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Nurses At Unity Center Release Report On Staffing, Safety As Contract Negotiations Stall

Management says it has addressed safety and staffing and that the administration values its nurses.
Unity Center for Behavioral Health is in Northeast Portland.
April 5, 2021

Nurses at Portland’s only psychiatric emergency hospital, Unity Center for Behavioral Health, have taken their frustrations over stalled union negotiations to the public with a report that accuses the administration of allowing unsafe conditions.

The March report, published by the Oregon Nurses Association, the largest nurses union in the state, cited instances of staff injury, missed breaks and compromised patient safety and care, which it indicated were largely due to short staffing. The report accuses Legacy Health, which runs Unity, of falling short on fixing the safety and short-staffing problems that threatened to end Unity’s federal funding in 2018, the year after it opened.

The report says that the nurses decided to release the report to alert the public to conditions at Unity. But Legacy officials say the report is a bargaining ploy.

“The report put out by ONA is a bargaining tactic, and it is not an accurate depiction of what is happening at Unity,” Melissa Eckstein, president of Unity, told The Lund Report.

She said it was unclear what the report was based on. The report cited dozens of nurse complaints to the union about staffing between last November and January. It’s unclear why that time period was singled out, though in November, the nurses filed a complaint against Legacy with the National Labor Relations Board that accused it of bargaining in bad faith.

The union declined to release the complaints cited in the report -- even to Unity, Eckstein said. The union also denied a request for the documents from The Lund Report.

Legacy also collects staff complaints -- but it, too, declined to release them.

The two sides don’t appear to be near an agreement even though it’s been nearly two years since the nurses voted to unionize.

Pay Is Not The Problem

Pay is not a big sticking point in the negotiations. The registered nurses, who make from about $40 to $60 an hour, say they’re satisfied with their current pay scale. But they want an increase in staffing.

“Short staffing is a huge issue,” said Ashley Anderson, who’s been at Unity for three years. “That’s the biggest issue for me.”

The report said that between November and January, nurses filed 52 complaints to the union about staffing shortages. 

Anderson said the hiring more nurses would minimize injuries and stress. Confused patients can lash out, nurses said, and sometimes they attack staff. The report said that in those three months, a patient broke a window with a chair and assaulted a nurse in another instance.

The latter happened to Anderson. In January, she went into a hold room to draw a blood sample from a patient and take his vitals. The rooms, which have a mattress but little else that could be used as a weapon, are used when patients pose a risk to themselves or others. 

“We try to minimize the use of those rooms,” Anderson said. “They’re only meant for crisis stabilization.”

After she took the blood sample, the patient attacked her.

“I got punched in the face and dragged down to the ground and was kneed in the ribs and the stomach several times,” Anderson said. “I had a bunch of hair pulled out while our security tried to get him away from me.”

Two security officials who had accompanied her to the room were waiting outside. Though they were quick to react, she said she ended up drenched in blood and had her cuts treated at Legacy Emanuel Medical Center’s emergency department. 

Anderson believes that if she had been accompanied by another nurse, the two of them could have calmed the patient down without the need for security guards. She cited the attack as an instance where short-staffing affects nurses.

Eckstein denied that Unity lacks nurses. She said that nurses are never on their own without someone else nearby. And she said nurses are always aware of the state of a patient when they have to treat them during triage, for example. 

“We also have a process in place where staff can ask, if they don’t feel safe and if they feel like they need some additional resource, whether that’s another person or whether its a consultation from a provider, that those things are available to them,” Eckstein.

She also said Unity encourages staff to report safety concerns.

“It doesn’t matter how big or small that concern may be.” Eckstein said. “We want to hear about it.”

That January attack didn’t discourage Anderson from returning to work, and she said she didn’t suffer permanent injuries. But she said she will no longer treat patients in hold rooms.

“People are still doing lab draws in these hold rooms, and checking vital signs,” Anderson said. “People are still having to put themselves at risk.”

She thinks the rooms are poorly designed but acknowledged it would be prohibitively expensive for Unity to redesign them now.

“It would be wildly expensive to change the layout of the hospital,” Anderson said.

Other Complaints About Staffing Shortages

Sarah Mittelman, who’s on the nurses’ bargaining team, is a charge nurse in psychiatric emergency services, or what’s known as the PES. It’s an open room with recliners. Patients are assessed and treated with medications as needed, and then discharged when they’re stable, unless they need to be admitted. The PES has about 30 chairs now - compared with about 50 before the pandemic - to ensure social distancing. But Mittelman said she still spends a lot of time “putting out fires.”

