Nurses trying to form a union at Indiana University Health’s Methodist Hospital claim they’ve been short-staffed and short-changing patient care.
The Indiana State Department of Health agrees with them.
Last month, the state agency issued a report on staffing levels at IU Health Methodist, which was prompted by a complaint. IBJ obtained a copy of the report, which has not been made public previously.
The department reviewed staffing levels on two Methodist patient units in December and February, finding that staffing was short 18 out of 23 days on one unit and 14 out of 16 days on the other unit.
The shortages were often only one registered nurse or one nurse technician. But occasionally, the unit was short by two RNs, or two techs, or a combination of nurses and techs.
The Health Department cited IU Health’s own internal policy documents as the standards for staffing levels.
The Health Department also reviewed 10 patients’ medical records. In eight of them it found poor documentation of physicians’ orders and of nurses reporting vital signs results back to physicians. In one instance, a patient was not given a dose of Heparin, a drug to prevent blood clots, until 2½ hours after it was scheduled.
“Based on document review and interview, the facility failed to ensure adequate numbers of licensed and unlicensed personnel were available to meet the needs of patients for 2 of 2 patient units and 8 of 10 patients' medical records reviewed,” Health Department staff members wrote in their March report, issued after conducting their complaint investigation in February.
Health Department officials also interviewed IU Health employees, who said short-staffing had contributed to an increase in patient falls in late-2014 and early-2015, caused medications to be administered late sometimes, and which prevented nurses from turning or bathing all patients as often as they should.
Both IU Health management and the nurses trying to unionize agree there have been staffing issues in recent months. But they disagree on the solution.
Linda Chase, chief nursing officer at Methodist, said the volume of patients at Methodist surged in the second half of 2014. That trend followed a period of high turnover at Methodist, which followed a period of layoffs meant to save money.
But IU Health then hired 452 new nurses at its three downtown hospitals during the six-month period from October until March. Because those nurses go through extensive training before caring for patients on their own, their impact on staffing levels still is yet to be realized, Chase noted in an interview.
“You have to get people trained and up to the level of competency,” Chase said, adding, “We actually started improving our staffing back in 2014.”
IU Health leaders, even before the Health Department’s investigation, set up a process to determine if they should delay transfers of patients from other health care facilities or divert ER patients at Methodist to other facilities. Also, Methodist closed some beds to prevent its staffing levels from declining further.
Methodist is working to reopen all closed beds by July 1, according to the Health Department’s report.
“We very much consider the State Department of Health our partner,” Chase said, noting that the Health Department reports are conducted by people who are themselves nurses or other medical professionals. “It really is a process that works. The collaboration and the education that we get is highly productive.”
But those working to organize a union say the source of the problems with staffing run deeper. They hope a union would give nurses more direct communication, not just with IU Health’s clinical leaders, but with its administrators.
“It’s not like they don’t hear us, but it’s not an equal playing ground,” said Lacie Little, a former nurse who was fired by IU Health last month "in retaliation for her union support," according to a federal complaint filed by the United Steelworkers, the union helping the IU Health nurses to organize. She is now working for the United Stweelworkers to help organize at IU Health. She added, “This is just a new way of communicating with the uppers.”
The union hopes to hold a vote in May.
Beginning this month, the Health Department began monthly audits focused on documentation of nurses’ activities, reporting to physicians and patient falls.