HEALTH CARE CRISIS: Nurses flag culture amid shortfall

Oct. 29—TRAVERSE CITY — It was the late 1980s when Heather Rollo, then 20, recalls paging through a Northwestern Michigan College course catalog, trying to decide on a major.

Rollo said she'd planned to study elementary education at Central Michigan University, but changed her mind when it came time to move away from home.

"I was born here and raised here, I love it here, I flipped through that big book at NMC, saw nursing and thought, 'I can do that,'" Rollo said. "Which was divine intervention because nursing could not have been a more perfect fit for me."

Memories of patient interactions during her 33-year career spill out.

There was the horticulturist who named a lily after Rollo; the man who didn't have a ride to his medical test so Rollo drove him in her car — after signing liability waivers — and the adult patients with literacy issues who Rollo read out loud to, over the phone, complex surgical instructions.

"It's the toughest job you'll ever love," she said.

The profession has changed since Sept. 10, 1990 — the day Rollo was hired by Munson Medical Center — and she said decision-makers prioritize finances and management policies, sidestepping concerns voiced by nurses who work directly with patients.

Munson leaders say they do listen, want to hear from employees, and that the issue of burnout in the healthcare industry is not limited to Michigan or Traverse City, but is a national crisis.

Recent data from national and state studies bear this out.

Professional exodus

Research by the National Council of State Boards of Nursing in April, for example, indicated that 100,000 registered nurses left the workforce during the pandemic because of stress, burnout and retirement.

Another 600,000 nurses said they plan to leave by 2027, the study found, and more than 180,000 younger nurses — those under 40 — reported similar intentions.

A University of Michigan study, also in April, reported nearly 40 percent of state-licensed nurses plan to quit within the next year, with nearly 85 percent stating they regularly experience exhaustion.

Of the younger nurses surveyed here in Michigan — those under the age of 25 — nearly 60 percent said they plan to leave the profession.

"The value of what we did, and how we worked together, isn't the same," Rollo said. "What's most disturbing to me isn't easier shifts or more money, it's what's happening to patients when nurses are overloaded. We say that we are, and no one listens."

Staffing shortages and a firing

In June, Rollo was fired for what Munson Healthcare documents state was behavior that undermined the hospital's culture of safety and violated the employee code of conduct, a charge Rollo disputes.

The documents state Rollo raised her voice toward another hospital employee and threw a chart on the floor, creating a hostile work environment.

Rollo says she'd just come off a medical leave, the incident was overblown and she was retaliated against for speaking out about difficult working conditions and policies she disagreed with.

Rollo acknowledged she's outspoken. "I can get a little vocal" is how she describes it.

Records show she was disciplined in 2010 for insulting a co-worker during a staff meeting, and again in 2020 for refusing to leave the Emergency Room when staff there said pandemic lockdown orders prohibited her from accompanying her elderly father, who was seeking treatment for an infected dog bite.

The police were called, no arrests were made, and Rollo, who serves as her father's patient advocate, said she eventually agreed to wait outside.

A Munson spokesperson, asked about Rollo's firing, said the hospital could not speak about specific employees but said they do not take firings lightly and they will not tolerate violence in the workplace.

"Incidents involving staff acting violently is exceedingly rare at Munson Healthcare, but when it does happen, it is thoroughly investigated and, if substantiated, we have a zero tolerance policy for violence, as mentioned," said Megan Brown, Munson's chief marketing and communications officer.

Brown said employees who disagree with any employment-related decision can file a grievance and have the decision reviewed.

Brown also explained Munson's Voice program, which allows employees to submit concerns anonymously. "An executive team member reads every single one of these concerns," she said. "Policies have changed because of these submissions."

The hospital values feedback from frontline workers and, as a result, has changed packaging on medication, for example, and purchased new equipment, Brown said.

An annual survey, which is also anonymous, garnered 12,000 comments, she said, and the organization recently launched a virtual event, Ed Talks, this Fall, where employees can ask questions of Munson President/CEO Ed Ness.

