Opinion: To continue to improve, Mission Hospital must understand suffering of both patients and nurses

Jason Sandford

Jason Sandford is a reporter, writer, blogger and photographer interested in all things Asheville.

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Ashvegas: The City You Love. The News You Want.

Editor’s note: This is a repost of content lost in February.

By Donna Helen Crisp

I learned recently that Dr. Ronald Paulus, CEO of Mission Hospital in Asheville, has a five-point strategy to turn his hospital into the “Mayo Clinic of the mountains,” to make it “a shining star in the medical community across the nation.” Soon after, I heard a story on NPR’s All Things Considered byDaniel Zwerdling, who has been reporting a series of stories about injuries to nurses. Last week, Zwerdling’s report showed how Mission Hospital had refused to take responsibility to care for a nurse who worked there for two decades before hurting her back on the job. (His next story on Feb. 25 will feature a hospital that takes good care of its nurses, in contrast to Mission.)

Listening to NPR, I thought back to when I worked as a nurse at Mission from 2000 to 2005. It was the best job I had ever had. It was hard work and I loved it. We worked collaboratively to care for patients and to solve problems. I learned from other nurses and physicians, as well as my patients. My supervisor was wonderful. At times there was grumbling, yet turnover was low and I sensed no fear about being fired.

Since leaving Mission, I’ve heard many stories about how the hospital has changed, and not for better. Various people have told me Mission is no longer nurse-friendly, that it manufactures reasons to terminate experienced, well-paid, excellent nurses who are replaced with lower-paid hires. Several nurses have described their experiences to me about being fired and of having no support from HR when they explain that trumped up charges are untrue.

People have told me Mission is becoming a regional conglomerate, focused on profit at the expense of the quality of its employees. A Mission employee I met on the street last year said her department was carefully coached by the hospital about what to say outside work, if asked about Mission. Another person told me the lucky ones are given a forced retirement and then sworn to secrecy. She believed Mission, in its quest to take over all regional health care, sometimes emphasized superficiality over substance. Last week, a man said to me, “I was born and raised here. Mission used to be about the patients. Now they are all about the money.”

These testimonies have made me curious. I realize hospitals are complex environments, like little cities, each one with conflicts and issues. Mistakes happen. Yet, hearing Terry Cawthorn talk on NPR about how she was treated by Mission after she got hurt at work, made me sad and angry. She emphasized that nursing was not just something she did but that is was who she was, and that she had always believed she “mattered” to Mission Hospital, only to realize after her injury that she had not mattered at all.

I turned off the radio and thought back to March 29, 2000, when I attended a presentation at Mission St. Joseph’s Hospital, where Dr. Eric J. Cassell talked about Diagnosing Suffering. I had studied his classic book, The Nature of Suffering, in graduate school, learning that suffering involves an individual’s whole being, and that to recognize suffering, one must first believe it exists, and then, through compassion and living in the moment, recognize and ameliorate it. I believe Cawthorn’s suffering became her central distress, that her emotional and spiritual pain transcended the pain of her physical injuries in 2008.

How is Dr. Paulus going to transform Mission Hospital into the Mayo Clinic of the South? A great hospital treats its employees as well as its patients with respect, honesty, integrity, and transparency. To become an outstanding institution of excellence, Mission will need to review and re-pledge to honor its five Merit Values, excellence, respect, integrity, trust and teamwork, and, especially, mercy. (“We work to create a caring and compassionate environment responsive to the emotional, spiritual and physical needs of all persons.”)

To successfully mentor and influence his organization to apply core values to everyone, Dr. Paulus must be able to see the suffering in his organization, not just in patients, but in employees, from housekeepers to neurosurgeons, from unit secretaries to nurses. He must truly understand and live the words Dr. Cassell spoke 15 years ago, in the Heart Tower auditorium, when a young doctor asked, “How do you see the suffering?”

Dr. Cassell replied, “When you walk into a patient’s room, open your heart.”

Donna Helen Crisp lives in Asheville, where she works as a nurse and writer. From 2006 – 2012, she was a Clinical Assistant Professor at the UNC School of Nursing in Chapel Hill, where she taught the annual Nursing Ethics course each spring. Donna Helen Crisp, RN, MSN, PMHCNS-BC, JD.

Jason Sandford

Jason Sandford is a reporter, writer, blogger and photographer interested in all things Asheville.

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  1. Donna Helen Crisp June 2, 2015

    Dear Readers,

    Asheville is so rich in health care, especially nurses. I want to hear what nurses have to say about this New York Times piece. You will have to leave your email, but your “name” can be either your real name or a pseudonym. Your collective wisdom is monumental. Please share your voice here. Speak up. Your peace of mind, or your job, may be at stake, depending on where you work. Tell your truth, whatever it may be.

