The State of Our Hospital A Report by Registered Nurses at Wilkes-Barre General Hospital Wyoming Valley Nurses Association, a union local of the Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP) December 2018 Table of Contents SUMMARY …………………………………..…………………………………..…………………………………. 2 ISSUES IN DIRECT CARE UNITS …………………………………..………………………………….. 6 ISSUES IN CASE MANAGEMENT …………………………………..………………………………….. 12 STAFFING SOLUTIONS …………………………………..……………………………………………… 13 FINANCIAL REVIEW …………………………………..……………………………………………… 15 FORMATION OF THE COMMONWEALTH HEALTH HOSPITAL SYSTEM..……………………… 17 THE LABOR TRADITION OF NEPA …………………………………..………………………………….. 18 APPENDIX …………………………………..…………………………………..………………………………… 20 Inquiries may be submitted to the northeast Pennsylvania PASNAP office: 2007 Highway 315, Ste. 203 Pittston, PA 18640 Phone: (570) 654-3770 E-Mail: [email protected] & [email protected] THE STATE OF OUR HOSPITAL: A REPORT BY REGISTERED NURSES AT WILKES-BARRE GENERAL HOSPITAL Authored by the Wyoming Valley Nurses Association (WVNA), a union local of the Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP). PASNAP is a union of dedicated nurses and health professionals across Pennsylvania formed in 2000 dedicated to the belief that patients receive the best care when clinical care staff has a strong voice to advocate for both patients and themselves. December 2018 PURPOSE: To highlight ongoing staffing issues and the impact they can have on patient care at Wilkes-Barre General Hospital. This report will discuss economic data and a background on why an investment in adequate staffing is in the interest of area patients, nurses, and the Commonwealth Health hospital system as a whole. Figure 1 - Commonwealth Health System Hospitals SUMMARY: documented hundreds of unsafe staffing situations, that The Commonwealth Health System: the hospital has refused to respond to or even investigate. Wilkes-Barre General Hospital is one of six In March, the Pennsylvania Department of hospitals in the Commonwealth Health System in Labor cited the hospital for 10 violations of Pennsylvania northeast Pennsylvania owned by Tennessee-based Act 102, which bans mandatory overtime for nurses and 2 Community Health Systems (CHS). CHS is the largest other health care workers. for-profit hospital corporation in the United States and Following strikes in April over staffing issues at owned 119 hospitals in July 2018.1 two CHS facilities, First Hospital in Kingston and Moses At the time of purchase by CHS in 2008, Taylor Hospital in Scranton, on May 31, Wilkes-Barre Wyoming Valley Health Systems was the largest General RNs went on strike for one day citing the need employer in Luzerne County and Wilkes-Barre General to properly staff the facility with enough full-time RNs to Hospital was the largest facility within that system. Since maintain an appropriate level of patient care. that time, staffing at the hospital has been under scrutiny At that time, union nurses estimated that the by regulatory agencies, accrediting organizations, and hospital was short-staffed by about 107 full-time nurses. the local union for registered nurses (RNs). In the emergency room alone, the union counted more than 900 unfilled shift vacancies during a six-week 3 Hospital Staffing Concerns: period. In early 2018, as part of ongoing efforts to In July of 2018, WVNA alerted the improve staffing, RNs at the hospital documented several Pennsylvania Trauma Systems Foundation that WBGH serious, persistent staffing issues including illegal forced was not meeting the staffing requirements of its recently overtime, high patient to nurse ratios, and the utilization acquired certification as a Level II Trauma Center. The of expensive agency nurses to fill holes in schedules Trauma Foundation identified several areas of non- across the facility. Insufficient staffing is not a new compliance, which they investigated during a site visit in problem. Over the last several years, nurses have July. Despite being alerted to those issues, the Hospital 1 “CHS to sell two Arkansas hospitals to Little Rock's Baptist Health”, https://www.timesleader.com/news/695598/wb-general-hospital-cited- Modern Healthcare, July 18, 2018 by-state-for-allegedly-forcing-overtime http://www.modernhealthcare.com/article/20180718/NEWS/18071990 5 3 “W-B General nurses say staffing levels at hospital are unsafe”, Times Leader, June 1, 2018 https://www.citizensvoice.com/news/w-b- 2 “WB General Hospital cited by state for allegedly forcing overtime”, general-nurses-say-staffing-levels-at-hospital-are-unsafe-1.2344325 Times Leader, March 8, 2018 2 | P a g e continues to fall short of the requirements of its Trauma Issues in Direct Care Units: certification. While nurse to patient ratios are governed