In her nine years as a labor and delivery nurse at Sparrow Hospital in Lansing, Destinee Griffin has called in sick to work just once. She keeps a box of the cards patients have written her, thanking her for helping bring their babies into the world. But over the last 20 months, working conditions and patient care have deteriorated so drastically, she said, that she’s willing to walk off the job if things don’t change.
“It is absolutely a last resort,” Griffin said Thursday. “I honestly hope that leadership and management does not push us for that. I am nervous about what would happen if that happens. But if needed? I will. I will strike if I need to.”
As of Oct. 30, Griffin and some 2,200 Sparrow nurses, pharmacists and other health care workers no longer have a contract. Their union, the Professional Employees Council of Sparrow Hospital - Michigan Nurses Association (PECSH-MNA) has been negotiating with the hospital since the summer. And while both sides have agreed to federal mediation, union leaders said they still haven’t received a deal that addresses “critically low” staffing levels, said nurse and PECSH President Katie Pontifex. That’s pushing them to hold a Nov. 3 “informational” picket.
“If that doesn’t move them, then we will move forward with a strike authorization vote,” Pontifex said. “And we hope that will move them. But we are willing and ready and prepared to do whatever we need to do to ensure the safety of our community.”
But hospital leadership says they’re doing everything they can, amidst rising health care and staffing costs, employee turnover and absences, a cut in insurance payments following Michigan’s auto no-fault law overhaul, and increasing patient volumes.
“I’ve never been in a place where we tried to do as much [for staff],” said Alan Vierling, the president of Sparrow Hospital, on Friday. “We’ve addressed issues from assault by patients on staff, we’ve put in rest[ing] rooms and we’ve done massage chairs, and we’ve given bonuses and we’ve given money, and we’ve made resources available. And we continue to try. And people are tired. People are tired across the country… Is Sparrow any different? I don’t know that.”
Staffing shortages “absolutely” putting patients at risk, workers say
Bitter fights over whether hospitals are doing enough to retain and recruit health care workers aren’t unique to Sparrow. The issues here - like hazard pay, longevity bonuses, health insurance costs, and wages - are being hashed out across the country, as patient volumes and staffing shortages continue to put enormous pressure on an already burned out workforce.
But lately, contract fights have reached a new and unsettling pitch, workers in several health systems say. After 20 months of putting their own lives on the line and bearing witness to pandemic-era levels of death and suffering, now they’re watching an exodus of team members leaving the health care field altogether. And they struggle with what they say has, as a result, become an unsafe level of patient care.
On the medical-surgical inpatient floors, it’s now common for each day shift nurse to have anywhere from five to seven patients to care for at a time, Pontifex said.
“On night shift, we are seeing anywhere from six to nine patients that one nurse at any given time is caring for. … When you do that math, you're not spending more than 10 or 15 minutes with each patient, every four hours. And that leads to the, you know, missing of critical changes within your patient that could delay care for them. You might miss signs of a stroke or a heart attack.”
Overall, Pontifex said, about 10% of the positions at Sparrow are open.
I'm responsible for those people under my care. And when I can't give them the care and attention they need. And if I potentially miss something vital, you know, I take that home with me, and I don't ever want to be responsible for a detrimental outcome for a patient.Nurse and PECSH President Katie Pontifex
‘All of our areas are feeling short,” she said. “We don't have enough … environmental services people, so our facilities aren't getting as clean as they need to be or could be. … We don't have the staff in our departments in order to provide the hands needed to take care of the patients and then the patients suffer because of that. … So it becomes this, you know, domino effect of safety.”
“It weighs very heavy on us, which is why a lot of people are leaving acute care. … I'm responsible for those people under my care. And when I can't give them the care and attention they need. And if I potentially miss something vital, you know, I take that home with me, and I don't ever want to be responsible for a detrimental outcome for a patient.”
For labor and delivery, Griffin said, they were so short-staffed during the summer that they essentially stopped doing elective inductions for women with full-term pregnancies. Even those who needed labor to be induced for medical emergencies often had to wait.
“If we don’t have enough staff to safely do her induction, she will just be there, monitored and basically holding up that space in that bed,” Griffin said. “Every single day, we actually would have sometimes upward of 10 or 15 women that were at home waiting for induction, just waiting for us to call because there wasn't either a bed or a nurse to care for them.”
These shortages are “absolutely” putting moms and babies at risk, she said.
“In obstetric emergencies, you sometimes have minutes to respond to an emergency, and that can be the difference between a lifelong deficit for a neonate [and life-threatening] heavy bleeding [for the mom].”
Registered Nurse Tracie Cullinan, who has worked the last five years in the Mother Baby Center at Sparrow Hospital, said pre-pandemic, most of the women and infants she cared for were healthy.
Now, she said, it’s not unusual to have mothers of newborns who have COVID or other illnesses, which adds more work on top of the already higher patient loads she and other health care workers in her unit are carrying.
“We have COVID patients now that we have to account for, which have higher acuity. So it's definitely putting a strain on my co-workers and I,” she said.
It’s been too much for some of them.
“Nurses are leaving for better opportunities,” she said. “They're leaving for better incentives. So we're not retaining the current experienced staff that we have.
“A lot of our nurses have left to become travel nurses. A lot of nurses are leaving for jobs … out of state or where they can work from home or where they’re not hit as much with the effects of a pandemic. So they're just not feeling appreciated.
