Response from Mission Health to Petition from National Nurses United

Recently, Mission Hospital received a petition from the National Nurses Organizing Committee/National Nurses United (NNU). Upon review, we were not surprised to learn that Mission Health had already implemented and communicated nearly every “demand” included in the petition.  Because we are committed to making sure that you have accurate information, we are posting our response here for all our leaders and team members across Mission Health to review.

Response from Mission Health to Petition from National Nurses United

Mission Health is fortunate to be home to some of the very best caregivers – highly-skilled, compassionate nurses, staff and physicians who dedicate their lives to the health and wellbeing of our patients and community. We deeply appreciate our nurses and the incredible skill, passion and service they demonstrate in caring for our patients every single day. Our nurses are absolutely essential in ensuring our patients not only receive the high-quality, compassionate care they deserve, but in cultivating a healing environment and experience for everyone who entrusts our hospital with their health.

As the crisis with COVID-19 evolves, our nurses – along with all our caregivers – play a critical role in the fight against this virus within the community we’re proud to serve. We stand together for our patients and for our colleagues. That’s why Mission Health, and HCA Healthcare, has:

  • Actively Prepared for a Medical Surge: Mission Health has well-established protocols in place to care for patients with infectious diseases, and our emergency planning efforts related to COVID-19 began weeks ago and continue today. Specifically, we have been focused on:
    • Staffing: To ensure we are prepared for an influx of patients, we have staffing contingency plans, which include the use of HCA Healthcare’s in-house staffing agency and plans for emergency credentialing nurses and doctors who may not be part of our current workforce.
    • Supplies: While we have the supplies and equipment we need at this time, we are doing everything possible to secure products as the worldwide shortage of personal protective equipment (PPE), including masks, face shields and gowns is a reality we are addressing with realistic, workable solutions.

To help ensure our caregivers and patients continue to have enough supplies and equipment, we are implementing steps recommended by the Centers for Disease Control to conserve PPE. All Mission Health hospitals have an assigned clinician that is solely responsible for overseeing PPE inventory and stewardship. We are adopting specific protocols, outlined by the CDC, for the appropriate reuse of certain PPE and we are asking our colleagues to conserve these items by adhering to the guidelines for infection prevention.

  • Capacity: We are engaging in detailed bed utilization planning to prepare for the epidemic. Suspension of non-essential surgeries allowed us to free up beds for patients in the event of a surge. As needed, we are also able to access additional bed capacity by converting other hospital beds into ICU beds.

This week, we have started standing up tents at all Mission Health hospitals to create additional capacity for triaging patients outside of emergency departments in the event of a surge. The tents are part of our standard emergency planning protocols. Over the coming days, Mission will conduct training exercises and drills in the tents, allowing caregivers the opportunity to become confident in this environment should we need the tents need to become operational.

  • Implemented a Universal Masking Policy: To protect our patients and clinicians, including our nurses, we have expanded our use of masks at Mission Hospitals beyond suspected or positive COVID-19 cases. These new guidelines apply to all patient care areas, not just those where suspected or COVID-19 positive patients are being treated.

We have taken this step because we have seen, while social distancing is a key strategy for interrupting the spread of COVID-19, it is difficult to maintain in the busy patient care environment. Our latest analysis of our ability to meet the demand for additional use of masks gives us confidence that our colleagues in supply chain are prepared to address our needs. Even though HCA Healthcare currently has adequate supplies of personal protective equipment, we will continue to take steps to conserve PPE, including reuse and reprocessing of PPE where appropriate.