by In response to a large packet of documented internal staffing grids which specify how many nurses patient care and staffing concerns at Wilkes-Barre there should be on each unit for a given number of General Hospital submitted by WVNA in July, patients, there are not enough nurses to meet those Pennsylvania Department of Health (PA DOH) initiated guidelines, and nurses therefore end up with more an unannounced onsite investigation on September 10 patients than are specified by the hospital’s own policy. that concluded September 14. In addition to registered nurses, the staffing grids also The PA DOH found a “systemic nature of non- call for ancillary staff such as nurses’ aides, technicians, compliance with regards to nursing services” citing, and unit secretaries that are in many cases understaffed among other evidence, that management “failed to or absent altogether. This results in bedside RNs being schedule a sufficient number of RNs and/or ancillary responsible for all aspects of their patients’ care, staff on the nursing units for 81 of 148 shifts reviewed.” decreasing clinical care time for each patient. The report found 91 open RN positions and reliance on For example, a nurse may be pulled away from an excessive use of overtime.4 her assignments into a room to monitor a psychiatric Investigators cited the hospital for violations of patient or a patient with a fall risk that could otherwise nineteen state and federal health codes related to patient be monitored by a mental health technician or aide. rights, staffing, and emergency services. The findings Without nursing aides, tasks like bathing, restroom trips, were based on interviews with at least 61 hospital and meals keep RNs from other clinical duties that can employees and multiple patients, as well as review of only be performed by an RN, such as ongoing staffing grids, schedules, and selected medical records. assessment and provision of medications. Without unit Inadequate staffing can spread nurses thin, secretaries, an RN can be overwhelmed with the volume causing a negative impact on patient care. Also in of calls to their unit, clerical duties, paperwork, and November, The Leapfrog Group, an independent hospital trying to reach doctors during their on-call hours. watchdog, gave a “C” grade to Wilkes-Barre General The Pennsylvania Health Care Cost Hospital in their Fall 2018 hospital safety report.5 The Containment Council (PHC4) found in 2016 that the report found performance to be below average on various hospital exceeded expected mortality rates while treating metrics including the rate of some infections, patient heart attack patients with angioplasty and arterial stents, falls, and dangerous bed sores. patients with kidney and urinary tract infections, Even after citations by state agencies and the pneumonia patients, and sepsis patients. May strike, nurses report that the hospital continues to In 2017, PHC4 found that the hospital exceeded force RNs to work beyond their schedule shifts, even expected mortality rates while treating patients with when a hole in the schedule could have been predicted abnormal heartbeats, acute kidney failure, and sepsis. and filled with a full or part-time RN. Safe staffing is part of the solution to saving Nurses continue to propose adding stronger lives. Studies show that every additional patient-per- staffing language to their union contract that would nurse in a Pennsylvania hospital increases that patient’s enable RNs to give meaningful input into overall patient risk of death by 7%.6 Surgical patients in hospitals with care. Unfortunately, hospital management has not agreed 8:1 ratio have a 31% higher risk of death.7 Research from to the RNs’ staffing proposals and contract negotiations other states suggests that short-staffing increases remain ongoing. patients’ risk of death by between 4% and 6%. This risk Meanwhile, staffing legislation modeled after is higher within the first 5 days of admission.8 California that would set minimum staffing levels Higher patient-to-nurse staffing ratios have been remains stalled in the state legislature in Harrisburg. significantly associated with higher rates of hospital mortality9 and with administration of the wrong 4 PA Department of Health findings, November, 2018. 7 Aiken, Sloane, Cimiotti et al, ‘Implications of the California Nurse https://sais.health.pa.gov/commonpoc/content/publiccommonpoc/PDF/ Staffing Mandate for Other States’, Journal of the American Medical PBUB1187050031100L.PDF Association, 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908200/ 5 Leapfrog Hospital Safety Grade report, Fall 2018, http://www.hospitalsafetygrade.org/h/wvhcs-hospital-inc 8 Needleman et al, ‘Nurse Staffing and Inpatient Hospital Mortality’,