Sparrow talks about radical loving care, but we just aren't feeling that. There just hasn't been, really, much of anything done to retain the staff that we have.Registered Nurse Tracie Cullinan
“Sparrow talks about radical loving care, but we just aren't feeling that. There just hasn't been, really, much of anything done to retain the staff that we have.”
She’s willing to strike if it comes to that.
“What's really scary is that we sign a contract for the next three years, and nothing changes,” Cullinan said. “What’s scary is the day-to-day short staffing that we're currently facing. I would really hope that Sparrow doesn't push it to that point, that they agree to a fair contract before we ever get to a strike. But so far, we really haven't seen them moving in the right direction.”
Asked about staff concerns over patient safety in the hospital broadly, and in labor and delivery specifically, Sparrow’s spokesperson released a statement:
“Sparrow is committed to safe nurse staffing to ensure quality experience is delivered throughout our hospital. Like the rest of the country, we continue to address staffing challenges in creative ways to meet the needs of our communities.”
Could the hospital change this? Workers say yes
These shortages can’t just be blamed on changes in the labor market, Pontifex said.
“They're not retaining the experienced staff that they already have right now,” she said. “There is actually not a nursing shortage nationwide. There is a shortage of nurses willing to put themselves in harm's way, by working in an unsafe environment.”
Sparrow could improve retention, she said, by helping workers feel valued: hazard pay. Longevity bonuses. Retention bonuses. Lowering health insurance costs. These simply aren’t happening for their union members, Pontifex said.
In their initial offer to the PECSH-MNA, Sparrow offered a 1% cost of living raise for each year of the contract, Pontifex said. As of Friday, Sparrow increased that offer to a 4% raise for all members, and an additional 3% over the following two years of the contract, said hospital spokesperson John Foren. Combined with an additional 1% raise for workers in certain pay brackets, the health system will spend $15 million in wage increases over the span of the three-year contract, Foren said. Sparrow also has proposed a $1,000 one-time bonus for all full-time workers in the union, as well as $500 for part timers.
But the raise hikes still wouldn’t cover cost of living increases, Pontifex said, pointing to the 5.9% increase in Social Security for 2022. There’s also a 12% rise in health care costs next year and significantly higher premiums, especially for part-time workers whose family members are on their insurance, she said.
But Vierling said health insurance coverage costs are rising for the hospital, and those retention bonuses didn’t come previously because they were heading into new contract negotiations. Plus, he said, generous bonuses were already offered to those willing to pick up additional hours.
“So over a period of eight weeks, they would work one additional shift per week, and two of those would be over weekends. And if they did that, we would give them a $10,000 bonus at the end of that time period.”
“We have really looked at where we are short staffed, and we've tried to add additional staff,” said Sparrow’s Chief Nursing Officer Amy Brown. “We implemented the temporary float pool [of nurses who could be sent to help out wherever there were staff shortages.] The $10,000 opportunity [was available] for part time, per diem, and full time [staff]. We also offer bonuses for people to pick up additional shifts. And then we also had multiple times where we had [travel] agency nurses that are working as well.”
“We lost $5.7 million dollars in September, spent on labor costs above what we would have ordinarily spent, because we’re trying,” Vierling said. Meanwhile, more nurses have been hired, he said, but their orientation period is taking longer than usual because many are fresh out of nursing school — and had to do a portion of that training virtually.
But Vierling and Brown said nurses are calling in sick so much that it’s adding to the shortage problem.
“We had 90,000 hours of nurse call-in time in a period of a year,” Vierling said. “That’s 20 nurses calling in 12 hours a day, every day. And so that does play a role.”
But Pontifex said that’s not fair.
“We are being gaslighted every day about how we don't have a staffing problem, we have a call-in problem. Well, when you tell me that we are 90 nurses down [hospital] wide, and I ask you how many call-ins there are, and they say 20, that’s not call-in problem. That’s an open shift problem. And it’s exacerbated by the fact that you can’t retain your caregivers.”
Sparrow lost $31 million in 2020, Foren said, “and that was after substantial federal relief funds. We’re expect[ing] to post an operating loss for 2021, like a lot of health systems. But that’s some of the bigger context… We have taken some real financial hits, so we’re also negotiating in that climate.”
But arguments over why Sparrow can’t pay more feel hollow, workers say, after the experiences of the pandemic. For Griffin, the labor and delivery nurse, she’s stuck it out even as co-workers leave for higher pay in travel nursing. She wants to work at a hospital where she knows her team, she’s serving her community, and where her family is based, she said.
“It's not like I need an incredible amount of money to keep doing this job. I will go to work every day and give 100%. [But] I just feel like Sparrow does not value me...and looks at me as just another number. If I left, they would be like, ‘Oh, another person left,’ you know? And I know people are feeling that way. When people feel undervalued and not compensated for their work, it is really hard.”
The Detroit Free Press, Bridge Michigan and Michigan Radio have teamed up to report on Michigan hospitals during the coronavirus pandemic. If you work in a Michigan hospital, we would love to hear from you. You can contact Kristen Jordan Shamus at kshamus@freepress.com, Robin Erb at rerb@bridgemi.com or Kate Wells at katwells@umich.edu.
