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On a recent Saturday night, Nurse Joan Greaves worked a shift in Greater Southeast Community Hospital’s labor and delivery ward alongside only one other nurse. Greaves usually has at least three colleagues at her side, or maybe two when things are tight. At the financially imperiled hospital on Southern Avenue SE, things have been tight a lot lately.
Greaves resigned herself to a long night. “You just come to work,” she says. She’d been badgering her bosses for either staffing help or a reduced caseload, but no relief was forthcoming. There would be no third nurse, no re-routing of patients to other hospitals.
The delivery-room shift started out badly and got much, much worse. One patient came in about to deliver. Another came in screaming and high on marijuana. Another was in labor all night. And then came a woman high on crack and ready to give birth. “She was jumping out of bed,” Greaves says. “She was crazy, period.”
Greaves heard a scream. In Room 6, yet another patient, in active labor, refused to take her clothes off. By the time Greaves and a fellow nurse had gotten her undressed, she, too, was ready to deliver. And Greaves had still more patients to watch.
By 4:30 a.m., Greaves’ supervisor was watching over the crack mother, and a nurse who had worked an earlier shift and slept over had been waked up to help out. “It can get very tight,” Greaves says. “And it got very tight. I would call all of that a close call. Patient comes in ready to deliver, you do what you have to do. [The hospital] tries to cut it as close as they can.”
Being a nurse is never easy. But at the only hospital in D.C.’s impoverished Ward 8, where the danger of fiscal collapse makes a nurse’s next paycheck uncertain, it’s almost impossible. For those who dodge staff cutbacks and the occasional shot at an easier assignment to stay at Greater Southeast, nursing’s traditional job description falls well short of their day-to-day functions. Greaves says the very factors that leave her wearycaring for more patients than she says she can handle, staying at work late, not getting a substantial raise for years, and worrying about whether the hospital will meet its next payrollare also the things that make her unable to imagine going anywhere else.
“I’m not going to leave,” says Greaves, who has worked at Greater Southeast for 23 years. “I’ve been there too long. They need good nursing care just like the people across the bridge. They need us….We do the best we can. This is part of why people stay there. You go somewhere else, and you are on your own.”
Last year, Greater Southeast had an estimated operating loss of $68 million. It owes millions to creditors and last fall its bond rating tumbled. The hospital has laid off more than 300 employees over the past two years. Although the D.C. Council passed emergency legislation last week that could bring the hospital a $5 million loan, the bill probably won’t alleviate chronic staffing shortages any time soon. Mayor Anthony A. Williams’ decision to speed up city payments to Greater Southeast will likely mean the institution will meet its next payroll, but its long-term status remains cloudy.
“I think we recognize the challenges we face, and we intend to meet them,” says Paul Porter, Greater Southeast’s vice president of corporate planning and development.
The nurses aren’t holding their breath. “It’s very unstable,” explains Jane Link, a nurse who has been at the hospital for 10 years. “I polished up my résumé. It makes for a lot of emotional upheaval. Will I have a job next month? Next year? Will I have to travel farther to another hospital? Change my lifestyle? Other people have leftfive or six of my friends have left.” A friend put in her resignation a day ago, and Link admits she’s a little jealous.
Payroll uncertainty is just one of the staff nurses’ gripes. Of the 300 Greater Southeast employees recently laid off, Valerie Tate of the District of Columbia Nurses’ Association reports that roughly 60 were nurses. Another 60 have since left on their own, Tate adds, claiming that Greater Southeast has replaced them with what she considers poor substitutes: temp nurses.
Tate criticizes temps from a patient-care standpointshe claims they don’t know the computer system and don’t have the same long-term devotion to the hospital and its patientsbut staffers have some obvious bottom-line complaints, too. Although the hospital administration refuses to give figures on temp salaries, several nurses interviewed who also work part-time as temps say they have received as much as $45 to $50 per hour for irregular work. According to Michelle LeSane, a spokesperson for the hospital, the average salary for full-time nurses is $24 per hour.
But it is when they talk about the workplace that Greater Southeast’s nurse stories turn from your average office gripes to something more dramatic. Nurses work double shifts, sometimes sleeping over in emergencies. Some get left to cover whole wards alone. Nina Zupancic remembers being left at the mercy of one crazed patient on her psychology ward. Marge Meskunas often works the pediatrics night shift alone. Although the ward has lost four nurses and a part-time secretary, she still cares for as many as 14 patients.
