Two nurses at Confluence Health describe some of the systemic issues they’ve encountered as new A sub-variant of Omicron reaches hospitals across the country.
When Sarah Morgan Bergenholz started working at Central Washington Hospital five years ago, she saw Confluence Health as the “gold standard” in nurse-to-patient ratios.
“There was a sense of community in the facility and a belief that we were really working for the betterment of our community,” Bergenholtz said.
The nurse to patient ratio depends on the acuity or level of care required of their patients. Depending on which ward a nurse has been assigned to, each nurse will only be allowed a certain maximum number of patients per day.
Bergenholz said compared to last year, nurses in the medical oncology unit will treat a maximum of five patients per day staff and six per night staff, compared to last year’s four patients per day staff and five patients per night staff.
“Right now with our staff, there have been times where the nurses have seen seven patients,” Bergenholtz said. “Which puts us at our previous contingency of crisis staffing levels.”
Paul Stamilio has been a nurse for more than 10 years and said he moved from North Carolina to Washington because of the state’s high medical standards.
It wasn’t until the pandemic hit that both nurses noticed a significant cultural shift in the workplace, with stress, burnout and strained resources further escalating the staffing problem at Confluence and at hospitals across the country.
Stamilio said that since COVID-19 hit, several nurses have decided to leave or retire early, leaving the remaining nurses at Confluence Health to pick up the slack.
According to the US Bureau of Labor Statistics, there are 3.1 million registered nursing jobs nationwide and predicts that 203,200 new jobs will be added each year through 2031 due to nursing retirements or attrition.
According to a COVID-19 impact assessment Research from the American Nurses Foundation and American Nurses Association, 52% of nurses plan to leave their position because of insufficient staffing, work that negatively affects health and well-being, and inability to provide quality care. 60% of critical care nurses report feeling burned out and 75% report feeling stressed, frustrated and exhausted.
“When we go to work and we miss him and it’s a bad day, someone died when they shouldn’t have,” Bergenholz said. “That’s why people leave.”
Last year, both Stamilio and Bergenholz were moved to the emergency room. Since then, both nurses said it’s rare for either of them to have a full lunch break.
After HB 1155 was signed into law, breaks became mandatory and had to be scheduled for every nurse throughout the day, shifting responsibility from nurses to administration.
Although that law goes into effect in 2020, Bergenholtz says the break schedule hasn’t been enforced for some time, and it’s common for nurses to forego their lunch breaks because of the high volume of patients.
In response to low staffing levels, several hospitals began hiring traveling nurses as a short liaison. Yet, as travel nursing agencies offered higher wages and flexible scheduling, many nurses left travel nursing positions.
Average, travel nurses could earn an average salary of $103,695 per year. It was becoming such a lucrative business that the American Health Association he asked federal COVID-19 response team to intervene.
“A system that works well shouldn’t be paying someone $5,000 a week in an intensive care unit in Texas to take care of an unsafe number of patients,” Bergenholz said.
According to Bergenholtz, Confluence Health had to close one of its step-down units, a cardiac unit, due to a lack of travel nurses.
She also shared that in recent contract negotiations with the Washington State Nurses Association (WSNA), Confluence Health agreed to hire a respite nurse, a nurse who will cover for other nurses during their breaks. for one year experience.
But Bergenholz says she hasn’t seen a plan for that.
Stamilio credited the lack of state funding for rural health systems as another obstacle, with most of Confluence Health’s funding coming from private insurance rather than Medicare and Medicaid reimbursements.
Funding is often stifled if hospitals admit patients who are usually harder to discharge.
Bergenholtz says the majority of patients who find it difficult to be discharged are those with advanced dementia, who are inevitably caught in a dead end situation due to the lack of available rooms in long-term care facilities.
“Unfortunately when [a facility] decide someone is too much work for them, they functionally kick them out by sending them to the emergency room and refusing to take them back in,” Bergenholtz said.
There are currently two bills in the 2023 state legislative session that address some of the issues facing nurses.
SB 5236 is a bill proposing to establish minimum hospital staffing standards, requiring hospital staffing committees to develop staffing plans, addressing mandatory overtime, lunch and rest periods, and provide enforcement.
This bill is similar to a set of bills proposed in 2022 Legislative Session, who proposed similar requests. The Washington State Hospital Association opposed the both accounts from last year and this year billstating that this would negatively impact patient access.
The second account is SB 5103which proposes to pay hospitals for difficult-to-discharge Medicaid patients who are waiting in the hospital to be discharged either to a long-term care facility or back to the community.
“However you want health care to be, the fact is that we live in a for-profit system, and if the Legislature doesn’t take that seriously and take care of those who are most vulnerable in our communities, then this problem will continue to are getting worse,” Bergenholz concluded.
Confluence Health declined to comment.