We have deployed three types of masks, depending on the clinical role, the type of care the patient is receiving, and the level of suspicion for infection with COVID-19:

  • Level I “procedure” masks for all staff not needing higher levels of protection. These masks can also be used for caring for suspected or confirmed COVID-19 patients when paired with a full face-shield.
  • Level 3 masks for additional protection from fluids and droplets, and for use by staff caring directly for suspected COVID-19 or COVID-19 positive patients, except when performing aerosolized procedures.
  • N-95 respirators for staff caring for suspected COVID-19 or COVID-19-positive patients; these also are the only masks that should be used during aerosolizing procedures, such as intubation, nebulization, bronchoscopy, or suctioning.
  • Secured our Supply Chain and PPE: Our supply chain continually works with our epidemiologists and data scientists to track usage and anticipate demand of PPE so we can allocate our stocks appropriately. While we have adequate supplies for today, they are working around the clock to safeguard existing supplies and secure additional shipments because we can’t be certain what amount of supplies will be needed in the coming weeks. We have appointed PPE stewards in each of our facilities to manage supplies in the face of oncoming surges.
  • Provided Ongoing PPE Training: For our colleagues to learn more about specific isolation procedures and the use of PPE, Mission Hospital recently conducted a series of PPE clinics. These clinics, which were available to staff 24 hours a day, 7 days a week, helped educate colleagues on donning and doffing of PPE, differences between different types of masks and how to use them, and how to use QR codes for supplies. Additionally, nurses from our COVID-19 Task Force at Mission Hospital are actively rounding with fellow nurses and other clinicians to provide hands-on, in-person training to our colleagues on the proper protocols for using and conserving PPE.
  • Ensured Proper Protocols for Isolation of COVID-19 Patients: Mission Health is following the CDC guidelines for isolating suspected or confirmed COVID-19 patients by placing them in single-person rooms with the door closed and a dedicated bathroom. Per CDC guidance, our airborne infection isolation rooms, also called “negative pressure” rooms, are reserved for patients undergoing aerosol-generating procedures. Mission Hospital currently has 68 active negative pressure rooms, complete with anterooms, and another 89 rooms that can be converted into negative pressure rooms. Additionally, there are another 31 negative pressure rooms in our regional hospitals.  Mission Health has the most negative pressure rooms in the region.
  • Elevated Visitor Restrictions: On March 21, to protect our patients and colleagues, we elevated our visitor restrictions to the highest level. Currently, no visitors are allowed at Mission Hospitals, with exceptions for pediatric, Labor & Delivery and end-of-life care patients who are allowed one adult visitor at a time.
  • Started Implementing a COVID-19 Dashboard: To help provide transparency to our colleagues, we are building a tracking tool that will allow Mission Health caregivers to see data about the number of COVID-19 positive, and presumptive positive, patients in our care. Once rolled out, this dashboard will provide our colleagues with a daily snapshot of how the crisis is affecting our hospital in real time.
  • Implemented Increased Screening Protocols: Protecting the health and safety of our patients and colleagues is our top priority, and this week we implemented new screening procedures for colleagues at Mission Health. All colleagues are now asked about COVID-19 symptoms and any contact with anyone who is positive or presumed positive for COVID-19. Additionally, all colleagues have their temperature taken using a no-touch, infrared thermometer.Colleagues who answer “yes” to the screening questions or record a temperature over 100.0 are directed to see a provider via Mission Virtual Clinic for evaluation at the door.
  • Protected Job Security: As we continue our response to this public health emergency, we have taken proactive steps to protect our employees from job loss. While many hospitals are being forced to use furloughs or layoffs, Mission Health is not in that position today as part of HCA Healthcare.
  • Implemented Quarantine Pay: We understand the importance for any of our colleagues to be quarantined following exposure to, or contraction of, COVID-19. In circumstances where the CDC guidelines recommend colleagues are quarantined, they are paid 100 percent of their base pay during the quarantine period, regardless of whether the exposure was at work or in the community.
  • Implemented Pandemic Pay: As Mission Health has experienced decreased patient volume and limited elective procedures as part of our COVID-19 preparations, many of our outpatient facilities, clinics and departments have temporarily closed. This has resulted in a reduction of hours for many employees, including nurses. However, HCA Healthcare is committed to supporting our colleagues during this time and has implemented the following pandemic pay practices at all facilities including Mission Hospital:
  • For full-time and part-time colleagues with reduced hours in clinical or non-clinical facilities or support services:

In closure or call-off scenarios, we are working with employees first to identify redeployment opportunities to keep them working where volume levels are high and to support our COVID-19 preparations.

