Pat Meade, treasurer of the St. Joseph Nurses Association and community liaison worker, with 35 years of hospital experience, told the World Socialist Website Wednesday Monday that a fourth nurse was suspended for defying emergency room orders at Ascension Saint Joseph Medical Center to carry out her duties despite a dangerous staff shortage.
Last Friday, four nurses were escorted off the premises for refusing to work in unsafe conditions. They had explained to managers that they were only ready to “clock in” if management ensured that they had adequate staff. Meade said that means having at least 12 to 14 nurses per shift in the emergency department (ED). That night, only four were affected.
The following day, when three of the nurses returned to take their shifts, they were barred from entering and told they had been suspended pending an investigation. A rally was held outside the ER that evening with around 100 nurses present to support their colleagues.
Hannah Puhr, who was the day shift nurse in the ER that Friday, provided more crucial details in an interview with WJOL, a local news channel on Wednesday. She explained that the day was busy and staffing issues were a chronic problem at Ascension. When they reviewed the night shift nursing assignment, they realized that the night shift had only four nurses scheduled, which included a charge nurse and another nurse who had taken a shift.
“Essentially, there were technically only three nurses to care for the patients. [that night]. It’s ridiculous; absolutely unacceptable. There were 51 patients in the emergency room. There were also about 30 people in the waiting room and the rest were in the main ER side.
She continued, “I felt like we had to do something. I contacted the INA [Illinois Nurses Association] because it was a very dangerous situation; very dangerous. If you could imagine if we had a critical patient or a code, there wouldn’t even be enough nurses to run that code, cardiac arrest, that night. So I spoke to the night shift. They came for their shift. They were willing and ready to work. They were waiting to clock in until management or senior management secured safe staff for their patients.
Puhr added that management simply didn’t care what nurses had to say or listen to nurses’ grievances. And because they didn’t ‘clock in’, security was called, and they were quickly kicked out like criminals or hooligans. The day shift stayed past the end of their shift until management was able to scrounge up about seven people – two nurses from St. Joe’s, two supervisors, a nurse from Kankakee Ascension, a nurse from floor and a nurse manager – before allowing them to leave.
This was deliberate intimidation used to warn nurses that the health care system would not tolerate any dissent from staff. Meade, who attended the rally, admitted she too received a warning from management for being there to support the nurses.
In response to the question of why there were only four planned, she replied: “Is there a shortage, do people not want to work or is the medical center just trying to save money?” problem, with a mass exodus of nurses from St. Joe’s since Ascension took over in 2018.
During our discussion, Meade explained that before the 16-day strike in July 2020, there were approximately 750 nurses. The figure has fallen to 650 and the hospital continues to steadily lose nurses. Retention is bad because nurses are treated badly. “You have agency nurses earning triple your salary next to you. Why don’t they use this money to take care of their nurses? She noted that young nurses don’t stay because they can make an extra eight or ten dollars an hour at another hospital.
She also reported that the hospital was slow to deliver the increases agreed to in the 2020 contract. There have been ongoing problems with the payment of salaries and bonuses. When the payroll system was hacked last year and the healthcare system switched to using paper, it led to major discrepancies that sometimes saw nurses’ salaries seized for an alleged overpayment.
But the staffing issue has been at the heart of nurses’ grievances against the hospital. There have been over 160 Assignment Despite Objection (ADO) forms completed solely on the issue of patient acuity and staffing shortages. An ADO form is a documentation tool used by nurses to object to an unsafe or potentially unsafe patient care assignment.
Puhr said that since the pandemic “there has been a reduction in resources, a steady degradation in the quality of the products that we use to care for our patients. And the market value they now bring to nurses is ten dollars below the Illinois average. I understand this is a common problem all over America… there are few staff, they are busy… I mean, the nurses don’t ask for more money. They ask for appropriate remuneration. We demanded it and we asked for it at the hospital. They continued to refuse to raise wages.
It is a long-standing tenet of the nursing profession that if they believe a patient care assignment is unsafe, they have a legal and professional obligation to inform the healthcare system. The goal is to protect nurses if the health care system does not resolve the situation and an untoward event occurs that causes harm or injury to a patient.
Pat Meade said Friday’s event was not just a spontaneous action by nurses. She thought it stemmed from a similar situation that had happened a few nights before in the Intensive Care Unit (ICU) that served as the triggering event. The previous Tuesday, when the intensive care nurses took their shift, they were assigned three patients instead of two. They protested that these were unsafe conditions and the head nurse intervened to remedy the situation.
But the next day, the number was one nurse for four patients. The situation became unstable and the nurses agreed to accept a one to three assignment. No one was suspended, but the event must have received high-level attention and informed decisions to suspend ER nurses.
Meade explained that the 2020 contract did not incorporate an element of acuity into the terms of the agreement, i.e. a clause specifically requiring safe staffing ratios. And the contract says nurses can’t strike; there is a non-stoppage of work clause. And these rules are in effect until July 2023.
Now management is using the no-strike clause and lack of minimum staffing rules in the 2020 contract as a virtual slave charter, threatening to discipline nurses who refuse to work in extremely dangerous conditions. Many victim nurses have multiple certificates in critical care and trauma. If they accepted their short-staffed assignments, it would mean taking responsibility for any onerous outcomes for the patients they care for.
Meade said the suspended nurses are currently undergoing an “investigation process” where they are sitting down with human resources and nursing administrations to discuss the terms of the contract and the events of the night in question. Meade said one of the 17-year-old nurses at Ascension, who was working seven days a week, ten to 12 hour shifts, to fill in for the reduced staff, started crying, asking “how could they make her that”.
Ascension only offered the following statement to the media obscured in the usual legalistic jargon, saying “Joliet [Ascension Saint Joseph] is committed to working in partnership with nurses while respecting the terms of our employment contracts. In doing so, we conduct a thorough investigation of recent events. However, Timothy Nelson, a spokesman for the health system, said the nurses’ union was engaging in “illegal work stoppages”. He added, “As the hospital faces nursing shortage issues that all hospitals are currently facing, the Illinois Nurses Association (INA) has decided to promote and encourage nurses from the hospital not working their scheduled shifts.”
In truth, the nurses’ decision not to be in unsafe and unsafe conditions was a by-product of the rank-and-file nurses reacting spontaneously to an untenable situation. It was the previous sell-off contracts negotiated with the support of the INA that tied the hands of the nurses and sanctioned disastrous and dangerous understaffing. The health system is now responding by threatening nurses with reprisals to send a message to the grassroots that such action will not be tolerated.
In order not to be isolated and victimized, St. Joe’s healthcare workers must not leave their struggle in the hands of INA bureaucrats. They must come forward and seek the widest possible support from Illinois health care workers, nationally and internationally, who increasingly work under the same intolerable conditions. We encourage nurses and other health care workers to share your stories with the WSWS Health Care Worker Newsletter. Your names will remain confidential.