“We’re often unable to deliver one-on-one care because we’re putting fire after fire out,” Mittelman said. “We would like better staffing to a level that it feels safe. Right now it doesn’t feel safe. And we’ve been saying this for awhile.”

Christine Allen, who joined Unity before it opened in 2017, echoed a similar sentiment. Allen is a charge nurse in the in-patient portion of Unity, and she, too, is on the bargaining team. 

She recalled in February an attack by a patient on a nurse.

She heard screaming from a dining room for patients that was far from the nurses station.

“I started running immediately,” Allen said. “I thought it was a patient assaulting another patient.”

She found a nurse on the ground and a patient pulling her hair and beating her up. Allen intervened as other staff arrived.

“(The patient) caught her off guard and pushed her to the floor,” Allen said.

She said the nurse has not worked in her unit since then over fears of being attacked by the patient who is still there.

Allen said short staffing is a culprit in situations like these.

“In the fall and winter, my unit was understaffed about 50% of the time,” Allen said.

Legacy Health has a staffing grid to determine the number of staff members needed. Based on the grid, Allen said she should have five or six nurses on most days but sometimes runs short or needs more than the grid calls for.

“If you have six very sick patients who are highly psychotic or suicidal, it’s impossible for a nurse to care for five or even four patients,” Allen said. 

Unity Weathers Past Problems

Unity opened in 2017, founded by Kaiser Permanente, Oregon Health & Science University, Adventist Health and Legacy, which runs the facility. By 2018, it was facing complaints of short-staffing, negligence, a sexual assault and staff and patient injuries. Two patients died, including one by hanging. Unity almost lost its federal funding. 

Eckstein was hired in 2019 to keep the facility on track. She said that 25 nurses have been added since the facility opened. About 200 nurses now work at Unity.

“We have adjusted our staffing over the years based on safety concerns,” Eckstein said, “and I think that when we’re compared with similar facilities we are on par if not better than those other facilities.”

Providence, which is not part of Unity, did not respond to a request for its staffing levels for psychiatric patients, and a manager at Cedar Hills, an in-patient psychiatric hospital in the Portland area, also declined to respond. The American Nurses Association which maintains a staffing database, also did not immediately respond to a request for comment.

The nurses say they don’t know how many more need to be hired to make them comfortable but they’re pressing for more in the negotiations.

A federal report last September cited new problems at Unity, including sexual encounters in a bathroom, an attempted suicide and a lack of nurses. At the end of the last year, following a corrective plan by the administration, the Centers for Medicare & Medicaid Services said Unity was in compliance.

Eckstein said that nurses have a say in staffing levels through their representation on a staffing committee. Each unit of Legacy Health is represented, including Unity. 

“Our nurses have a place where they can review the staffing plan, have input into the staffing plan and vote on the staffing plan,” Eckstein said. “We also have an established mechanism in place every day where nurses and charge nurses and house supervisors look at our acuity across the board and if nurses voice concern about safety -- say they need acuity staffing -- that’s something that they can request at any time.” 

But Mittelman, who is on the staffing committee, said that acuity levels -- the severity of symptoms -- are not being accounted for in staffing.

“What we want is to deliver safe care and reduce harm to patients,” Mittelman said. “One of the ways to achieve this is to staff units according to patient acuity and nursing intensity.”

Some patients in a mental health crisis -- which is the main population Unity serves -- can demand more time from a nurse.

“Sometimes our patients misinterpret their environment and this can lead to stressful situations. They don’t realize they’re in a hospital or that we’re there to help,” Mittelman said. “But management is very resistant to helping us get more staff.”

A Demand To Be Heard

Besides staffing, the nurses are pushing to have a bigger say in how the hospital is run. They want to form a committee to be able to influence patient care. 

“I don’t think the management at Unity allows nurses to have a voice when it comes to problem solving,” said Anderson, who was assaulted in January. “We don’t have a lot of input into how the hospital is run and how care is given. But we spend the lion’s share of time with these patients.”

Allen, the in-patient charge nurse, agreed. She said that since Unity opened, much has improved, but not a feeling that management is more interested in the financial bottom line than its staff.

“We need union protection to protect us from (managers) who’ve made us feel that they are out to protect the corporation -- Legacy Health -- and not us,” Allen said.

Eckstein denied that her administration is insensitive to nurses’ needs.

“We could not do the work that we do here at Unity without our nurses,” Eckstein said. “We value our nurses, and they really are at the heart of everything that we do and the care that we provide. We care about them, and we want them to be safe. We also want them to be compensated fairly for the exceptional work that they do.”

And so the negotiations continue, nearly two years after the nurses voted to unionize, with the two sides meeting once a week and no contract in sight.

You can reach Lynne Terry at [email protected] or on Twitter @LynnePDX.