Nurses challenge new CHS/HMA monopoly’s misplaced priorities of high charges, cuts in care

Billboard (top) and lawn sign Greenbrier RNs are using to get their message out to the public
 

Registered nurses from Greenbrier Valley Medical Center (GVMC), in Ronceverte, W. Va. are stepping up their campaign to make the public aware of their growing concerns about patient safety in their hospital in the wake of a recent merger, the National Nurses Organizing Committee (NNOC) announced today.

Community Health Systems’ refusal to address nurses’ widespread concerns about patient safety was the driving force that galvanized GVMC RNs to organize and win representation with the NNOC in August of 2012. Since that time, GVMC has been charged with multiple violations of federal law related to nurses’ efforts to advocate for patients and win economic and workplace fairness. Hospital executives have not addressed nurses’ concerns about patient safety issues and cuts in patient services.

Last August, GVMC nurses alerted the public to the attack by CHS of their role as patient advocates. Nurses are now stepping up their campaign by asking residents and businesses in the community to show their support by displaying a sign in their window or on their lawn.

The nurses’ increased concerns center on the recent buyout by CHS of another large, for-profit health system, Health Management Associates (HMA). At a Jan. 8 shareholders meeting convened to vote on the merger in Naples, Fla., Greenbrier RNs joined CHS nurses from around the United States to express their opposition to the buyout.

“CHS/HMA is now the largest hospital chain in the country, controlling 206 hospitals, mostly in rural communities where patients have no other options for hospital care, making small isolated areas like Greenbrier vulnerable to low safety standards and inflated prices,” said Pat Franson, who works in the intensive care unit at the hospital.

Data released by National Nurses United, the national nursing organization to which NNOC is affiliated, earlier this month on hospital pricing practices documented that six of the nine most expensive hospitals in the United States – all setting their prices at 10 times their costs – are operated by either CHS or HMA. Greenbrier has the third-highest charges over costs in West Virginia, setting its charges at on average $358 for every $100 of their costs. Another area CHS hospital, Bluefield Regional Medical Center, ranks fifth highest in West Virginia, setting its costs at $322 for every $100 of costs. Both are well above West Virginia’s statewide average of 248 percent, or $248 for $100 of costs.
 
GVMC made $15 million in profits in 2012.
 
NNU and NNOC say the CHS and HMA hospitals both fit the national profile of setting higher charges as part of a national strategy of operating and acquiring hospitals in small and rural communities where they have little competition. Patients have few alternatives and are faced with high charges or cutbacks in patient services.
 
Patient Safety Issues on the Rise
RNs believe that patient care is compromised by:
 

• Unsafe RN-to-patient staffing ratios throughout a majority of the nursing units
• Unsafe “floating”— requiring nurses to work in units outside their area of expertise
• Lack of essential equipment such as thermometer and blood pressure cuffs
• Staffing critical care and emergency room units with primarily new graduate nurses who lack the skills and expertise to handle complex patients.

 
RNs in the intensive care unit, where the sickest of patients are placed, are routinely assigned three patients, a number considered unsafe. The national standard for ICUs is no more than two patients, ideally one, per RN. The nurses say that the absence of experienced RNs in that unit, coupled with the unsafe nurse-to-patient ratio, poses an ongoing daily risk to patient safety.
 
“On our floor we don’t have enough blood pressure cuffs, IV poles, suction canisters, or staff.  We spend much of our time running from room to room looking for basic equipment which shortchanges the time we need to spend to care for our patients in a safe manner,” said Tara Evans, a Greenbrier RN who works on the general medical-surgical floor. “The priority for nurses is safe patient care, but it seems like the priority for CHS is making as much money as they can.”      
 
“The nurses in my department are regularly sent to work in other units that are short staffed,” said Trish Ridgeway, a Greenbrier RN, who works in the obstetrics unit.  “RNs who are trained to care for women before and after delivery don’t have the expertise to care for patients in critical care, the emergency department, and pediatrics. We need to hire more staff so the people of our community receive the care they deserve.”    
 
Nurses have reported an abnormally high patient fall rate often resulting in injury throughout many units. High fall rates are directly correlated with a lack of adequate number of nurses and support staff. Compared to patients whose nurse had three or fewer patients, studies have shown fall rates to be seven times higher when the nurse had seven or more patients (Lake, E. and Cheung, R. 6, 2006, Western Journal of Nursing Research, Vol. 28.)
 
RNs who work on the third floor medical-surgical units document occasions when nurses on night shift were responsible for the care of 15 patients with the assistance of just one licensed vocational nurse.