    Last week, on May 28, 2015, the New York Times published an Op-Ed piece entitled, “We Need More Nurses,” by Alexandra Robbins. http://nyti.ms/1Bqv6RQ

    Here are some excerpts:

    “Inadequate staffing is a nationwide problem, and with the exception of California, not a single state sets a minimum standard for hospital-wide nurse-to-patient ratios. Dozens of studies have found that the more patients assigned to a nurse, the higher the patients’ risk of death, infections, complications, falls, failure-to-rescue rates and readmission to the hospital – and the longer their hospital stay. According to one study, for every 100 surgical patients who died in hospitals where nurses are assigned four patients, 131 would die if they were assigned eight.”

    “Nurses are well aware of the problem. In a survey of nurses in Massachusetts released this month, 25 percent said that understaffing was directly responsible for patients death, 50 percent blamed understaffing for harm or injury to patients and 85 percent said that patient care is suffering because of the high numbers of patients assigned to each nurse.”

    “And yet too often, nurses are punished for speaking out. According to the New York State Nurses Association, this month Jack D. Weiler Hospital of the Albert Einstein College of Medicine in New York threatened nurses with arrest, and even escorted seven nurses out of the building, because during a breakfast to celebrate National Nurses Week, the nurses discussed staffing shortages.”

    “It is not unusual for hospitals to intimidate nurses who speak up about understaffing, said Deborah Burger, co-president of National Nurses United, a union. ‘It happens all the time, and nurses are harassed into taking what they know are not safe assignments. The pressure has gotten even greater to keep your mouth shut. Nurses have gotten blackballed for speaking up.’ ”

    Robbins goes on to discuss how hospitals decrease nursing staff to boost their profit margins, which unfortunately is at the expense of patient safety. Then, if a bad patient outcome results from nurses having to cut corners to get their work done, the hospital fires the nurses.

    Research has long shown that nurse staffing is directly tied to patient outcomes. Robbins ends her opinion piece by praising nurses as the key to improving American health care. “Nurses are unsung and underestimated heroes who are needlessly overstretched and overdue for the kind of recognition befitting champions. For their sake and ours, we must insist that hospitals treat them right.”

  2. Mark May 15, 2015

    I worked 16 years at mission and witnessed many wrongful terminations including my own. I still have not been given a reason for my termination. Recently at an off campus facility they removed 4+ employees with one having 30+ years. The NC Labor Commission has made dozens of rulings against them with dozens pending. Bob Burgin knew how to operate a hospital and employees were treated with respect. Employees work in fear and under threats of termination and nothing is done. Mission is a great place with great people I just hope they realize it.

  3. The latest healthcare transitons in WNC ( Mission Hospital, no mention of park Ridge or Pardee) story published by the ACT is a story. Healthcare is very complex as the article describes, but there is so much more to it. The care of patients is in the hands of expert frontline employees, who because they take on such a huge responsibility, take their work very seriously and do not respond well or work well with authoritarian management. What you have at Mission is authoritarian management who don’t want to hear dissent. Nursing vacancies are at an all time high. There is a “Shine for Mission” program that RP wanted all emplyees to be trained in within 3 months after he announced in a management team meeting that the culture of WNC was mean. Ostensibly, it was to provide positive statements for employees to use when Mission was criticized. That is not a bad effort, but it has come across as employees should not speak dispargingly about Mission. I agree, but it has also been said over and over, if an employee doesn’t agree than they are not with us. Not agreeing is considered being critical of Mission. Best practice in medicine requires that all speak up for the safety of patients. These squelching efforts will cause employees not to speak up and unfortunately patients may be hurt. Employees who have been laid off sign contracts that they will not speak disparagingly about Mission. If Mision treated its employees and even laid off employees better, they wouldn’t even have to have a program called “shine for Mission” or a gag clause in the contract. And they do lay off older employees and escape lawsuits via the contract signing for severance, a pretty normal practice,but Mission HR is not nice about it,even negligent with the whole process. The public will never know what is really going on and it is not pretty. The positive highlights were the only thing hit upon by ACT and a token negative article about the MDs in Spruce Pine, that I am sure Mission marketing approved before publishing. The ACT can’t afford to lose daily ad revenue from Mission. That proves the ACT has done some investigative reporting, right? Not. Ask about the number of VPs and executive directors Mission has vs Greenville Memorial Hospital or Huntsville Hospital in Ala. For a poor payer mix, Mission, having to support a greater number of those huge salaries is an interesting issue.
    I heard RP interviewed for the Geisinger CEO position which opened last summer or fall to be put in place by June 2015. According to ACT, he told the board he was staying fot 10 years in 2010. That one piece of information is conflicting. Think about all of the other information
    that is unbalanced and slightly(?) slanted.
    Smoke and mirrors folks, smoke and mirrors. RP is smart and talented and understands the big national healthcare picture but fails at bringing along the people who do the work as colleagues. His executive team doesn’t let reason, logic, or expert opinion get in the way of the marching orders RP has given. Quite talented at not dissenting and doing the lemming thing, those execs are. I have heard it more than once, “but RP might get mad.”

