University of Iowa nurses protest higher patient ratios

Ashley Lynn, a cardiac nurse at the University of Iowa Hospitals and Clinics, protests Thursday at the University of Iowa Hospitals and Clinics in Iowa City. “I’m tired of being asked to nurse less,” says Lynn, who explains that the increased patient-to-nurse ratio is affecting the care the hospital is able to provide to patients. (Geoff Stellfox/The Gazette) (Geoff Stellfox/The Gazette)

Several nurses, who declined to be named for fear of employer reprisals, protested outside University of Iowa hospitals and clinics on Thursday in response to news from hospital unit chiefs that nursing staff will have to start caring for an additional patient. (Geoff Stellfox/The Gazette)

Several nurses, who declined to be named for fear of employer reprisals, protested outside University of Iowa hospitals and clinics on Thursday in response to news from hospital unit chiefs that nursing staff will have to start caring for an additional patient. (Geoff Stellfox/The Gazette)

Several nurses, who declined to be named for fear of employer reprisals, protested outside University of Iowa hospitals and clinics on Thursday in response to news from hospital unit chiefs that nursing staff will have to start caring for an additional patient. (Geoff Stellfox/The Gazette)

Ashley Lynn, cardiac nurse at the University of Iowa Hospitals and Clinics, speaks to the media Thursday at the University of Iowa Hospitals and Clinics in Iowa City. “I’m tired of being asked to be a less nurse,” says Lynn, who explains that the increased patient-to-nurse ratio is affecting the care the hospital is able to provide to patients. (Geoff Stellfox/The Gazette)

IOWA CITY — With signs and sunglasses and heavy hearts still fully committed to the mission that drew them to health care, nurses at the University of Iowa gathered outside their hospital Thursday to express grievances and warnings on the news that they will be taking on more patients at a time than is typical or ideal.

“When you think about everything a nurse does on a shift, it’s pretty overwhelming,” Ashley Lynn, a staff nurse at UI hospitals and clinics, told reporters, holding a sign urging cars passing by honking their horns as a sign of support and solidarity.

Assigned to the Cardiac Unit, Lynn said her patients can get quite sick, requiring more of her time than a few minutes.

“Just to get everything done and spend time with your patient and have rapport with them really takes up your whole day – including the mapping,” she said. “So you add another patient and all those extra responsibilities, it just seems really impossible.”

Joining Lynn around the corner for a peaceful protest against the increase in the number of nurses in UI health care were nurses who had been there for a decade or just two years; nurses in their twenties and sixties; nurses on the surgical floors and the intensive care unit; some eager to be named and others fearful of reprisals.

Depending on the unit, floor and level of acuity, a typical patient load can range from two per nurse to four or five per nurse, they said. Increasing ratios means juggling less, nurses say.

A medical-surgical nurse told The Gazette she was told from Saturday she would balance five patients at a time, up from four now and the favorite three, which would require her to keep their drops, medications and their call signals – a task made especially difficult when spread over different pods.

“It’s hard to deal with all of this, especially if you have a confused patient or someone who is rehabbing or needs frequent neurological checks,” she said. “It’s impossible to manage that when you’re dealing with five patients. And we lack auxiliary nurses on top of that.

Sending a nurse home after a 12-hour shift of five patients at a time will only hasten the burnout playing into the nursing shortage affecting the state, region and nation – an amplified shortage by the pandemic, some of the protesters said.

“And we don’t have auxiliary staff,” said a nurse. “So not only are we nurses, we are also auxiliary nurses, the laboratory staff. What else can we do?”

Nurse overload is not just a concern for the moral and mental health of the workforce, it is a safety and quality issue for patients, they said.

“There is a direct correlation between patient ratios and medication errors or medical errors in general,” an intensive care nurse told The Gazette. “It affects the well-being of patients and nurses. This affects security. You see an increased number of falls, you see an increased death rate in patients at all levels. You are seeing an increase in medication errors and it is affecting the happiness of your nurses.

“You see more absenteeism. You see nurses leaving the industry completely.

UIHC administrators are working to hire more staff nurses – holding recruitment events to fill the 381 open nursing positions on the UI jobs website. They have been using traveling nurses to plug the holes for years – paying contracting agencies a bonus for temporary nurses who step in for a few months at a time.

Although some staff nurses have historically expressed annoyance that these visitors earn more than they do, nurses who protested outside the UIHC on Thursday said they didn’t care how much they earned – as long as they were on hand to help.

“I see travel nurses as temporary to fill in the gaps so I can do my job qualitatively,” Lynn said. “And I don’t see anything wrong with that.”

UIHC officials did not respond to questions about whether they are changing the pay of traveling nurses or whether they plan to rely on them less in the future.

“I know across the country travel costs have gone down overall, but the university still needs to make theirs competitive enough to keep them here,” Lynn said. “We have quite a few travelers in my unit and they do a wonderful job.”

UIHC officials did not respond to questions about whether they were increasing nurse-to-patient ratios. They provided a statement calling the personnel changes optional.

“Hospital staffing needs can change rapidly depending on the number of patients and their level of acuity (severity of illness),” the statement said. “When more staff is needed, existing staff have the option of taking shifts or overtime for extra pay.”

Administrators reiterated their commitment “to providing safe, high-quality care”.

“It means having a team of staff caring for patients in a safe and supportive work environment.”

Regarding questions about changes in the use of travel nurses, officials said, “The number of travel nurse contracts has remained consistent at UI Health Care.”

“The number of travel nurses taking on these roles can vary from month to month. Traveler rates vary based on supply and demand and prevailing market rates, and we continue to pay contracted rates that are market competitive.

Regardless of the reason behind the higher nurse-to-patient ratios, UIHC physiotherapist Barbara Stanerson, 63, expressed concern.

“The community is really invested in this hospital, they love this hospital, this university,” said Stanerson, who has worked at the UIHC for a decade and joined Thursday’s protest. “In Iowa, that’s the only place I want to work. And I’ve always been very proud of the work they do here. But in the past year, I have for the first time been bothered by some of the care patients are receiving – because there just aren’t enough staff.

Vanessa Miller covers higher education for The Gazette.

Comments: (319) 339-3158; vanessa.miller@thegazette.com

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