Post-Lockout, Seton Nurses Return to Diminished Patient Care and Hostile Management

“Picking up the pieces”

Ascension nurses picket during their planned one-day strike, before Ascension locked them out for three extra days (Photo by John Anderson)

Medically fragile babies missed lab tests and vitals checks. Patients waited for pain medication they needed urgently. Fill-in nurses didn't communicate with Spanish-speaking patients and family members. And staff nurses returning to work felt as intimidated as ever by hospital management.

Ascension nurses had planned only to strike for one day out of concern for patients – they knew temp nurses filling in during a strike would have much to learn about hospital protocols in little time. Unfortunately, Ascension's decision to lock striking nurses out for an additional three days had exactly the kind of consequences striking nurses had feared. When nurses returned to work Saturday morning, they found a litany of problems with the care their patients had received during their time away. "You can't just throw a random nurse into a specialty unit and expect the same quality of care," said Neonatal Intensive Care Unit nurse Kris Fuentes.

When a nurse doesn't agree with the conditions of an assignment, they fill out an Assignment Despite Objection form. A July 1 ADO with 12 nurse signatures given to the Chronicle cites "unsafe conditions seen under the care of strike RNs" in the mother-baby unit. Nurse Kristine Kittelson says temps missed more than 10 lab tests on moms and babies. "And there were actually [temp] nurses that told some of my peers they understand why we went on strike, because the conditions are horrible – verbatim, their words."

Most concerning are the reports of infection protocols skipped in the NICU, inadequate pain control, and longer waits for pain medication. Some bloodwork was collected incorrectly and thus couldn't be submitted to the lab. On July 2, an ADO details a nurse being forced to care for a postoperative patient in a unit they don't usually go to, without any support staff, leading to "delay in treatment."

"We all feel like we're picking up the pieces," says Kittelson. "It's going to take a few days for us to really get things back in the right direction. This is why we did the one-day strike, because we want our patients to be safe."

The drop in patient care quality also speaks to the service Ascension staff nurses are normally able to provide: Fuentes says she's never seen more than 20 nurses working the NICU – she says Ascension brought in 35 nurses for the strike and subsequent lockout. "They did that and they still had suboptimal care," says Fuentes. "And when we returned yesterday, we returned to six nurses short, begging for unscheduled nurses to come help … It seems like they staffed up for show, and now we're back to our unstaffed conditions."

“You can’t just throw a random nurse into a specialty unit and expect the same quality of care.” – Neonatal Intensive Care Unit nurse Kris Fuentes

They also returned to hostility. Though Ascension CEO Wes Tidwell was there to smile and welcome nurses back as the morning staff returned post-lockout, later that afternoon, when Kittelson was visiting other nurses in her unit, her manager told her she had to leave, "basically escorting me out." Kittelson says it's common for nurses to come in when they're not scheduled – "We have baby showers, we have potlucks" – so her manager's reaction was "disappointing to see. I really feel like it's upper management that's making these demands, and it affects morale on all units. But I also feel like everyone is getting a direct feeling of really how strong we are, and that's pushing a lot of these actions – because the control is switching."

Kittelson is not the only one experiencing tension after the strike – Fuentes said that there were administrators and management around for her first shift back, which is unusual for a Saturday. "Management implied that nurses that had been on strike were going to be aggressive or treat the staff that had stayed inside poorly. There were reports that they spoke to the leaving shift, [saying], 'If there are any problems, come get us.'"

There weren't any problems, Fuentes says: "We come to work because we want to take care of patients, not because we want to fight with each other. This problem isn't amongst the nurses, this problem is with the Ascension management."

Despite management's combative response, nurses say they're optimistic post-strike: "My colleagues who participated in that strike have continually shared that this was the most empowering day of their nursing career. I've been a nurse for 21 years and I can say the same for me," says Fuentes. "We finally have a voice to speak up for our patients. I think Ascension has done a great disservice to our Austin community by failing to commit to nurse retention and safe staffing. We want to take care of patients, we want to take care of their loved ones, but we want to do it well."

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