When Tara Chilcote arrived for a recent shift at McLaren Central Michigan Hospital in Mount Pleasant, she realized she was the only nurse working in the ICU. But she didn’t have time to panic.
Her three patients all needed her attention immediately: One was recovering from surgery, and two were in critical condition, hooked up to multiple IV drips dispensing medications that had to be continuously adjusted. “You can cause serious harm if you put in the wrong numbers (on the IV drips),” she said.
With the help of a nurse’s aid, Chilcote also needed to discharge the patient recovering from surgery, and educate them about the follow-up care and medication they’d need to manage at home. It was a frantic 12-hour shift, she said.
“You go to the bathroom and you almost have a little freaking out moment about, ‘If I go, something could happen.’ Everything’s quick, quick, quick, when you feel that sense of responsibility,” she said. “There have been numerous days where I felt like I did a horrible job, but I did the best that I could. And it's not necessarily that I did a horrible job and something medically affected the patient, but I like to make them feel comfortable, make them feel important, make them educated like they want to be.”
Nurses across the state say dangerous levels of understaffing are becoming the norm, even though hospitals are no longer overwhelmed by COVID-19 patients. The number of Michigan nurses reporting a patient death due to understaffing has doubled in recent years, according to a new poll commissioned by the Michigan Nurses Association. This year, 42% of nurses said they know of a Michigan patient who died because staff were stretched too thin, compared to just 22% who reported such a death in a similar poll from 2016.
Two-thirds of nurses polled said they were aware of “medication errors, such as the wrong medication, wrong dosage, or missed meds” due to nurses being required to care for too many patients. Nearly 70% reported “infections or other complications for a patient” due to chronic understaffing.
One nurse at MyMichigan Medical Center Alma, who asked that her name not be used for fear of reprisal, said she’s regularly reassigned from her inpatient unit to the Emergency Department, because they’re so short-staffed there. If there are seasoned ED nurses on duty, she said, they can make it work, even when each nurse is stretched to care for up to six patients at once. But sometimes it’s only “float” staff like her from other departments, and travel nurses working on temporary contracts.
“It's not uncommon to go in and have not one core staff scheduled, and that is not safe,” the nurse said. “It's fearful for the float staff, because they don't feel safe taking care of those types of patients. And when they have nobody down there to guide them, it can be scary.”
Representatives from both McLaren Central and MyMichigan Alma vehemently deny claims of unsafe staffing at their hospitals. “The implication that patients have been harmed because of understaffing at MyMichigan Medical Center in Alma is simply false and offensive to our employees, providers, health system and the entire community,” said Marita Hattem-Schiffman, central region president of MyMichigan Medical Centers, in an emailed statement.
But nurses interviewed by Michigan Radio say bare-bones levels of staffing are becoming the norm.
“I worked during the pandemic, [and] it was horrible, but the future is … much more scary,” said Shenan Shinabarger, an inpatient nurse at MyMichigan Alma and president of the local union, which just voted to authorize a potential strike. “Where health care is headed is so much … scarier than what we’ve been enduring during the pandemic.”
$3 billion in taxpayer money for Michigan hospitals since the pandemic
It is no secret in Michigan that the health care staffing crisis is directly impacting patients, from overcrowded emergency rooms where patients languish for hours, even days, on stretchers in the hallway, to one children’s hospital closing 40% of their beds in the midst of the recent RSV surge because they simply didn’t have enough staff.
“Our greatest challenge … has been the staffing crisis,” said Dr. Rudy Valentini, chief medical officer at Children’s Hospital of Michigan, during a December press conference.
At the time, kids in critical condition were forced to wait in the emergency department because there were no available staffed beds in the ICU, he said at the time.
“We've done ventilator support in the ER. I've done a hemodialysis session myself in the emergency department where we brought our dialysis unit … to the emergency department so that we could provide care and prevent an ICU admission," Valentini said. "It's put a great burden on our medical staff and our medical system.”
Since 2020, Michigan hospitals have lost 1,700 beds due to staffing vacancies, according to the Michigan Health and Hospital Association, a trade group for the industry. “This creates a cascade of problems, from longer wait times in the emergency department, reduced services, particularly in rural areas, and more difficulty transferring patients to the appropriate care setting,” according to an MHA press release in December. “Communities and families across our state could lose access to the high-quality health care they have now if we don’t address these challenges.”
But hospitals largely attribute the staffing crisis to the pressures of the COVID-19 pandemic and a shortage of qualified nurses. And the industry has repeatedly looked to taxpayers to help foot the bill: Since 2020, Michigan hospitals have received more than $3 billion in federal and state dollars, according to the MHA.
This week, the group asked state lawmakers for an additional $112.5 million for “recruitment, retention and training of health care workers.” But the MHA argues that’s just a fraction of the $1 billion increase in labor costs for Michigan hospitals last year. (The MHA is also “developing additional funding proposals … to improve the safety at hospitals for health care workers and patients,” MHA CEO Brian Peters said in an emailed statement Tuesday.)
A standoff between nurses and hospital administration
Yet some nurses balk at the claim that hospitals can’t independently afford to recruit and retain enough staff to safely care for patients.
“It's tough to stomach that a health care system like McLaren, for example, has one person, a CEO that does not touch patients, that makes over $8.75 million a year and that health systems are pleading poverty,” said Jessica Lannon, a board member of the Michigan Nurses Association and a labor and delivery nurse at Sparrow Hospital in Lansing. “Michigan hospitals have already received millions of dollars from the government. And still, the conditions are getting worse.”
