Layoffs hit, nurses fret

The rumors were true.

As we noted in Newlines last week (“Rumors of layoffs rife”), fears that most or all of Enloe Medical Center’s certified nursing assistants (CNAs) were about to be laid off rippled through the facility early last week.

On Thursday, Jan. 11, the fears were realized. That morning, the hospital’s interim CEO, Beth O’Brien, and Board of Trustees chairman, Darby Makel, sent out a memo to staff announcing that 179 employees, most of them CNAs, would be laid off effective March 12 and another 36 part-timers would see their hours reduced.

Some of the ousted CNAs would be eligible to apply for approximately 60 new or existing positions, the memo added. Another 22 who are work-study nursing students will be guaranteed jobs when they obtain their RN certifications.

Altogether, Enloe is reducing its staff of 2,205 employees by about 119 people, or 5 percent.

The layoffs were “the first step in performance improvement” called for following a two-month-long “Pathway to the Century Project validation process—an assessment of our current strategic, financial, and operating condition,” the memo reads. The goal of the process, it continues, “was to identify strategies that would move us toward new clinical space, strengthen financial performance, and improve the patient experience.”

Translation: Enloe is streamlining and cutting costs. As Makel explained during a CN&R interview with him and O’Brien that Thursday, for the past two years the hospital’s expenses had risen by 10 percent, but its revenues had gone up by only 4 percent. “It doesn’t take long for the scales to tip and flip on that very rapidly,” he said.

The trustees decided they had to control costs, Makel added, and “the reality is that half of our expenses are in labor.” After comparing Enloe’s staffing levels to those of other hospitals, it became clear that Enloe “needed adjustments in its workforce.”

He stressed that, of the 119 positions ultimately eliminated, eight are management jobs that will be axed altogether and another 13 are nurse managers who will be reassigned to staff nursing positions.

The employees who received 60-day notices—100 full-time, 79 part-time or per-diem—also include 34 clerical workers and 33 technical workers (lab assistants and pharmacy techs). But nurses’ aides constitute the majority, 91, of which 46 will have the chance to stay at Enloe.

The cuts will leave the hospital largely without CNAs, who do the grunt work of patient care. Now RNs will have to do it, on top of performing their already demanding jobs.

A nurse who e-mailed the CN&R over the weekend explained it well:

“In one shift, I have five patients,” she writes. “Those fresh out of surgery have to have vital signs taken every 15 minutes. Wounds need to be cleaned and dressed. Drains have to be monitored and emptied, blood needs to be transfused, medication has to be handed out, sometimes handfuls of pills every two hours, and some of those have to be crushed and put into tubes. IV medications have to be hung; most patients have at least one or two of those. IVs have to be started. … Suctioning patients who cannot breathe, putting tubes into noses and placing Foley catheters, stitches and staples have to be taken out, blood sugars and insulin must be given, family members need to be spoken to and informed of what is going on. …”

She continues in this vein for another couple hundred words, piling job on top of job, before saying, “Without CNAs … I now have to walk patients, bathe patients, put them on commodes or take them to the toilet (those with diarrhea go multiple times in a shift), make beds, brush teeth, brush hair, fluff pillows, get warm blankets, empty commodes and urinals and catheters, some patients have to be turned over in bed every 2 hours, … clean up vomit, transfer patients from bed to chairs for meals, feed patients who cannot feed themselves, run to the kitchen because a patient wants hot chocolate instead of coffee, the list is endless.

“It’s not that I don’t enjoy doing all the CNA duties, because I do. It’s the fact that everyone has their own job and now I have to do two jobs in the same shift. … It just cannot be done. Something has got to give.”

Like all of the several nurses who contacted the CN&R, she is worried that the cuts will hurt patient care. As one soon-to-be-laid-off nursing assistant put it, “It’s already hard enough. Most nurses leave [their shifts] late as it is.” This CNA, who’s worked at the hospital for two years while attending nursing school, said she made $10.66 per hour weekdays and $11.66 on weekends.

The hospital plans to replace the floor CNAs with what are called “lift-and-move teams,” small mobile groups of CNAs who help with lifting patients into or out of beds and chairs and transporting them. “We don’t have all the answers yet,” O’Brien said, “but we’re trying to develop the best model we can for helping nurses.” She noted that a number of other hospitals have developed similar systems with great effectiveness.

To David Welch, an Enloe RN who represents the California Nurses Association, the cuts are a violation of the intent of the state law mandating certain nurse-patient ratios.

In a Jan. 11 e-mail memo to Carol Butler, vice president of nursing services, and Carol Linscheid, vice president of human relations, Welch notes: “It is clear in the [Department of Health Services] discussions associated with the staffing regs that they based the ratios on the idea that current levels of ancillary staff [including CNAs] would be maintained.”

If local media asked his opinion, he writes, he would tell “the people of this community that, while their care might not be less safe, the quality of the patient experience will in fact decline.”

Charles Idelson, Oakland-based spokesman for the nurses’ association, agrees with Welch about the staffing rations, adding: “When hospitals need to lower costs, we always recommend that budget cuts be directed away from patient care.”

In the interview on the day the cuts were announced, O’Brien said that she’s not sure how nurses are going to take the change. “The RNs will want to know where they have support in caring for their patients,” she said. “We’ll have a different sense a month from now” when the lift-and-move teams are up and working, she said.

“Today people are sad,” she continued. “This is a difficult day.”