Richie Tiamzon, RN

St. Joseph’s Tacoma is the flagship hospital of CHI Franciscan, the vanguard that is supposed to lead the way for other hospi­tals. Google St Joseph Medical Center and that is the first result. FLAGSHIP.” Why doesn’t it feel that way?

We are a trauma II center, a certi­fied stroke care facility, an AHA recog­nized quick response team for NSTEMI/STEMI inter­ven­tion, a facility whose CTS surgeons have received numerous accolades, a recog­nized leading cancer treat­ment facility, birthing center, an expanded NICU. You name it, we have it. SJMC nurses know this because on our shifts we see patients routed from every other hospital in the region for consults with our special­ized teams on TOP of serving our local commu­nity, adding to our critical surge capacity.

Nurses are the backbone of this care. I recog­nize the neces­sary and hard work of our staff and services at the hospital, but at the end of the day (and night) it is us that spend the majority of time with patients. This is reflected in patient satis­fac­tion surveys: 9/10 HCAHPS questions pertain to a patient’s percep­tion of respon­si­bil­i­ties fulfilled by nurses.

I have worked at St Joseph Medical Center for 4 and a half years now. In that time I have seen Franciscan Health rebrand to include its parent company, CHI. I have seen it affil­iate with Virginia Mason. I have seen it merge with Dignity Health, turning into a $29 billion dollar national company dubbed Common Spirit.” 

On paper and in the media CHI always pushes that we are achieving excel­lence in safety, quality, and patient care.” Are we? Maybe according to metrics and numbers deliv­ered to our execu­tives we are.

"... in our flagship hospital over 4.5 years, I have seen a crumbling infrastructure in my own small corner of the hospital (PCU and critical care) held up on the backs of nurses stepping up to provide higher quality care under worsening staffing/resource conditions."

Meanwhile in our flagship hospital over 4.5 years, I have seen a crumbling infra­struc­ture in my own small corner of the hospital (PCU and critical care) held up on the backs of nurses stepping up to provide higher quality care under worsening staffing/​resource conditions.

Here’s an example of what I mean – in 2016, when the company decided on budget cuts, we lost some of our care assis­tants and had to change our staffing model. In short, care assis­tants were reduced to an unaccept­able level. Patient safety issues increased (for a while), but it’s in our nature as nurses to provide excel­lent care even under the worst circumstances. 

When the company pulled the rug from under us, we didn’t just whine and complain about our condi­tions; we had no choice but to be better or people would die. We nurses stepped up and found a way to fill missing roles and take more respon­si­bility on our shoul­ders while the company enjoyed its savings and didn’t see much of a change in patient safety/​patient outcome numbers on paper due to our diligence and sacri­fice. But did we see any concrete changes to support such a drastic shift in patient safety and outcomes? No.

Over the past years, to supple­ment max capacity of our hospital, we have intro­duced a higher rate of surging” in critical care, with my unit in PCU taking a 4:1 patient-to-nurse ratio; 5th and 6th floor especially have seen an adoption of a 2 and 1 nurse/​care assis­tant model to take care of 8 patients on their respec­tive quads. Though we have been told that this is not the usual care model, many of us in critical care have felt for consec­u­tive shifts — and weeks to months at times — that it has become the new standard. Assign­ments are balanced as best as possible so PCU nurses taking a 4:1 assign­ment see a lesser acuity. Is that always the case? No. There have been plenty of times that 4:1 assign­ment ends up having just as high acuity patients as you would when taking 3:1 critical patients.

"We are asked to do more with less and once again nurses find a way to band-aid these issues and spread ourselves even more thin in order to save our patients’ lives."

Our resources and staffing are reduced for dollars saved on a spread­sheet. We are asked to do more with less and once again nurses find a way to band-aid these issues and spread ourselves even more thin in order to save our patients’ lives.

On night shift there have been times when in the first few hours we have not had a charge nurse nor a care assis­tant. There are nights where there is only one charge nurse for all 3 critical care floors. During a day shift where I picked up a SWAT shift to stay over for 4 hours, I was told that aside from me being a resource nurse for that measly 4 hours there was liter­ally only ONE charge nurse avail­able in the hospital because all the other nurses had been pulled. One charge nurse in a 366-bed hospital? How is that even a possibility?