McLaren’s 15 hospitals include McLaren Central Michigan Hospital in Mount Pleasant, where nurses like Tara Chilcote recently voted to authorize a potential strike. The system’s revenues include $258 million in federal money to help cover COVID-related costs, as well as $9 million in FEMA funding for pandemic expenses, and $17 million in state funding for “workforce retention,” according to public financial disclosures. According to the most recently available IRS form 990, the top 15 executives at McLaren made a total of more than $23 million that year, including bonuses.
A spokesperson for McLaren Central Michigan denied allegations of unsafe staffing levels at the hospital, claiming that on average, the hospital meets or exceeds benchmarks for safe nurse-to-patient ratios:
Chilcote, the ICU nurse at McLaren Central, said she received $3,000 in retention bonuses spread out over nine months during the pandemic. She believes she could make more money at another hospital, she said, but she’s stayed this long because she grew up in Mount Pleasant. “It's my community. … I know the patients that come in. You know their history. You know how they are.”
Sitting in her home, she broke down talking about the experience of working during COVID.
“Nobody would even come into our unit to help us … yet they (the executives) got all these bonuses,” she said. “Where were they when people were dying? I know they weren’t there holding their (the patient’s) hand, because I won't let somebody die alone. It was very frustrating. We're not trying to be greedy. We just want what's best for the patients.”
A staffing crisis brewing even before the pandemic
The current staffing crisis isn’t because there aren’t enough qualified nurses in the labor force, the union argued, pointing to data from the U.S. Bureau of Labor Statistics and the state's licensing agency that show there are roughly 50,000 registered nurses with active Michigan licenses who aren’t actually working as RNs in Michigan.
That’s why Christopher Friese, a professor and director of the Center for Improving Patient and Population Health at the University of Michigan, prefers the term “nurse vacancies” rather than “nurse shortages.”
Nor is the crisis purely a result of the pandemic, he said. “One of the big things to clear up for the public is that … we saw the writing on the wall that vacancies were going to be a problem for us, before the pandemic hit our shores,” Friese said.
Studies were already suggestingthat nurses believed low nurse-to-patient ratios were harming patients, he said. “Obviously, COVID has made things more difficult and more challenging. But … if we look back and track nurse surveys over time, I would say we’ve known that workplaces have been unsafe and unsupported for about a decade.”
But that crisis accelerated during COVID, Friese said, when many hospitals tried to reduce costs by laying off staff. While doctors can order expensive tests and procedures that drive revenue for hospitals, “nursing is 100% expense. It is a labor cost … so often the first place hospitals look (for cuts) is to the nurse staffing budget.”
It turns out that was a “really bad idea,” Friese said. Many nurses with decades of experience were given retirement incentives. Meanwhile, the remaining nurses found themselves caring for really sick patients, without enough help. Burnout rates skyrocketed. Private staffing agencies offered lucrative paychecks that incentivized travel nursing through temporary contracts — something that ended up costing hospitals even more money when they found themselves short-staffed.
So when hospital administrators tell Friese they can’t afford to pay nurses more, he tells them they’ll just end up paying more in the long term. “How much are you spending on your recruitment budget and your orientation budget, when you’re losing a quarter of your nurses each year? A quarter of your nurses are leaving your system every year and you’re recruiting and you’re orienting and you’re trying to get people up to speed, and that’s loss you’re never going to get back.
“And we also know these younger nurses are now the most likely to leave. So the future (nursing) community, these are the folks who we hope would work for 20 to 30 years, are heading for the exits.”
Across the country, nurses and hospitals are fighting over staffing ratios, as the risk to patients has grown. “I get a lot of calls and emails from [physician] colleagues saying, ‘This is really dangerous. I’ve never seen anything like this in my career, I’m very worried for my patients.’ A very prominent senior physician in the Boston area has called me and said, ‘The system is sick.’ This is not sustainable.”
But while hospitals in Michigan ask for taxpayer funding to help with staffing and lobby against legislation that would mandate nurse-to-patient ratios, they also publicly insist that staffing levels aren’t currently endangering patients. Asked about the MNA poll suggesting an increase in patient deaths due to understaffing, an MHA spokesperson said the organization couldn’t comment on it specifically because they hadn’t seen the poll. “There has been no scientific study that we’re aware of that supports this claim,” the spokesperson said in an email. “Staffing at the local level is necessary to ensure hospital and patient needs are met, as conditions and severity can vary widely by locality.”
On Wednesday, Hattem-Schiffman, the central region president of MyMichigan Medical Centers in Alma, Clare, and Mount Pleasant, sent an internal email to staff at the Alma hospital, where the nurses’ union recently voted to authorize a potential strike. In her email, Hattem-Schiffman said a Michigan Radio story with nurses alleging unsafe staffing at the hospital was forthcoming, and that nurses from the hospital had participated in the story:
“As we work faithfully toward [a contract] agreement, we still must ensure that the outstanding work and reputation of this entire team and our medical center is maintained, so that patients continue to feel safe when entrusting us with their care. I am so proud of everyone who works at MyMichigan Alma and I am proud of the great work we do for the communities we serve. I will not let anyone disparage the great work we do."
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