January 28, 2023
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Patient death spurs Orlando Health nurses to sound alarm about staffing – Orlando Sentinel

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The suicide of a patient at Orlando Regional Medical Center last month has fueled unrest among nurses about what some describe as severe understaffing at the hospital, though a state review found the facility was not at fault for the death.

On May 27, a TikTok user known as Nurse Nander posted a video sharing several widely percolating rumors, including that short-staffing contributed to the May 16 suicide — in which a patient broke open the window of his eighth-floor room and jumped to his death.

In the following weeks, the video garnered over 1.5 million views. Comments about short staffing and poor working conditions at Orlando Health poured in from dozens of users who claimed to be employees.

Records from the Orlando Police Department’s investigation of the suicide, obtained by the Orlando Sentinel, did not address whether staffing played a role in the patient’s death. But they revealed investigators were unable to interview the nurse who last saw the patient alive or others responsible for his care prior to his fall.

No one working the night of the suicide was willing to speak on the record to the Sentinel but employees say the video highlighted a rampant issue throughout the health care system: understaffing.

Though short staffing is a nationwide issue, some nurses say they feel conditions at Orlando Health are worse than the norm and allege the health system could be doing more.

“The standard of care is so low that… we just feel lucky if we can get through a shift where our patients all survive,” said Mariel Barte, a former travel nurse for Orlando Health.

In response to questions about the suicide, Orlando Health spokesperson Kena Lewis shared a copy of an Agency for Health Care Administration letter clearing the hospital of responsibility for the suicide.

“The Agency for Healthcare Administration conducted a thorough investigation of the circumstances surrounding the suicide and found that Orlando Health did not have any deficiencies,” Lewis said. “In essence, Orlando Health did not contribute to the tragedy in any way and could not have prevented it.”

The turmoil at ORMC comes as the hospital is in the midst of a leadership change. An internal email obtained by the Sentinel shows Kelly Nierstedt, until now president of Orlando Health Winnie Palmer Hospital for Women & Babies, recently replaced Mark Jones as ORMC’s president.

Among Nierstedt’s other accolades, the email mentioned her experience as a registered nurse: “Kelly is … a passionate and engaged leader of people — and a nurse at heart.” Jones, ORMC’s president for nine years, will take on the newly-created role of Orlando Health Foundation senior vice president and director of capital campaigns.

Asked to explain the leadership change, Lewis in a statement said the moves would “position the organization for growth and provide new opportunities for leaders to bring a fresh perspective and their dynamic and exceptional expertise to new roles.”

Travel nurses are hired to fill hospital shortages, so Barte was used to working in short-staffed conditions during her three years at an agency. However, she said conditions at Orlando Health were worse than anywhere else she had visited.

“It was the only company I’ve worked with in which I truly felt profits were put before patient safety,” she said. “There needs to be something done. Every day that they keep their staffing that short, it’s not safe for the patients.”

Barte shared an assignment sheet showing that during one shift at Orlando Health Dr. P. Phillips Hospital, she was responsible for ten patients, more than she had ever been asked to care for in her five years of nursing. She said other hospitals generally assigned her five or six patients.

Orlando Health’s ideal nurse-to-patient ratio for the medical-surgical unit where Barte worked is 5:1, according to a job listing posted on the organization’s website. Barte, who said she accepted the job expecting that ratio, said she quit eight weeks into her 13-week contract with Orlando Health because she did not feel she could safely care for patients.

Another former travel nurse, who is now part of a pool of Orlando Health nurses dispatched to short-staffed units throughout the system’s hospitals, said working conditions have significantly worsened during the pandemic, compared to when she worked for Orlando Health before COVID-19.

The nurse, who asked to remain anonymous because she is still an employee and fears retaliation, echoed Barte, saying she is often asked to take care of more patients than she feels she has time for.

“My last shift, I cried. I’ve been a nurse for five years, and I was so frustrated,” she said, starting to tear up again as she recounted the experience. “If [I] make a mistake on one of these drips, one of my patients can bleed to death. I literally don’t have enough time to do my job properly. … And if I make a mistake, my license is out the window.”

The two nurses say they think the hospital could do more to bump up its staffing levels, such as providing more monetary incentives to current nurses and higher base pay to new graduates, or capping patient admissions at manageable nurse-to-patient ratios.

