In a world where nursing and other healthcare worker shortages are the new norms, it might sound unbelievable that any healthcare system would have ever focused on cutting down their employee staff—but that’s what the Ascension Hospital System did in the years leading up to the pandemic, claims a new investigation by the New York Times (NYT).
The article claims that Ascension Hospital Systems, responsible for 139 hospitals across the nation, including Genesys in Flint, MI, strategically focused on reducing the number of employees per occupied beds and “boasted” about slashing $500 million in labor costs—all before the pandemic hit, leading to what is now critically unsafe nurse-patient ratios that are affecting patient safety and healthcare workers’ mental and physical health.
Nurse.org spoke to Linda,* a 15-year veteran nurse of Genesys with nearly 30 years of healthcare experience, who confirmed that staffing is the #1 challenge nurses are currently facing at the hospital. Linda believes they are at unsafe levels. She described issues she has witnessed at the hospital from physicians leaving to patient care being compromised to her own well-being suffering.
“I wanted to walk away from nursing altogether,” she tells Nurse.org, citing the conditions she has been working in. “I’ve been a nurse in my heart since I was a little girl and have worked in the healthcare system since I was 15 years old. So for me to have those kinds of raw and very real feelings is very telling. Because I’m a nurse to my core. I take it very, very seriously.”
Ascension Hospital Accused of Downsizing, Massive Profits & Unsafe Conditions
To illustrate what the NYT called a larger strategy by Ascension to cut costs and boost their own profit ($18.1 billion cash reserves and an investment company that manages $41 billion in assets), the investigation focused on two specific Ascension hospitals: St. Joseph in Illinois, acquired in 2018, and Genesys, a unionized Ascension hospital, in Michigan. Reporters from the Times reviewed more than 3,000 pages of logs from nurses that documented unsafe conditions and spoke to 70 current and former nurses as well as other workers at the hospitals.
The reports and logs detailed staffing cuts, patients not receiving timely care, delayed surgeries as a direct result of insufficient staffing, and requests for more staff turned down, despite open positions. “Every day it’s unsafe staffing!!!” one nurse’s note read in June 2020, said the Times.
Driving the lack of staffing, the Times claimed, was Ascension’s executives handling the hospital system as a for-profit business, despite the fact that the hospital chain is non-profit, a status that saves it $1 billion in taxes annually. Their strategy included hitting financial targets. “Their whole approach to the finances was right out of the Wall Street playbook,” said William Weeks, who worked as chief operating officer of a five-hospital chain in Oklahoma owned by Ascension, told the paper.
In 2021, Ascension’s CEO, Joseph Impicciche, was paid $13 million according to the Times.
Ascension’s Pandemic Problems
The Times reported that after Ascension had acquired St. Joseph’s in 2018, staffing became progressively worse—and then the pademic hit. Reports of being overwhelmed from nurses, concerns for patient safety, and formal complaints quickly piled up. Times reported that according to the Illinois Nurses Association, the number of Registered Nurses at the hospital dropped by 23% at St. Joseph’s since Ascension’s acquisition.
Nick Ragone, an Ascension spokesperson, countered the claim to NYT reporters, citing that St. Joseph’s number of employees per occupied bed actually increased by 6% between 2018 and 2021. But, NYT pointed out that that figure partly reflects Ascension having reduced its overall capacity and additionally, does not reflect nursing-specific rates. Ragone declined to provide data specific to nurses, the Times reported.
Linda confirmed that while staffing challenges have always existed at Genesys, they were somewhat “manageable” before the pandemic. However, now, she says staffing has reached critical levels in many units. On a critical care step-down unit, for example, she says nurses are routinely expected to take up to 7 patients, nearly double what their contract stipulates as an acceptable nurse-to-patient ratio of 1: 3-4.
“I don’t think I could stress that enough,” she replied when asked if she believed nursing staffing is at unsafe levels. “I don’t even know that anybody could even possibly understand that unless they have been in the thick of it. This has been really bad…I don’t know that they ever had the proper ratio ever.”
“I do hear people screaming and crying out for help and you just can’t get to them,” she added. “Family members are frustrated because things aren’t done in a timely manner. Some people cut corners in charting, taking much needed breaks, or are having to delay basic hygiene needs of the patients in order to meet more pressing needs like administration of medications or execution of other medical services.”
“You can’t do it all,” she continued. “It’s unbelievable. So yes, I do think absolutely patients are negatively affected, and not only patients which are our number one priority, but any staff member that works there cannot be in tiptop mental and otherwise shape.”
