The Rot From Within, or Murph’s Report

Why can’t the hospital hire local nurses? Hint: It is not the cost of housing.

I have asked several nurses I know as to why they don’t work at MCDH (Mendocino Coast District Hospital). They all looked at me as if I was suggesting they engage in the black arts. They stated, simply put, “Nobody will work for them! They have a horrible reputation for how they treat their nurses”. I asked another 30 year nurse friend of mine about nurses and what was happening. She said,”I’m just glad I don’t work there anymore!” Maybe a dialogue should start as to where this reputation came from. I don’t think a new web page or glossy brochure can do much with a reputation like this. With a reputation like this a house cleaning seems in order.

Last August My partner and I spent 22 hours in ER performing patient advocacy for a dear friend of ours who was experiencing severe pain (including chest), dehydration and severe nausea for several days.  Having had quadruple bypass heart surgery 8 weeks prior, he was rightfully worried. He was admitted into ER and after laying there for an hour, finally saw the doctor, had his blood taken and sent to the lab. He was diagnosed as having a rare form of kidney disease usually only seen in teenage boys.  All the time our friend keeps telling them that his chest hurts. After 22 hours of multiple botched tests, misdiagnoses, repeated violation of special health issues related to our friends condition (alcohol or hand sanitizer will trigger an acute autoimmune reaction and/or death and staff repeatedly walked into the room rubbing it onto their hands).

 

Hours were spent tracking down a hospital that would accept a patient with such a rare kidney disease.  Then, discovering the blood sample was tainted as it was taken through his IV line, blood was taken again with the staff person muttering “Nobody could do anything with the sample taken”. So, a new diagnosis was made, he didn’t have a rare kidney disease only found in teenage boys. The new disease diagnosis, also ultimately inaccurate, required the doctors to argue whether it could be treated at MCDH or if he needed to be transported elsewhere.  After determining MCDH was not appropriate,  a new round of hospital search began. During the whole day and night nobody took his shoes or pants off, so did not check for ankle swelling, common after heart surgery. In fact, it was the next hospital which finally diagnosed his life threatening ruptured aorta and transferred him to the one of the top hospitals in the country, who performed two heart surgeries, saving his life.

The other constant drama was the visibility watch and ability to escape to another facility. Throughout the night the hospital staff was in constant contact with the helicopter pilots who wouldn’t fly until the visibility lifted for a certain amount of time. After they finally found the correct hospital to take him at 4 :00 am, it was low visibility again, the ambulance staff had been on duty too long and had to sleep before he could be transported.  By 8 am an angel in the form of a nurse employee arrived on duty and straightened the whole ER out in about 30 minutes in such an amazing display of efficiency, knowledge and grace that I realized that she probably has to arrive to put things in order every single day. I almost didn’t want her to leave the room to attend to her other duties and patients.

When we were notified at 9am that they were considering putting him in an ambulance to Ukiah where they would put him a fixed wing aircraft to fly him to Santa Rosa Airport where they would put him on another ambulance to take him to Memorial. The plane was being prepped and would be in Ukiah in 2 hours. Once the plane landed they would load our friend into the ambulance for the trip to Ukiah. I asked the new nurse, (her name escapes me) if they would consider just putting him into an ambulance and just leave immediately for Santa Rosa Memorial. No stops or transfers. She thought it a sensible idea, talked the rest of the staff into it and they had him on the road within the hour. They stabilized him there, did more tests and he he ended up in Stanford where they patched up his burst artery.

Twenty two hours of nightmarish incompetency by a group of out of town incompetent fools and this only covers some of the details that night. There is no excuse for this hellhole of an ER. We later found out that this was the first month for the new Emergency doctors and the last day for the first idiot doctor that bungled the diagnosis. If this is what MCDH thinks is what the coastal community will put up with and approve a parcel tax, they are sadly mistaken. The community has to tell their stories to the caretakers of our hospital district and demand a response. It’s time they hear the truth and stop hiding behind procedure and parliamentarian rules. Peoples lives are at risk! Board of Directors, take your job seriously and investigate the sources of the disease that has rot our hospital from within!

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From the Anderson Valley Advertiser March 6 2013

UNSAFE DECISIONS

To: Terry Murphy, chief nursing officer at Mendocino Coast District Hospital

Dear Ms. “Murph,”

Well, what an incredible disappointment your return to MCDH has developed into at this point. Let me begin by stating that I was among many who originally welcomed your rehire. Your reputation of being organized, efficient and holding staff accountable on an equal playing field was going to give this facility the facelifte it needed. We had the attitude that change would be difficult, but necessary, and collectively as a staff we were willing to work hard for you. What a difference the decades have made toward your prior reputation, and how quickly did your song and dance pony show from your interview be proven false.