Orlando Health did not answer questions about the nursing shortage, but leaders have previously told the Sentinel they are taking steps to attract more nurses, including by partnering with Seminole State College of Florida and offering tuition reimbursement, signing bonuses, and opportunities for career growth.

The TikTok user called Nurse Nander, a former Orlando Health nurse who asked to remain anonymous, citing threats she has received online, is also the founder of The Last Pizza Party, a healthcare worker advocacy group. In an interview, she said she felt compelled to speak out about what she was hearing from inside ORMC.

“I chose to leave Orlando Health because of these unsafe conditions, but to hear how bad it has gotten since then is shocking and unacceptable,” she said.

This is not the first time the health system has faced backlash from employees amid allegations of unsafe staffing.

In 2013, a group of Orlando Health nurses attempted to unionize in order to fight pay cuts and improve nurse-to-patient ratios. They sued, alleging managers illegally intimidated and harassed union organizers, and Orlando Health settled in 2014 without conceding any wrongdoing, according to the National Nurses Organizing Committee-Florida, which is part of the National Nurses United Union.

Other local health systems are also struggling to retain nurses. A nurse at HCA Florida Osceola Hospital has spoken out repeatedly about what she views as unsafe and understaffed conditions. AdventHealth and HCA Florida Healthcare have also told the Sentinel that nurse recruitment and retention are leaders’ top priorities.

There is no universally agreed-upon standard for nurse staffing ratios. The American Nurses Association notes appropriate ratios may change daily based on patients’ conditions.

California, the only state to mandate nurse ratios based on a unit’s specialty, requires a 1:5 ratio in medical-surgical units.

The National Nurses United union recommends capping medical-surgical units at a 1:4 nurse-to-patient ratio and contends hospitals are purposefully understaffing units to increase profits and not paying nurses enough to retain them. The group cites 2017 federal data suggesting Florida will actually have a 53,700-nurse surplus by 2030 as evidence that hospital wages and working conditions are to blame for staffing woes.

The Agency for Health Care Administration did not respond to a request for more details related to its investigation of the May 16 suicide.

Orlando Police Department records and witness interviews identified Richard Stonge, 43, as the patient who broke open his eighth-story window that night with a metal rolling bed tray before taking his own life.

Off-duty staff members who were at ground level told OPD Detective Barbara Sharp they saw Stonge prior to him jumping and tried to talk him out of it. One staffer got security as the group tried to determine which floor Stonge was on. None of them saw anyone in the room with him.

After Stonge jumped, staff attempted to save him before he was rushed to the trauma bay, treated, and ultimately pronounced dead, the records show.

Police records did not include interviews with any of the nurses responsible for the patient.

Sharp wrote that Joshua Montemayor, Orlando Health’s senior director of risk management and claims prevention, told her Stonge had last been visited by a nurse at 10:03 p.m., 49 minutes before police received the 911 call. The nurse had attempted to give Stonge medications, but he refused them, Montemayor said.

Montemayor told Sharp a nurse who was working on the eighth floor that night feared giving an interview because she had overheard Sharp explaining over the phone that all unnatural deaths are investigated as homicides, which is standard protocol.

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“Joshua told me the nurse feared I would arrest and handcuff her during the interview. I told Joshua that it was absurd that I just needed to ask her general questions about the incident,” Sharp wrote.

At Montemayor’s request, Sharp agreed to allow nurses she interviewed to have someone present for emotional support. Montemayor then asked if the nurses involved could provide written statements instead of doing an in-person interview, which Sharp said was not acceptable, her report shows.

Sharp wrote she didn’t hear back from him for weeks until she received a voicemail from him asking if the investigation was over and for a copy of her report.

“I was under the impression he would call me back to let me know how we would be moving forward with the interviews,” Sharp wrote.

In response to questions about the night of Stonge’s death, including why Orlando Health’s risk management director was communicating on behalf of the nurses and why he didn’t facilitate interviews, Lewis, the Orlando Health spokesperson, provided a statement saying the hospital system has expressed its condolences to Stonge’s family and provided grief counseling to impacted team members.

“Orlando Health nurses and other clinicians who witnessed the tragic incident immediately responded to provide medical assistance to the patient, who, unfortunately, could not be saved,” Lewis wrote. “We commend our team members for their dedication to and care of our patients.”

ccatherman@orlandosentinel.com; @CECatherman on Twitter

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