An Ascension Nurse Speaks Out
Linda told Nurse.org that she has been personally threatened with potentially being “walked out” by hospital administration if she did not comply with her assigned patient assignments—ratios that were contractually inaccurate, forcing her to take nearly double the patients she could possibly have. “The ratio was supposed to be three to four,” she says. “But very rarely, were we allowed to have only three patients, even though our contract–that is seemingly safe–says three.”
She cites many problems that she has personally witnessed as a Registered Nurse with Ascension, including:
Nurses were routinely told they must draw their own labs because lab staff was not available.
Nurses are routinely expected to act as pharmacy liaisons–another separate staffed position responsible for reconciling home medications for the PCP.
Entire units are being shut down, reportedly due to a lack of staffing
Grievances filed through the Union that has been ignored.
The loss of benefits for nurses such as discounts in health care services to Ascension employees, and fewer options of medical insurance coverage, frozen pensions, and frequent denial of personal time off.
Physician staff leaving.
Postings for “Lean practitioners,” which Linda explains she was told were positions for people hired to come into the hospital to find ways to save money. “I guess it’s not a bad thing, in theory, but slowly over the years, we noticed where they would get rid of in-house services [sic] and that became something that they contracted out of the house,” she said.
Lack of patient transporters, which sometimes resulted in testing delays or requiring an already short-staffed floor to have their own nursing assistants or nurses leave and take patients to test or procedures.
Nurses in long stretches of hallways by themselves with no one to cover them should they need to use the restroom or take a break.
New policies were enacted that allowed ER to simply deliver a patient to the floor with a written sheet of paper without ever having to speak to the receiving floor nurse in the event they were unavailable with other patient needs.
Delays in procedures such as pacemakers or other heart procedures due to inadequate levels of cath lab staff.
Linda also recalled an incident that she called the “turning point” for her when a patient passed away in a manner she believes was directly tied to unsafe patient-nurse staffing ratios.
“Can I say that it was 100% a staffing issue?” she noted. “I cannot say that. But if you’re going to ask me what my gut instinct as a nurse of 26 years is? Yes, I think that it probably was.”
On December 16, Ascension Genesys posted a video to their Facebook page of Chief Clinical Officer Dr. Rich Fogel encouraging viewers to learn how the hospital is “putting patient safety and quality first.” Read through the comments to see responses from nurses who work there.
Ascension’s Public Response
Ascension posted a public response on their website that they stated was sent to NYT reporters before the article went live. The statement claims that the NYT article is wrong and that staffing levels not only did not decrease before the pandemic, but actually increased:
“Unlike what The New York Times has indicated that it was told, the reality is that Ascension’s hospital staffing levels – particularly bedside nursing staffing – increased in the years leading up to the pandemic and continue to exceed levels maintained by the majority of our peers.”
In addition to providing evidence of quality measure standards—such as reduced readmission rates, urinary catheter infections, and a low overall risk-adjusted mortality rate—Ascension listed data behind their staffing levels. According to Ascension, staffing increased from 82,334 full-time equivalents (FTE) employees in the fiscal year 2010 to 124,995 FTEs in June 2020, before the pandemic hit.
They also said that from 2016 to the present, the number of full-time equivalent bedside nurses per patient discharge increased 64% while the number of discharges has remained relatively flat. The statement continued:
“Furthermore, independent third-party analysis by Accenture demonstrates that our staffing levels overall exceed those consistently maintained by our peers – with our Michigan market most significantly exceeding comparable industry benchmarks. From 2013-2021, Ascension Genesys’ level of nurse staffing far exceeded the state of Michigan median. In fact, Ascension Michigan’s hospitals overall exceeded the median. In Illinois, our hospitals had staffing levels comparable to their peers, yet while other systems’ nursing numbers are falling, Ascension Illinois’ are growing, and our nurse staffing exceeded the median in 2021, the most recent year that data is available.”
Ascension also stated that any current staffing challenges they are experiencing are a direct result of the COVID-19 pandemic, not reflective of any of their prior actions in staffing, and in line with what every other healthcare network is experiencing:
“Any allegation that Ascension’s current workforce challenges relate to workforce decisions made in years prior to the COVID-19 pandemic is fundamentally misguided, misleading, and demonstrates a lack of understanding of the impact of COVID-19 on the healthcare workforce.”
Nurse.org asked Linda if she believed Ascension’s claim that staffing—specifically bedside nursing staffing—has increased since the pandemic was true.
“Wholeheartedly, absolutely false,” she replied. “If I could be more impassioned, I would. That’s a big no.”
Nurse.org reached out directly to Ascension for a comment regarding the Times article and will update this article once a response becomes available.
*Name has been changed to protect privacy