Meskunas says other nurses try to fill in. If they can’t, she’s out of luckand takes her bathroom breaks in public, since she can’t be out of her patients’ earshot. “I pee with the door open, like when my own kids were little,” Meskunas, 59, says. “You want to keep an eye and ear out for when someone comes on the floor. Someone can take a child. A lot of weird things can go on. I don’t feel safe to close the door.”
Christina Carver and Joanne Francis say short staffing and a carousel of temps have added up to close calls on prescription dosage. “Medication errorswe found wrong calculations on medication,” Francis says. Porter says he is not aware of any such problems.
Still, the veterans stay. Meskunas says she can’t leave because after 15 years at Greater Southeast, her co-workers have become family and her patients have grown into familiar faces. The day-to-day grind has become a Catch-22: Meskunas can’t leave because the problems are so bad, yet she wants to leave precisely because the problems are so bad.
Merriel Georg lives two blocks from Fairfax Hospital but gets in her car and drives the 25 miles to Greater Southeast to work the day shift in the intensive-care unit. She says she ends up staying late most nights. On a recent Wednesday, Georg worked her usual 12-hour shift. The temp who spelled her didn’t normally work the critical-care center. So at the end of the daylike a nervous parent leaving a baby sitter with her kidsGeorg took time to leave a detailed set of instructions. “You work here,” Georg says, meaning the temps don’t. “It’s your responsibility to make sure those patients are taken care of properly.”
On a warm Thursday evening, Carver and fellow nurse Helen Moore slowly stutter-step out of the emergency room. Cigarettes already in hand, they immediately light up, ignoring the “No Smoking” signs along the entrance. They are big women, with big laughs, who smoke big cigarettes: Benson and Hedges Deluxe Ultra Light Menthols for Carver and Winstons for Moore, who still wears her stethoscope around her neck. It is the end of their 7 a.m.-to-7 p.m. shift. They look tired as hell, their eyes glassy, their voices rough. Both are still in their nurse’s uniforms.
Moore, 43, has worked at Greater Southeast for 20 years. She knows the hospital used to be one of the best in the countrylanding kudos from the Harvard Business Journal and the American Hospital Association. In the early ’90s, as other health institutions suffered, Greater Southeast’s administrators were feted with retreats and praised for their innovations such as bringing doctors into area schools and providing services to the elderly.
The hospital’s main entrance wallswith their ’80s-era black-and-white photos, laminated newspaper clippings, and kindergarten-orange paint trimtell the story of its not-so-distant glories. And because the same decorations now haven’t been changed in a decade, they tell the story of the institution’s more recent difficulties, as well. The hospital publicly blames its financial trouble on the bulk of its clients’ being uninsured or receiving Medicaid.
Whoever’s at fault, hospital staffers will pay some of the cost. A few months ago, nurses bargaining for a new contract faced the proposition of a 10 percent decrease in pay and no retirement benefits as a reward for their dedication. After the Nurses Association caused a stir, the proposals were taken off the negotiating table. Tate hopes to reach a settlement for a new contract this week.
More than 300 nurses, activists, and former patients showed up for a late-April union protest. It quickly turned into a demonstration in support of the strapped hospital, a pep rally to keep the institution on life support. They held red, white, and blue signs reading: “Save Our Community Hospital” and “Support Our Community.” They prayed and sang spiritualsnot over jobs, but over the institution itself.
After 12 more hours in the trenches, Moore says she doesn’t care that the agency nurses make more. She doesn’t care that staffs sometimes come up short. She says she’s still in it for the long haul. “I’ve gone through anger, frustrationnow I don’t care,” she says. “Whatever happens, happens. I think about it and just laugh.”
As Moore leaves to finally head home, Shirlisa Snowden, 29, walks out for a quick break. An emergency-room nurse, she’s working an extra four hours tonight, giving herself a 16-hour shift. She has worked at Greater Southeast for only the past seven years. Ironically, since the hospital hasn’t been in a raise-giving mood, Snowden says she has had to resort to working as a temp nurse on her days off.
Instead of her usual $19.96 per hour at Greater Southeast, Snowden says she can make as much as $40 per hour as a temp. With a new house and a fat mortgage that needs paying off, Snowden has little choice. “You do what you have to do,” Snowden says. “I don’t fault the hospital. I temp because I need the money.”
With her five minutes up, an ambulance rolls in. Snowden asks the driver what the patient’s problem is. He tells her it’s a “detox,” no big deal. But Snowden goes inside to help anyway. You never know. CP