Let’s start with the fact that you made rounds to the different departments for maybe the first several weeks and introduced yourself by walking up to employees with demands of patient care information. Was this a test of HIPPA to see if we would reveal such information without knowing who you are, requesting your position or reason for requiring this information? Or were you just trying to make it clear that you are incapable of offering professional mutual respect and common communication skills by introducing yourself first? Name and handshake is not too much in the way of expectations. You returned to us with a chip on your shoulder and a defensive attitude. We wanted you here; you were given a welcomed clean slate. Shelley and Jeanna had been working themselves into the ground seven days a week because they cared! They reciprocated their appreciation to the employees as well. They were much more effective as interim CNP job sharing than you will ever be able to hold a candle to. By the way, you forgot to thank Jeanna at the board meeting for her hard work when you thanked Shelley, but that’s typical of your behavior to not appreciate someone else’s extra efforts. Let’s take it a step further by having expectations that you might actually offer appreciation of nurses who have been working above and beyond expectations to make sure patients and coworkers were cared for in a safe environment. It has been difficult, but we were in it together and pulled together. Yet you continue to threaten your nursing staff with punitive actions if even so much as a name badge is accidentally forgotten at home (never mind they worked a 14 hour day prior and were exhausted). Keep yourself locked away in your office and completely unapproachable.

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You still do not have any grasp of how dire the situation actually is with regard to patient care areas in the hospital. How could you understand when you do not bother to communicate on any level with the charge nurses of the departments or the supervisors, and you have completely stopped making any effort to communicate or check in with any of the departments and staff? There are many rumors as to your punitive new rules, but yet none have been placed in writing. Has anyone ever explained effective communication to you? There again, you seem to think that we are breaking these fictitious rules of yours on purpose. Believe me we are only trying to get through the hour 12 hour shifts without causing harm to the patients or ourselves as you (and Wayne) have created such an unsafe work environment. Most employees still do not know who Wayne Allen is or what he looks like as he certainly has never made rounds to departments. The same could be said with our human resource director, Scott Kidd. He has files on employees that he is not even capable of putting a face to when shopping in his leisure clothes at Harvest Market during the middle of the weekday. I expected more from you Ms. Murph.

So let’s get to the specifics.

As of recently, you made significant cuts in our staffing. You announced to the newspapers the plan to downsize and layoff employees before you gave us the respect of notification prior. You announced to the public that these cuts would not affect patient safety and you are able to say this with a straight face? You (the newest administrator who cannot put even a quarter of our faces to a name) and a CEO (who never enters patient care areas) decide without advice from charge nurses or supervisors who should be let go. How irresponsible of you both. When injuries occur to patients and staff members (and they will), it will lay on your shoulders. Not unsafe working conditions?

1. You fired all the nursing aides from the night shift. Tell me how it is possible for a nurse to administer total patient care when several patients who are in isolation (just about every patient admitted has history of MRSA), most are weak, elderly, and have dementia, patients with mobility restrictions were deemed to be at fall risk, incontinent of liquid stool and urine, and your threatening messages to punish nurses who do not complete the new requirements for the NexGen computer system. Who is accountable when patients have to lay in their feces and urine because the nurse cannot leave another patient’s side? That would be you and Wayne, Murph! How can you possibly make morale any worse than by punishing nurses for not having enough time to chart “meaningful use” when you have physically exhausted them with a staffing crisis? I heard a rumor that when we do not have nurses available for emissions, you will not allow patients to be transferred to other facilities. Your solution, burden the nurses with too many patients, be out of compliance with mandated state law, then you will “self-report us” to the state officials? Well, you really do know how to operate an acute care hospital.

2. Next example, you decided to let go a full-time float nurse who is experienced in critical care/emergency room. Brilliant decision. The one person who could actually work in any department during this critical staffing crisis that you created, you decided was disposable. Nevermind that you were completely unaware of the fact that the emergency room only has one nurse at night after 8pm until 7am, and the float nurse was the second ER nurse between 7pm and 11:30pm. Never mind that you were unaware that the ICU was already lacking two full-time nurses and the emergency room has permanent vacancies in its schedule every other weekend nightshift. Nevermind the fact that the full-time float nurse you decided could be cut worked beyond her 12 hour shifts frequently because it would be considered patient abandonment to leave as she never had relief at the end of her shift. You actually thought the float shift should be downsized to eight hours? Who would give meal breaks to the now overworked nurses? Is it your expectation that the supervisors should be doing that job? How exactly are they supposed to respond to other areas of the hospital in the emergent situations if the house supervisor is “taking patient assignments”? Not to mention all the additional tasks you’ve placed on them. Wasn’t it your idea that supervisors should not be doing direct patient care? You have created such a shortage that there was actually no qualified emergency room nurse this past Saturday after 8pm at night until 7am, and the night supervisor had to be the emergency room nurse and try to manage the entire hospital for 12 hours. Did you report that to the state? Your ignorance has caused tremendous grief to the nurses remaining. Thank goodness you had a moment of clarity to at least rehire that float nurse back (but to nightshift in the ICU?)! Now her shifts are uncovered and yet again, the emergency room is out of compliance without qualified nurses as backup.

