicious threats, and brought Erlanger’s lack-of-caring attitude for those employees who care the most.

* * *

ERLANGER CLOSES FLOOR WITH 32 AWAITING ROOMS

As of this Monday, Erlanger administration has shut down the Central West Wing 7 unit.  This planned shutdown of CWW7 was not because the rooms were not needed.  At the beginning of dayshift on Tuesday, there were 32 holds in the Emergency Department (ED), and 18 of those were intensive care (ICU) holds.  (“Holds” are patients that are admitted and just waiting to go to a bed on the floor.)

There were also other patients in the ED that were being tended to who weren’t necessarily being admitted.  During that time, there were reportedly only 6 RNs, 1 LPN, and 2 Paramedics.  That is definitely far too high of a nurse-to-patient ratio to provide the proper care needed for these patients.

Ratios are often bad in the Emergency Department, but 18 ICU holds cripples the department and makes it next to impossible to provide adequate care to both the ICU patients and the other patients that come in that medical staff is trying to resuscitate and make stable.

Meanwhile, there are perfectly good nurses who have been wrongfully terminated by the previous Chief Nursing Officer (CNO). There have been numerous accounts of experienced nurses being immediately terminated for speaking up against the ridiculously high nurse/patient ratios.  Most of these nurses had excellent nursing care records and had dedicated decades of their lives to Erlanger.  Some of these were the seasoned nurses who taught the new nurses fresh out of nursing school.

Instead of listening to the advice of these nurses who had vast experience working directly with patients on the floor, which was something (the former CNO) hadn’t been able to relate to in years (if ever), she chose to immediately terminate these nurses to make examples of them in an attempt to keep the rest of the staff in line.  This made the nurse-to-patient ratios even higher.  

The higher ratios caused other nurses to quit out of exhaustion and desperation. This snowball effect that the former CNO created has quickly caused Erlanger to be in the worst state that most nurses can ever recall witnessing during their years at the hospital.

A simple solution (and the responsible solution) would be for administration to review the decisions the former CNO made during her last several months at Erlanger, evaluate the records of any employees that she terminated recently, and reinstate those nurses who were wrongfully terminated.

Administration has basically acknowledged that the former CNO was a problem, which is evident by her conveniently-timed “retirement” following the multitudes of public complaints against her by employees who accused her of mistreatment.

If administration realizes there was a problem, and does not review and reinstate those nurses who were fired without even having had write-ups, probations, suspensions, or other courses of disciplinary actions taken before being terminated, then they are being negligent by turning a blind eye to what was taking place. 

Also, administration is, at the same time, doing themselves (and Erlanger as a whole) an injustice by not bringing exceptional nurses back to the floors to lower the nurse/patient ratios in order to provide sufficient patient care.

There was recently a petition circulating to have three nurses from the North Wing 8 unit reinstated.  It had over a hundred signatures from their co-workers (ranging from nurses, doctors, patient care techs, respiratory therapists, and other specialists) who know these nurses, who have no doubt in their nursing abilities, and who want to see justice for them.

Administration should also follow up with nurses who quit since the COVID-19 crisis began, find out why they quit, and encourage them to come back and be “reinstated” without having to wait out a rehire waiting period or repeat orientation (if they haven’t already found other jobs.)

Staffing should be concern ‘Number One’ with Erlanger Administration right now, whatever the cost.  Our patients and our community deserve the safest and most excellent care possible.

* * *