    1. MoreVPs??!!@@ June 28, 2015

      Let’s cut costs because of our reimbursement levels. Let’s cut Doctor’s Day, that costs very little and is a huge perk to physicians, but let’s add even MORE VPs. Directors who are leaving and have left over the last year due to dissatisfaction and bullying are being replaced by VP positions. Whaaaat?

  4. Donna Helen Crisp April 16, 2015

    When my opinion piece first posted on February 24 of this year, before the website failed and content was lost a few days later, an RN working at Mission Hospital left a comment, along with her whole name, about how the hospital treated her (not good). I thought she was very brave and I wonder how many comments about her comment might have been lost as well.

    If she reads these words, she will know who she is. I hope she will post her comment again, for all to see and ponder.

  5. RN April 11, 2015

    Another former Mission RN. I chose to leave Mission Hospital in Asheville after seeing so many wrongful terminations and exploitation of nursing and other direct care providers. I had the opportunity to work for Mission prior to the Joe Damore and Ron Paulus style of management. Before those two CEO’s my plan was to retire from Mission. I cannot make myself even apply to work for Mission Hospital. I left upon my own accord and in good standing and yet, I doubt seriously they would rehire me because of my age and previous years of employment even if I could force myself to apply. Instead I have chosen to leave WNC, leave my home, rent out my house and move away from friends rather than endure the Mission Hospital oppression and Corporate health care take over in WNC. I believe Mission Hospital is focused on profit and positive PR. Their vision statement may say something different, something full of compassion and care yet their actions speak louder than their empty words.
    I do not believe Ron Paulus cares about Nurses or any other direct care providers. So his enlightenment to compassion would be somewhat miraculous.
    Thank you Donna C. for the very mindful, compassionate and insightful letter submitted to Ashevegas.

    1. your comment made me sad April 16, 2015

      Your comment makes me sad. I don’t know the nurses who work throughout the Mission empire, what they earn, how much experience they have, or how professional and effective they are. I do know that nursing is a difficult and challenging profession.

      Over the years at Mission, it seems like working conditions for nurses have gradually devolved. Twelve hour shifts used to be a nurse’s choice. Now, to make more money, Mission requires most nurses to work 12-hour shifts, whether they want to or not. In the short run, this may serve the hospital’s financial goals. But ultimately, no hospital can be truly excellent without excellent nurses. And excellent nurses do not tolerate (unless they have no other choice) working in a broken system where they are not honored and rewarded for their expertise, experience, and commitment to caring.

      Mission may succeed financially, but it will never be a great hospital, no matter how excellent their marketing strategies may be. Not without excellent nurses.

      Nurses used to feel pride in saying they worked at Mission. Now, that is not as true. As stories of Mission’s betrayals (and even illegal actions) permeate our regional culture, confidence in Mission continues to erode. Even if Mission decides to change its “intentions” toward nurses (and other workers), it may take many years for the hospital to become a place where knowing people do not fear working there, and where patients receive the extraordinary care they deserve, from excellent, respected, well-paid nurses.

      What most patients do not realize is that, when they are cared for in a system that treats nurses poorly, the patients may suffer more. Because of nurses who are not as competent as they need to be. Because the best nurses leave to work in a setting where they have the right leadership and mentoring to become more excellent. Because the best nurses have too much integrity to stay.

      Great nurses realize they practice a science as well as an art. Great nurses will not willingly work in a toxic environment.

      When Mission terminated Terry Cawthorn, the nurse featured on a National Public Radio story about injured nurses in February, the hospital cast a cloud over not just her, but over every nurse who has ever worked at Mission, or may work there in the future. Ms. Cawthorn’s story, now told to the world, will continue to resonate in ways that cannot be predicted. What goes around comes around.

      If an institution is truly great, it does not have to pretend to be great. The truth ultimately speaks for itself.

    2. Your comment preaches to the choir of all those who know at least some of the Mission truth. You said “nursing vacancies are at an all time high.” I just checked the Mission website and if you click on Mission Hospital and on Nursing, over 300 vacancies come up. Make no mistake. This is intentional. For every posted job that goes unfilled, there is more money in the coffers to pay high salaries to the privileged few who have nothing to do with direct patient care.

