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Have staff shortages at Mission meant less care for patients?

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Lilly Knoepp
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Mission Health system has about 600 jobs open online. The hospital says its part of the national labor and nursing shortage while some others say it is management.

Nurses at Mission Hospital have been calling out dangerous levels of staffing shortages since HCA purchased Mission Health System in 2019. Mission says there is a nationwide nursing shortage. 

BPR dug into both sides of the story.

Since the nurses joined the National Nurses United Union in September 2020 calls about unsafe staffing levels have become louder in the form on community actions, federal and state complaints and more.

In October, dozens of nurses gathered outside of Mission Hospital calling for solutions to staffing problems.  A Mission Health spokesperson said at the time she was unaware of any documentation to support any of the union’s staffing shortage claims and said that these claims haven't been reported to Mission leadership beyond the almost 600 nurses positions open across the hospital system.  

Lori Hedrick has been a nurse at Mission Hospital since 2014.  In October, Hedrick posted a photo of a bed covered in Assignment Despite Objection Forms.

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Credit Lori Hedrick
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Lori Hedrick is a member of the union's professional practice committee. She posted this photo of ADOs in October.

“Basically, that means I'm accepting this assignment but it is unsafe. What the nurse has to do to fill out the form is verbally to a supervisor or manager object to the assignment,” said Hedrick.

Hedrick says the 40 forms in the photo were from July to August from one ward. She has the forms because of her position on the union's professional practice committee.

National Nurses United Union can’t share the details of the forms with BPR because of federal HIPPA regulations. The union claims from September to mid-November nurses at Mission filed 103 ADO forms and that all were related to short staffing.

Hedrick explains that when nurses are responsible for too many patients the quality of care drops.

“I can't tell you how many times I've had nurses tell me that they've gotten a patient that didn't eat their breakfast because there was no one available to feed the patients. Along with that, there's the whole problem of patients who are incontinent. And there's nothing pretty about this,” said Hedrick. “There's no pretty way to say this, but when patients are lying in their own feces or urine. That is a pretty undignified for the patient and it doesn't make any caregiver…it just doesn't make anyone feel good.”

In response, Mission points to a recent report from non-profit Leapfrog which gave them a 100 percent score on nurse staffing. They also said they have been working to recruit more nurses. 

In an official statement Mission said, "While Mission Hospital recently received a Grade A from Leapfrog, which included the best possible score of 100 for having enough qualified nurses, we know there is more work to be done. At Mission Health, we are keenly aware of the growing shortage of healthcare workers across our country that has increased through the COVID-19 pandemic. The country’s critical nursing shortage reaches beyond Asheville, as estimates indicate that last year more nurses retired than ever before with an additional 500,000 retirements anticipated by 2022.”

The Leapfrog scores are based on voluntary surveys that is then verified by Leapfrog and federal data.

Erica Mobley is vice president of administration at Leapfrog. She explains the nursing employee score is not based on patient to nurse ratios.

“We are not looking at the number of nurses as it relates to the number of patients,” said Mobley.

Instead, it is based on the nursing qualifications of leadership in a hospital and on training provided to staff.

“For example, is there a nursing leader in the C-suite which signifies that the hospital has really placed a priority on nursing,” said Mobley.

Overall Mobley says that there isn’t good federal data on what patient to nurse ratios are or should be.

“It is not addressed largely because there is not a good national data source on that,” said Mobley.

Mission Health would not confirm its patient to nurse staffing ratios.

Hannah Drummond, chief nurse representative at Mission Hospital, says Mission agreed to safe staffing ratios for all different wards.

“It’s different for every floor across the hospital but the general rule is like on a med surg floor 5 patients per nurse. On step down floors 3 to 4 patients per nurse depending on the area that they are in. In ICU it’s 2:1 or sometimes 1:1,” said Drummond.

But she claims those grids aren’t being upheld during day-to-day operations. 

“I have a friend who works on the trauma floor and they’ve been taking seven patients at night.  And the grid that trauma care has says that they should have no more than 5 [patients],” said Drummond.  

These unsafe conditions are why nurses file ADO forms, says Drummond.

In November, National Nurses United said they didn’t know if Mission had a process to review the ADO complaints. Hedrick and Drummond say that the ADO forms were given to management and discussed as part of the staffing committee which was created in September.

According to National Nurses Union in September and October Mission said in a staffing meeting with management that they did not have a system in place to review the ADOs.

Mission told BPR in December that the staffing forms such as ADOs are reviewed by the advisory staffing committee.

Beyond internal complaints, official complaints have also been filed.

There were complaints filed with the North Carolina Department of Health and Human Services, which found no rule violations. There were also complaints filed with the state Department of Labor. That investigation is still on-going. All complaints are confidential so the topics of the complaints cannot be shared.

Mission also points to The Joint Commission’s accreditation as proof of acceptable staffing. None of the private company's measures were below the target value/range for safety in 2019 or 2020.

Most recently, The Joint Commission was on-site at Mission Hospital on October 22, 2021. This survey is currently under review.

For Lori Hedrick, short staffing and the nursing shortage are related – but not in the way that you might think.

“When nurses cannot provide quality care to their patients, they want to get out of nursing because it's demoralizing to us, as well as, the patients,” said Hedrick. “There's plenty of nurses out there. We could get them back in the field if we improved the entire nurse patient ratio.”

The National Nurses United Union has been working on a federal law for staffing ratios for a long time.  The Union is currently working on a federal mandate.  

Lilly Knoepp serves as BPR’s first fulltime reporter covering Western North Carolina. She is a native of Franklin, NC who returns to WNC after serving as the assistant editor of Women@Forbes and digital producer of the Forbes podcast network. She holds a master’s degree in international journalism from the City University of New York and earned a double major from UNC-Chapel Hill in religious studies and political science.
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