Critical Condition

St. Anthony Hospitals, part of the Centura Health network, is emphatic about its mission -- so much so that the hospital lists its "core values" on the back of every employee's name tag and outlines its commitment to them on its Web site.

Centura Health is a nonprofit, faith-based health care system dedicated to improving the lives of the people in our communities.... The ministry of Christ calls upon us to act justly and love mercifully. Our actions are guided by a set of seven core values: Integrity, Stewardship, Spirituality, Imagination, Respect, Excellence and Compassion.

These are more than just words to us. Our mission is lived out every day by our actions.... In addition, every significant decision made within Centura Health must undergo a Values Impact Analysis that weighs the decision in light of our core values.

Integrity, Stewardship, Spirituality, Imagination, Respect, Excellence and Compassion. Those are St. Anthony's guiding lights -- except when it comes to nurses. They receive their own, more detailed set of guidelines on how to interact with patients. Under a recently adopted program known as "Person First," the nurses were told that they need to "sense people's needs before they ask, take the initiative to put customer's needs first, and go the extra mile to satisfy them" -- and to do it all using a script approved by hospital management.

"I'm sorry this has caused you concern. Let me take care of that right now for you," nurses are supposed to tell patients who bring up a problem. "I'm glad you brought this to my attention. Is there anything else I can do for you? I have the time."

Of course, some problems even a caring nurse can't solve; there's a script for that scenario, too.

"I'm sorry this has caused you concern. This is not my area of expertise. I will find the right person who can help you with this. Before I leave, is there anything else I can do for you? I have the time."

There's even a pre-approved method for following up.

"Did the doctor see you about that concern? Before I leave, is there anything else I can do for you? I have the time."

Just to make sure the nurses adhere to the script in their interactions with patients, the St. Anthony staff was told there would be a "secret shopper" planted among the patients. They were warned that nurses who are not appropriately "positive" could lose their jobs. "They told us our customer-satisfaction level was down and it was our fault and we need to work on it," says one St. Anthony's nurse who asked to remain anonymous for fear of retribution. "It's so demeaning to treat nurses that way. I've been nursing for years; I know how to talk to patients."

But the most offensive part of the script for many St. Anthony nurses is the final assurance that they "have the time" to care for the patient.

"You don't have the time; it's a lie," says another hospital veteran. (A St. Anthony spokesman says the purpose of the Person First initiative is to "take us to the next level in increasing patient-satisfaction rates and make us the health-care provider of choice in the state.")

The frustration over feeling insulted by hospital management isn't limited to St. Anthony nurses. At hospitals all over Denver, exasperated nurses are speaking out about exhaustive workloads that make it almost impossible to provide proper care for patients, saying they've become the victims of cost-cutting managers trying to wring more labor from an overwhelmed staff. It's gotten to a breaking point for dissatisfied nurses, many of whom are leaving the profession, resulting in a national and local nursing shortage. In Denver alone, more than 900 nursing positions are currently unfilled. And nurses point to a New England Journal of Medicine study published last year that found that for every one patient over a normal load a nurse has to care for, the overall death rate among patients increases by 7 percent.

In a largely female profession that traces its roots to the nun-like sense of mission fostered by Florence Nightingale, rabble-rousing doesn't come easy. Unions are now targeting hospital workers, but in Colorado, they've had limited success so far. Just three years ago, a union drive failed at St. Anthony, in large part because the hospital hired an out-of-state union-busting firm to intimidate nurses. But a major effort is now under way to create a union among nurses at Denver Health, the huge public agency that provides much of the care to Denver's uninsured residents, and many of the nurses involved say they've had enough and are ready to shake things up.

"There are things that nurses see that we simply can't get anyone to do anything about," says Denver Health nurse Jack Elston. "I've despaired of getting these issues addressed. There are so many obstacles, but I know we can bring these issues up at a union contract negotiation."

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Stuart Steers
Contact: Stuart Steers