A nurse with St. Joseph Mercy Hospital in Ann Arbor, Michigan, spoke with the WSWS recently about staffing shortages, deteriorating conditions and low worker morale at the 500-bed facility as the pandemic approaches its third year and surges to new heights in the Great Lakes state. Her words echo those of nurses and health care workers across the country and around the globe as health care systems buckle under the strain of COVID-19.
Danielle is a bedside nurse who has been with St. Joseph for over five years, and she has grown increasingly frustrated with the hospital’s response to the pandemic and mistreatment of its staff. “You’re stressing out people to the point where it’s not safe,” she said.
The most critical issue at Danielle’s hospital, as at hospitals everywhere, is staffing. With hospitals inundated with COVID-19 patients, nurses and other workers are stretched to the breaking point. Asked about staffing levels before the pandemic, Danielle described them as “adequate.”
“You had the potential to go on-call (go home) for the rest of a shift,” she explained. “This happened frequently before COVID, but not after.”
Asked whether staffing is adequate now, Danielle said it is not. “Fully staffed, we had a ratio of one to four. So typically, I would have four patients to care for. Now I’m getting a fifth or sixth patient. Even a seventh. I remember the first time I had a seventh patient,” she said with a shudder. Danielle spoke of departments with 32 beds. “Now they’re putting the 33rd and 34th patients in the hall.”
She recalled a time when, overworked, she made a mistake with a patient’s medication. “You know that has to be happening to other people. It has to be happening all the time. You’re not getting safe patient care.”
With the hospital so full, Danielle said, “There’s a huge push for discharging patients as quickly as possible.” This can lead to inadequate patient care, she said. At the same time, hospital departments undergo regular financial audits. Asked whether the audits result in more pressure on nurses, Danielle said, “Oh God yes. Staffing is low, and it’s not just the nurses. Sometimes I think Environmental Services has it the worst. They’re responsible for keeping the hospital clean and getting the rooms clean on time.” She added, “I feel like they get the brunt of it. But if they didn’t do what they do, the place would come to a screeching halt.”
Danielle also noted that meals are getting to patients late, a new problem since the pandemic began, suggesting that the dietary department is understaffed as well.
Asked about protective equipment, Danielle said, “They seem to have enough PPE [personal protective equipment]. They have reusable gowns now. But they call people out for four-hour increments to do laundry, even nurses. You’re still getting paid, but that’s not what I’m there to do.”
Saint Joseph Mercy Health System is a not-for-profit Catholic hospital network that, according to the American Hospital Directory, made $2.5 billion in patient revenue last year. The hospital is owned and operated by Trinity Health, a national not-for-profit Catholic health system with corporate offices in Livonia, Michigan.
According to nonprofitlight.com, Trinity’s CEO for the Michigan region, Robert Casalou, received a salary last year of $1.45 million. Trinity’s overall CEO until June of 2019, Richard Gilfillan, received an annual salary of $2.8 million. In all, the health system had at least 15 employees with salaries of over $1 million in 2020.
Although legally designated not-for-profit, Trinity and St. Joseph nevertheless operate according to the capitalist profit motive, which values workers’ health care as slightly as it does their food and housing needs and the education of their children. Hospitals and health care system administrators try to maximize revenue and cut costs at every turn. And as everywhere in capitalism, a hospital’s money is made on the backs of its workers.
With the implementation of social distancing and other pandemic controls in the spring of 2020, St. Joseph and Trinity—like almost all hospitals and health care systems—reported losses in year-on-year revenue and net assets. Their response, like that of all corporations, was to intensify the exploitation of their workers to the detriment of patient care. “It’s all about making money,” Danielle said. “They don’t care about the staff and the patients.”
Asked about morale among the staff, Danielle said, “It’s horrible. Everyone was rallying around nurses in the beginning (of the pandemic), but that’s over.” She observed that St. Joseph has seen an exodus of nurses during the pandemic, and that they are being replaced by traveling nurses. “The traveling nurses are making three times what we make. We had a ton of nurses that left to do traveling.”
Surprisingly, Danielle said, there is no tension between the hospital’s nurses and the traveling nurses. “The tension is with the hospital,” she said, which has failed to increase workers’ pay in any way commensurate with their increased burden. “They gave us a $600 bonus that turned out to be only $400 after taxes. And yet they hire travel nurses. Okay, why?”
