University of Iowa nurses protest higher patient ratios

IOWA CITY — With signs and sunglasses and heavy hearts still fully committed to the mission that drew them to health care, University of Iowa nurses on Thursday convened outside their hospital to air grievances and warnings about news they’ll be caring for more patients at one time than is typical or ideal.

“When you think about everything a nurse does in a shift, it's pretty overwhelming,” UI Hospitals and Clinics staff nurse Ashley Lynn told reporters, holding a sign enticing passing cars to honk in support and solidarity.

Assigned to the cardiac unit, Lynn said her patients can be pretty sick, requiring more of her time than a few minutes.

“Just to get everything done and spend time with your patient and have a report with them, that really takes up your whole day — including charting,” she said. “So then you're adding another patient and all of those responsibilities on top of it, it just seems kind of impossible really.”

Joining Lynn on the corner for a peaceful protest against UI Health Care increases in nurse-patient loads were nurses who’ve been there a decade or only two years; nurses in their 20s and in their 60s; nurses on surgical floors and the intensive care unit; some wiling to be named and others fearing retribution.

Depending on the unit and floor and acuity level, a typical patient load can range from two per nurse to four or five per nurse, they said. Upping the ratios means juggling more with less, according to the nurses.

A medical-surgical nurse told The Gazette she’s been told starting Saturday she’ll be balancing five patients at a time, up from four now and the preferred three, requiring she keep straight their drips and medicines and call signals — a task made especially hard when they’re spread over different pods.

“It’s hard to manage all those, especially if you have a confused patient or someone that’s detoxing or that needs frequent neuro checks,” she said. “It’s impossible to manage that when you’re dealing with five patients. And we’re short on nursing assistants on top of that.”

Sending a nurse home after a 12-hour shift of five patients at a time is only going to accelerate the burnout playing into the nursing shortage affecting the state, region, and nation — a shortage the pandemic amplified, some of the protesters said.

“And we don’t have any auxiliary staff,” one nurse said. “So not only are we nurses, we’re also the nursing assistants, the lab staff. What else can we do?”

Overburdening nurses is not only a concern for the workforce’s moral and mental health, it’s a safety and quality issue for patients, they said.

“There's a direct correlation between patient ratios and medication errors or medical errors in general happening,” one ICU nurse told The Gazette. “It affects patient, nurse well-being. It affects safety. You see an increased number of falls, you see an increased mortality rate in the patients across the board. You see medication errors going up, and it affects the happiness of your nurses.

“You see more absenteeism. You see nurses leaving the industry altogether.”

UIHC administrators are working to hire more staff nurses — holding recruitment events to fill the 381 open nursing posts on the UI jobs website. They’ve been using traveling nurses to plug holes for years — paying contracting agencies a premium for the temporary nurses who step in a few months at a time.

Although some staff nurses historically have expressed dissatisfaction those visitors make more than they do, nurses protesting outside UIHC on Thursday said they don’t care how much they make — as long as they’re on site helping.

“I view travel nurses as temporary to fill the holes so that I can do my job in a quality way,” Lynn said. “And I don't see anything wrong with that.”

UIHC officials haven’t answered questions about whether they’re changing traveling nurse compensation or planning to rely less on them going forward.

“I know nationwide the travel pay has gone down as a whole, but the university still needs to make theirs competitive enough to keep them here,” Lynn said. “We have quite a few travelers on my unit and they do wonderful.”

UIHC officials didn’t answer questions on whether they’re upping nurse-patient ratios. They did provide a statement characterizing staffing changes as optional.

“Hospital staffing needs can change quickly based on the number of patients and their level of acuity (severity of illness),” according to the statement. “When more staff are needed, existing staff have the option to pick up additional shifts or hours for additional pay.”

Administrators reiterated their commitment “to providing safe, high-quality care.”

“This means having a team of staff who care for patients in a safe, supportive work environment.”

As to questions about changes in travel nurse usage, officials said, “The number of travel nurse contracts has stayed consistent at UI Health Care.”

“The number of travel nurses who accept those roles may vary from month to month. Traveler rates vary based on supply and demand and prevailing market rates, and we continue to pay contractual rates that are competitive in the market.”

Regardless of the reason behind the higher nurse-patient ratios, UIHC physical therapist Barbara Stanerson, 63, said she’s concerned.

“The community is really invested in this hospital, they love this hospital, this university,” said Stanerson, who’s worked at UIHC for a decade and joined in Thursday’s protest. “In Iowa, this is the only place I’d want to work. And I've always been very proud of the work they do here. But in the past year, I for the first time have been embarrassed at some of the care that patients are getting — because there just isn't enough staff.”

Vanessa Miller covers higher education for The Gazette.

Comments: (319) 339-3158; vanessa.miller@thegazette.com