      You said “not agreeing is considered being critical of Mission.” This is so discouraging. Especially since professionals who are brave and dedicated to their work well know that being “critical” is not bad, it is part of the process of growing and evolving toward more excellence.

      You said “the public will never know what is really going on and it is not pretty.” I wish other people who do know what is going on would post comments here. They should know that when it says your name is required, you can give any name, such as Donald Duck; however you must give your correct email address.

      I feel certain that many Mission employees, past and especially present ones, would gladly post their two cents if they understood their anonymity is protected.

      No matter how much any particular patient praises their Mission experience, they need to realize that critical staffing shortages affect everyone.

      There may be no one to come and help a patient, for the simplest things. Like being helped back to bed after sitting in a chair late at night. Or having help to use the bathroom. No matter how excellent the nurse or nursing assistant is who eventually helps you, if there is not enough nursing staff to go around, too bad for patients.

      Ultimately, a hospital cannot be effective if there are not enough well-trained and satisfied nurses as part of the team. Eventually, the hospital will lose money if patients have other choices.

      In Asheville, the choices are limited, of course, because Mission either owns or is trying to own every single hospital bed and physician practice. Still, there are other hospitals to consider. Within about three hours of Asheville are hospitals in Charlotte, Greensboro, Winston-Salem, Durham, Chapel Hill, Atlanta, and in Tennessee, there are major medical centers in Knoxville and Johnson City.

  6. Jason Sandford April 8, 2015

    A reader had trouble posting, so here’s a comment from “Another nurse injured by Mission Hospital”

    The comment:

    I commend Ms. Crisp for her courage to speak out against Mission Hospital. I was also terminated while recovering after I had back surgery because of the years that I worked at Mission Hospital as a primary care nurse. As an ex-employee of Mission Hospital, I have had the opportunity to work under Joe Damore, the previous CEO, as well as Ron Paulus. It became apparent to me very early that the safety of health care workers and their value are not among Mr. Paulus’ priorities. He has consistently placed money over safety as decisions are made at Mission. For example, although Mission Hospital continues to build new facilities, they have terminated injured nurses and have even gone as far as to take Paid Time Off away from staff as standard policy. How can this be ignored?

    Not only does the organization terminate skilled nurses that are injured on the job, but they are also terminated as they grow old. I am personally aware of three health care workers that worked with me on my unit who were wrongly terminated due to age or injury. They all are fearful to tell their stories, so I have chosen to share my own:

    My back injury occurred as a result of protecting a patient from a fall while recovering from her own surgery. Although there was safety equipment available, it wasn’t accessible to me as the patient began to fall. Rather than allowing the fall to occur, I chose to intervene, and subsequently was injured. During my recovery from surgery, I received a certified letter from Human Resources informing me that they would not wait 16 weeks for me to recover and my employment was therefore terminated. I was also told that I would not be eligible for rehire for two years (the exact amount of time I was eligible to appeal to the labor board for wrongful termination). I was also informed that I would be welcomed back after the two years had passed. I learned too late that this was a deceptive way to take away any right that I had to appeal their wrongful termination. I have attempted to contact Human Resources many times since to understand why they had done this to me, only to be forwarded to a voicemail line that is never heard. Human Resources has never responded to my request to explain the circumstances behind my termination or to justify my constant denial as I attempted to apply for alternate positions.

    Because Mission Health Care has purchased or aligned with many community primary care providers, other regional hospitals, and home care agencies, I am also not eligible to work at any entity associated with Mission Hospital. I am qualified to perform many other roles as a nurse in the WNC community, but am consistently and routinely rejected for employment within the Mission Health System or their affiliates without ever being given a reason why. This in no way reflects the mission, vision, or values that Mission professes to uphold.

    Ron Paulus should be held accountable for the mistreatment of the nurses and other hospital staff employed under his leadership. It has become clear to me that he is not concerned with the safety of nurses or other hospital staff, regardless of what he professes publicly. I believe that the community needs to be aware of the routine mistreatment of hospital staff. The community should stand up in solidarity for the hard working health care professionals that provide the quality care that Mission Hospital takes credit for. I am confident that this mistreatment is the norm, not the exception for this health care system. SHAME ON YOU, Ron Paulus, for your mistreatment of the very staff dedicated to providing care to the patients that visit your organization! You are still bound by your Hippocratic oath to “FIRST, DO NO HARM” to the staff which you are obligated to protect.

    1. Thank you for sharing your story. I have read it several times and hope more nurses will share their Mission stories on this site.

      If Mission leadership reads any of these stories, and does not care, dismissing them as exaggerated tales from disgruntled employees, that just serves to substantiate the worst views held by many about the hospital, how it cares more about money and visibility than transparency and integrity.

      The truth will set you free. But first, it will make you very angry.


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