“They sent out an email offering a retention bonus, but that’s just because they’re in a world of shit now,” Danielle said. Under the retention bonus offer, nurses must agree to stay at the hospital for two years in return for $10,000. In addition to this, she said, “If they fire you or you quit, you have to pay it all back.” Nurses who sign for the bonus because they are in need of money are “trapped,” Danielle said.
Asked whether patients notice or comment on the tense situation in the hospital, Danielle said, “Yeah. They do. People were thanking us a lot more for doing what we do.” Nevertheless, she noted, nurses are aware of where the situation is headed. “One nurse had been to another hospital (with staffing shortages similar to St. Joseph). There, compassion has run out.”
“The way it’s going, it’s going to happen at St. Joe’s,” Danielle said. “Our patience with our patients is wearing thin. And it’s from the top,” she observed, commenting that the stress on the nurses is caused by the policies implemented by administrators.
“You didn’t get in this to treat patients that way, or to be working for a building that doesn’t give two shits about you. Or the patients, for that matter.” She added, “There’s a huge population [of nurses] that’s older that are just going to say, ‘Enough is enough.’ And they’ll leave. They’ll retire.”
Danielle commented on the increase in COVID-19 patients at St. Joseph since the beginning of fall and the start of the school year. She noted that floors designated for COVID-19 patients were filled and that other floors are being converted into COVID-19 floors.
Significantly, the Ann Arbor Public School (AAPS) district has seen a surge of cases. Two elementary schools were closed earlier this fall by the Washtenaw County Department of Health because of outbreaks. As of November 12, the AAPS had reported 367 cases of COVID-19 among students and staff. Meanwhile, the schools in Ann Arbor, as around the country, are experiencing their own staffing problems. In late October and early November, the district was forced to close a number of schools because they were not adequately staffed.
The reckless reopening of in-person classes, in Ann Arbor and throughout the country, has fueled a spike in the number of cases and put an unbearable strain on health systems. As the WSWS has reported throughout the pandemic, hospitals have been filled beyond capacity and health systems throughout Europe, South America, North America, India and elsewhere have collapsed or been pushed to the brink.
Yet capitalism’s demand for more profits persists. Danielle has been mandated to earn her bachelor’s degree. “They want a certain percentage of their nurses to have a bachelor’s to get their Magnet status,” she said. “It’s the highest accreditation you can get as a hospital. It’s all for funding.” She added, “I couldn’t believe with all this going on they’re making people go to school.”
“It’s not just the system of St. Joe’s breaking down, it’s the whole (health care) system,” Danielle said. “Nursing students come up on our floor, and I want to ask them, ‘Why do you want to do this? To enter this system?’ I know why they want to do it, but…”
The nurses at St. Joseph are not represented by a union, but as painful experience has shown over the past four decades these organizations would not help the situation. Most recently the nurses of St. Vincent Hospital in Worcester, Massachusetts, who walked out on strike over eight months ago, have found themselves isolated by their union, the Massachusetts Nurses Association, and their strike is coming to a heartbreaking end. Unions today are not true workers’ organizations. Rather, they fulfill the dual purposes of providing capitalism with cheap labor and blocking the development of the class struggle.
Asked what she thought needed to be done, Danielle said, “Take care of your staff. I don’t know. You’d have to start from the bottom up. It’s almost like the whole thing has to come down.” She concluded, “From the top, they enforce their level of not caring. It will get to the point where we are saying to patients, ‘I don’t care.’ They are asking people to do something that is not within them. This is not why we got into this.”
The way forward for the nurses and staff at St. Joseph in Ann Arbor, and at health care facilities everywhere, is to create new and independent organizations of struggle, democratic rank-and-file committees, free of the treachery of the unions, which offer workers a political perspective for winning their demands.
The WSWS has assisted workers in auto assembly and auto parts factories, schools and logistics facilities in forming such rank-and-file committees. Right now, the Deere Workers Rank-and-File Committee is playing a leading role in a strike that is challenging not only the employer John Deere but also the thoroughly corrupt and duplicitous United Auto Workers union.
Only through building new organizations can the working class gather its immeasurable strength and fight for fair wages, humane hours and working conditions and, most critically, putting an end to the pandemic. For information on forming a rank-and-file committee in your workplace, contact the WSWS today.
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