Those who cannot be redeployed will be eligible for a special pandemic pay program that continues paying 70 percent of base pay for up to 7 weeks (March 29 – May 16). This is not a furlough. Instead, it is a pay continuation program to assist colleagues until we better understand the long-term implications of this pandemic on the organization. This program will also apply to our colleagues in areas that support the facilities.

  • For colleagues working in patient care facilities:

If a colleague is quarantined per the CDC guidelines and works in a patient care facility, we will pay 100 percent of base pay for scheduled hours regardless of where the exposure took place. Any colleague who does not work in a patient care facility and is quarantined per CDC guidelines may be eligible for short term disability, or leave of absence, while they are ill.

  • Implemented Protections to Keep Colleagues’ Families Safe: We will be offering scrub laundering for colleagues who care for COVID-19 patients to protect them from potentially carrying the virus home on their clothing. By late this week, we will have worked out the details with four major hotel chains to provide housing for caregivers who provide care to COVID-19 patients and prefer not to go home to their loved ones after their shifts.
  • Expanded Access to HCA Hope Fund: Our colleagues are not just co-workers; they’re our family and we continue to rally around one another. The HCA Hope Fund helps HCA Healthcare employees and their immediate families who are affected by financial hardship. For our colleagues experiencing changes in financial circumstances as a result of COVID-19, such as the loss of a spouse’s employment or increased needs for childcare, the HCA Healthcare Hope Fund stands ready to help. Most recently, we announced special financial assistance to help with childcare costs for our working parents.
  • Implemented Executive Pay Cuts: As part of the effort to support our colleagues during this time, the HCA Healthcare senior leadership team has taken a 30 percent pay cut until the pandemic passes. Additionally, CEO Sam Hazen has donated 100 percent of his pay for April and May to the HCA Hope Fund. The HCA Healthcare Board of Directors has also waived their cash compensation for the remainder of the year, allowing the company to make additional contributions to the HCA Hope Fund.

While the petition came from Mission Nurses, it is part of a nationwide campaign driven by National Nurses United, the union that is attempting to organize the RNs at Mission Health.  As demonstrated above, Mission Health and HCA Healthcare are already doing everything in their power to protect our colleagues, including RNs, and the community of Western North Carolina during this crisis.  The petition asks that we stop “all anti-union meetings and focus on preparation for COVID-19 emergency.”  Of course, the union has only increased its activity — all related to organizing — during this healthcare crisis.  Patient care is our first priority – now and at all times.  We continue to offer RNs information about their rights under the National Labor Relations Act for those interested, but this in no way interferes with patient care.

Mission Health has frequently stated our position on unions, but the union’s behavior during a crisis shows exactly why we believe a union is wrong for Mission Health and Asheville:  while the union claims we are unprepared for this crisis despite all of our efforts described above, the union marches into our administration office, videotapes our leaders, and issues demands for things that we are already doing and have already communicated to our colleagues.  It’s unfortunate that the union is attempting to turn a crisis into a publicity event designed to promote the union’s own agenda and spreading fear and misinformation.  We will continue to demonstrate to our staff and our community that nothing — not even this — will distract us from our mission.

We understand these are challenging times for healthcare and for our nurses and other caregivers. Nurses are the differentiator for Mission Health and HCA Healthcare. Every day, nurses make the greatest single contribution to quality patient experiences. We are grateful for our nurses’ ongoing commitment to our patients, and to the communities we’re privileged to serve. We are truly grateful for their contributions to improving the health of Western North Carolina.

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