3. Next point, influenza season is in full force. The emergency room experiences most days with all eight beds full, patients on the gurneys in the hallway, and multiple patients waiting to be seen. You cut a full-time, experienced critical care nurse who could be pulled to help autonomously in this type of situation and now several times the emergency room is left without assistance or sent a nurse from med/surg for OB who are not trained in emergency/critical care. Apparently appropriate cross training and orientation is not of importance to you. Do you think that people do not have heart attacks, become unresponsive, unable to breathe for themselves, or have traumatic accidents in this community simultaneously? Or do you just not care about the safety of the patients or staff? I do, and I take pride in my job and hospital. I know that my coworkers and supervisors care because their actions speak louder than words. Supervisors are exhausted by your demands and staff demands, but at least the nurses know how to give mutual gratitude and respect. You have not thanked any members of your staff for their extra efforts, but you continue to threaten and devalue them daily. Shame on you! I understand that you are continuing to harass your experienced employees who are remaining such as a full-time ICU nurse who has over 30 years of experience and a full-time working manager in respiratory therapy, not to mention the med/surg nurse who actually holds her head up high and will not tolerate your disrespectful tone for no other reason than to enforce your “power.” When will you learn that patient care will suffer when you do not pay attention to the experience of the employees you are letting go? Pay attention to where they are crosstrained and all the different areas they are able to help out. A med/surg nurse who was crosstrained to not only oncology/infusion (only one of two other nurses who can actually float to that department), but she also is a relief house supervisor. You were not aware of this and almost let this valuable employee go. You look at their department title and do not speak to your peers; hence, you now have an unsafe patient environment. Your ignorance must be bliss for you and you alone.

4. Explain why the majority of employee cuts came from direct patient care areas? Nurses and CNAs should have been the very last. North Coast Clinic had zero cuts (a person retiring does not constitute a cut). Secretaries and full-time back office employees should have been downsized first. Dr. Graham can put his own patients in a room and take their blood pressure when he does decide to hold office hours. I’m sure he would agree that it is more important than firing hospital nurses to give total care to his inpatients. North Coast Clinic staff are all paid the same wages with benefit packages as the rest of us. Why was no one let go in Mr. Wayne’s Department (a recent fired employees for unrelated issue does not count)? Accounting and billing employees should work 12 hour days, nights and weekends. Instead, you let go a part-time patient registration clerk who could cover efficiently in any department; especially the emergency room? That must have saved the hospital a fortune. Who is paying attention to the decisions that you are making? I urge the Board of Directors to speak to the nursing staff. You and Wayne are making unsafe and irresponsible decisions. Your rude and condescending attitude will undermine the few employees who actually try their best for you; it has destroyed what little spirit that is left. You created a situation that is absolutely exhausting and impossible to sustain without as much as a “thank you for hanging in there during this difficult time.” I personally heard you tell someone that you shortened your name to “Murph” because it made you more approachable. You are no more approachable than a coiled rattlesnake ready to strike. By the way, please remove that obnoxious sign about “having flying monkeys and you’re not afraid to use them” from your desk. You don’t put something like that in public view when you are destroying families and lives.

5. Bottom line is that you are now recognizing the error you have made with all the nursing layoffs so your solution is to hire traveling nurses/registry?! Double the cost and out of area staff who are not familiar with any of our policies and operations. Again, an unsafe decision. Good luck finding quality “travelers” willing to come to this remote area under the work environment you have created. You fired local people who were vested in his community and took pride in their work and now you have to hire outside nurses to fix your mistake. The staff members you let go begged to remain per diem as they would rather give up benefits and continue to receive a paycheck. Per diem employees cost the hospital zero overhead yet is the paperwork too much for human resources to handle? Can’t “create” a position for those loyal employees you so willingly cut off at the knees? Safety for the patients and nurses is not your priority. You really screwed up! You affected real people with real families. I wish the same hardship on you. Shame on you! Shame on Mr. Wayne for hiding behind his closed/locked door as well.

6. Pay attention board members and public. You have people making decisions for this facility who do not have a clue as to the actual patient care operations and real people will be hurt as a consequence.

Sincerely,

A remaining employee at Mendocino Coast District Hospital (for now)

Fort Bragg