In a column for the Record-Eagle, Ness said Munson is facing a perfect storm — inflation, increased costs, set reimbursement rates and staffing shortages.

Safe Patient Care Act

Since being fired, Rollo said her focus is on the future.

She said she feels a sense of camaraderie with hospital nurses on TV or social media who've spoken out about the stresses of the job.

Locally, Munson representatives were recently on the Grand Traverse County Board of Commissioners meeting agenda to address the Safe Patient Care Act — state legislation that, if passed, would mandate nurse-to-patient care ratios, among other healthcare requirements.

Munson Healthcare is among the hospitals and healthcare associations opposing the legislation. Munson representatives at the meeting said the hospital is aggressively trying to hire more nurses.

Passage of the proposed legislation, they said, could actually reduce patients' access to care if hospitals had to close beds because of a lack of staff.

A group of local nurses, many of whom wore red T-shirts to signify unity, were not on the county commissioners' agenda to speak, but lined up to give public comment.

"One of the hardest things in my job is the stress of knowing the level of care I want to give, and then seeing what I'm able to give," said Lisa Kitchens, an ICU nurse at Munson.

Experienced nurses don't have time to be a resource for young nurses, which exacerbates the staffing problems, Kitchens said. "We're setting people up to fail — and then they're leaving the field," she said.

The Record-Eagle reached out to a number of healthcare workers for this story.

Seven nurses and three physicians currently employed by Munson, or who have family members employed there, declined to speak on the record, citing fears of retaliation.

All expressed a sense of exhaustion and burnout, and said they do not feel listened to by hospital decision-makers.

"If I spoke to you and you published my name in the paper, I'd be fired," one said.

Brown said patient confidentiality is of utmost concern and Munson has a policy about employees working with corporate communications if they get media inquiries.

"This is especially important in healthcare because we care for people in the most vulnerable times of their lives and because of laws like HIIPA," Brown said of the Health Insurance Portability and Accountability Act, which is designed to protect patients' privacy.

"We want to make sure they are not inadvertently distributing private patient information," Brown said.

The Voice program, and not the media, is the way for employees to resolve issues, she said.

Fulfillment, opportunities for many

Three registered nurses who also work for Munson — Marc Duvall, a charge nurse and patient care coordinator; Tori Sykes, manager of the Munson Medical Center's emergency department; and Brendan Franklin, director of nursing operations and emergency services — did agree to speak on the record about the demands of the industry.

Brown helped arrange the group interview and sat in on the call.

Duvall, Sykes and Franklin expressed genuine enthusiasm for their work and said they chose to go into nursing because they like taking care of people and would recommend the career to young people who are in the process of deciding what they wanted to study.

"I had a friend who moved up north, we would come up here hunting and fishing every year," Duvall said. "I took a tour of Munson's ER, thought it was exceptional, thought the people were fantastic and I loved the area."

Sykes said she likes the fast pace and making a difference in people's lives.

"If you don't enjoy one aspect of nursing, there's always different places to use that nursing knowledge," Sykes said of opportunities for career advancement. "You still get to impact patients' lives every day — and I think that's what brings so much fulfillment to nurses."

All three said they enjoyed working as part of a team, largely felt supported by the community during the pandemic, acknowledged their jobs are difficult but emphasized their desire to meet the needs of area residents as well as people who come to the region on vacation.

Franklin said, during pandemic lockdown orders, he regularly vetted emotional concerns from staff. Sykes said the unknowns at that time were particularly stressful. Yet both said the profession continues to be rewarding.

"At the end of the day, when you choose nursing, you choose it because you want to care for people and you want to make a difference," Franklin said.

Rollo, who's 56, didn't work in the emergency department, but said she misses the feeling of satisfaction that working as a nurse can bring. She's now had four months to think about whether she wants to continue working in the profession, albeit for another employer.

On Thursday, Rollo said she was out of state, pursuing information on what she called cutting-edge patient advocacy work that she'd like to bring to northern Michigan.