In 4 and a half years on night shift in critical care, I’ve seen not only my unit, but other units turn over almost their entire staff of nurses at rates I’ve never seen before. This is directly attrib­ut­able to the stress and burnout compounded by the increasing respon­si­bility placed on our backs. I have seen the smartest, sharpest, most compas­sionate nurses leave their positions for somewhere else. They realized not only how under­valued they are by the company, but also how if ever we take one step forward as a nursing team (inclu­sive of our direct nursing managers fighting for better condi­tions against upper manage­ment), the company often takes 3 steps backwards and tests the limits of its personnel, who are taking on higher respon­si­bility while still matching patient outcomes and revenue. You can see the stress in our turnover. In a lot of our units around the hospital, 1 – 2 years is becoming the standard to become a senior” nurse because once residency contracts are fulfilled, our smart/​battle hardened nurses look elsewhere for better pay, benefits, and respect.

Truly what has been holding us together all this time is the camaraderie and respect we have for each other as nurses, fighting along­side one another in the trenches daily to improve patient outcomes and safety with what few resources we have.

How much more do we have to sacri­fice person­ally, emotion­ally and physi­cally, how many more respon­si­bil­i­ties need to be tacked on in fine print under our RN lettering on our badge, how many GREAT nurses have and will continue to leave if we don’t see real change?

I love hearing from our veteran nurses that this is the most energized our nurses have been about truly effecting change. Why stop the momentum now? 

I agree that ADOs are a step in the right direc­tion. But when our hospital is reaching a breaking point with its nurses taking on so many respon­si­bil­i­ties that the infra­struc­ture as a whole is failing in multiple areas, waiting to build a paper trail over an extended period of time will take too long to fix problems that are immedi­ately causing our best nurses to burn out and/​or leave the hospital for good.

I respect our negoti­a­tion team. I admire the hard work and pressure it takes to sit at the bargaining table and stare down a company that probably feels quite comfort­able looking down at our negotia­tors with the backing of billions of dollars behind them. Turning down a small group of people at a table honestly is probably easy for them.

But our negoti­a­tion team repre­sents all of us at 1,200 nurses strong. Corpo­ra­tions don’t look at individ­uals, small groups of people, or their individual comments. They analyze numbers, metrics, their bottom line, and their public image in the media. We have the power to affect all of these things.

A strike is never off the table in negoti­a­tions in my personal opinion. We should never be afraid to consider this tool as that is what it is: a powerful tool in our arsenal to make a company too large to hear the cries of a few have to recog­nize an overwhelming unified voice 1,200 nurses strong. When a company can’t see past its bottom line and they find it easy to say no to our handful of nurses in a meeting room, it’s time to figura­tively fill that meeting room with 1,200 nurses to show them that the hospital is failing and things need to change.

We are a scary group to piss off, and if we mobilize together, we are a force to behold. The air in that little negoti­a­tion room changes immediately.

Facts are facts.

Nurses are the most trusted profes­sion in America and have been for the last 18 years. Out of 8 of our main hospi­tals for CHI in Washington, SJMC SINGLE-HANDEDLY has been bringing in 25% or more of total revenue for the Pacific North­west region for the past 5 years (if not more). Look at the DOH website; cost and revenue break­down is avail­able for every hospital in the state. SJMC is the largest of all the CHI hospi­tals in the region with the highest bed capacity and nurses under its employ serving all of its sister hospi­tals for specialty care and overflow.

We have the numbers and we have the power to make them ACTUALLY see us. Even a one-day strike would net somewhere near a million dollars of losses as well as further damaging their public image. Do you think our special­ized surgeons would be happy about conducting their regular surgery sched­ules with all unknown strike nurses taking care of their patients? A lot of our money makers for the hospital would grind to a halt. I truly believe that because we are fighting for our patients — for their safety, for their outcomes — and advocating for the much-needed resources to do that one job of saving human lives, the community/​public/​media will back us. Common Spirit is already under the public eye in the media for several lawsuits, and will be even more if its biggest hospital in Washington that is also consis­tently its top money maker brings atten­tion to its nurses desper­ately trying to get the resources to properly take care of patients and save lives. The backlash to their image would be too much.

Make no mistake, Common Spirit has the wallet to support our NEEDED changes. 

"... we're asking for the bare minimum to support ourselves and keep our nurses at this hospital so that we can stop the bleeding and properly support our patients and save their lives without destroying our own."

We’re not being greedy and asking for too much, we’re asking for the bare minimum to support ourselves and keep our nurses at this hospital so that we can stop the bleeding and properly support our patients and save their lives without destroying our own. If they have the money to constantly build brand new hospi­tals across the nation and nation­alize their mission,” they can afford to invest into the infra­struc­ture of their flagship” hospital. We are directly respon­sible for their success in the PNW, it is long overdue that they invested back into us.