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OHSU Manager Told Nurse To Staff Shifts With A ‘Fiscal Lens,’ Not Just A Safety One

An OHSU charge nurse was investigated for her “tone” when raising patient safety concerns, prompting the Oregon Nurses Association to file a complaint.
Photo of hospital building.
OHSU Hospital on Marquam Hill. | LYNNE TERRY/THE LUND REPORT
November 1, 2022

The Oregon Nurses Association has filed a labor complaint against Oregon Health & Science University after a manager urged a nurse supervisor to employ a “fiscal lens” when making staffing decisions, as well as considering patient safety. 

The nurse protested what she considered a threatening response to her concerns about the “fiscal lens” comment — and soon found herself under investigation for her “tone.”

The ONA filed a complaint with the state Employment Relations Board on Oct. 27 based on a disagreement between managers and Mackenzie Chown, a labor and delivery charge nurse and union steward who serves as a representative to the OHSU nurse staffing board.

In a statement to the Lund Report, OHSU spokesperson Sara Hottman declined to comment directly on the case, but said, “OHSU takes seriously our commitment to the safety of our patients and clinical staff, and we value our partnership with the Oregon Nurses Association in maintaining a safe and healthy workplace.”

The complaint is part of larger tensions over staffing levels at OHSU even as top leaders blame surging labor costs for undermining the institution’s bottom line. Under Oregon law, hospitals are required to have a staffing plan and set their own staffing ratios for different units and shifts, based in part on the needs of the types of patients served. 

Chown is set to be a witness in an upcoming grievance arbitration by ONA concerning staffing levels that is scheduled for March 6. In its complaint, the ONA suggests that the incident that began with an exchange between Chown and Molly Blaser, the director of women’s and neonatal services at Doernbecher Children’s Hospital, represented an effort to intimidate Chown ahead of the arbitration.

“OHSU managers hostile questioning and disciplinary investigation would result in a chilling of reasonable employee’s willingness to engage in protected concerted activity,” the union stated in the complaint, suggesting Chown’s treatment violated state laws protecting union officials from coercion and interference.

The friction began on Sept. 22, at a meeting of the hospital’s nursing practice committee composed of ONA and OHSU representatives. There, Chown expressed concerns regarding staffing safety issues, and ONA representative Amber Cooper cautioned attendees over discussing solutions outside of the grievance procedure due a pending grievance filed over staffing issues, according to the ERB complaint. 

Chown then had a phone conversation with Blaser on Sept. 28 in which Blaser criticized Chown’s staffing decisions, according to the complaint.

In an email later that day, Chown told Blaser she was “very uncomfortable with the conversation we had this morning. It felt like you were trying to bully and threaten me with the statement ‘we'll be talking about this later’ in regards to having extra nurses without assignment.”

In an emailed response, Blaser asserted that Chown overstaffed during a recent shift at OHSU Hospital by staffing nine nurses for four patients. Chown told Blaser the extra nurses were necessary for the shift, since all four patients had complicated deliveries that needed urgent attention.

“This was what[‘s] safest for our patients,” Chown wrote. 

In addition Chown told Blaser that two extra nurses were necessary during the shift to meet Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) standards by having meal and break nurses.

“As charge nurses we should be supported for doing what is best and safe for our patients and it is unacceptable to have to constantly advocate and justify having extra nurses on the unit that don't have assignments, especially being a high risk level one trauma OB hospital,” Chown wrote. “I did not feel supported.”

In response, Blaser wrote, “From my perspective, you were significantly overstaffed and should not have needed that many nurses at that time. I believe that we are not on the same page on how many nurses we should staff with only 4 [patients]. We are needing to staff safely AND with a fiscal lens as well.”

Chown then asserted that Blaser’s focus on staffing with a “fiscal lens” was “in direct violation of the OHA nurse staffing law” and also noted that OHSU’s staffing plan was approved by the staffing committee “months ago.” In addition, Chown told Blaser that AWHONN standards aremust be followed. At that point, Chown told Blaser she was not comfortable speaking further in person without representation.

On Sept. 29, OHSU manager Jane Russell emailed Chown requesting a meeting with Chown to discuss “Professionalism and code of conduct.” The meeting focused on Chown’s “tone/style of communication” in her exchanges with Blaser on Sept. 28 and on Chown’s “Code of Conduct issues,” according to the complaint. 

According to a transcript of the meeting, Russell cited and read aloud to Chown Article 4 of Collective Bargaining Agreement (CBA) regarding management rights: “These rights of management shall include, but not be limited to...suspend, discharge or take other proper disciplinary action against employees... relieve employees from duty.” 

Chown’s ONA representative Cooper alleged in response that citing the Code of Conduct to Chown was an act of intimidation that interfered with Chown’s witness regarding the staffing issues in the arbitration scheduled for March 6.

“When she’s speaking about staffing, she’s advocating for safe staffing,” Cooper said of Chown’s communication with Blaser. “With arbitration date of March ... for you to call her to a disciplinary meeting with that not settled, that’s intimidation, could have a chilling effect, we will consider filing unfair labor.”

Following the meeting, ONA pursued an unfair-labor-practices complaint with the ERB.

“She was targeted for both as a union steward and a nurse staffing committee member for her vital advocacy for safe staffing to protect the safety of Labor and Delivery patients at OHSU,” Cooper told the Lund Report in an email.

According to the OHSU media relations manager, Hottman, “Oregonians need OHSU now more than ever, and we thank our dedicated health care workers for continuing to go above and beyond through this unprecedented time to provide our patients with quality, compassionate care.”

Aurora Biggers can be reached on Twitter at @aurorabiggers.