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Haley Ramsey Resignation

Author: Wallace & Graham, P.A.

Published: Tuesday, September 7, 2021

Haley Ramsey Resignation


To Whom This May Concern,

I, Haley Ramsey, RN, am officially giving my 2-week notice of resignation to the Mother-Baby Unit of Mission Health.

After spending 20 years of my life dedicated to the Mission Mother-Baby unit, I have come to the sad conclusion that this chapter of my life must end. I have prayed and sought out wise counsel from family, friends, and coworkers whom I love and trust. This has not been an easy decision for me as I know it will impact a lot of people whom I care about. I would like to share some background as to why I have made this decision. I apologize for the length.

I was hired onto the Mother-Baby Unit in June 2000 as a CNA during the last year of my nursing education. I was thrilled to have been hired and be an employee of Mission Hospital. It was once something to be proud of, and I was. My role consisted of many different tasks. I helped our nurses keep our unit organized and well-stocked. I was able to learn and help with tasks at the front desk such as answering phones, answering call bells, and breaking down charts. This is no easy task. Kudos to our extremely hard-working and multitasking unit secretaries. We couldn't make it without you! I was blessed with the opportunity to help with patients as well. The most exciting part for me was being able to help give baths and do hearing tests on our very newest and tiny patients, the babies. I gained an immense amount of knowledge and skills during that time. The nurses took me under their wings and exposed me to as many situations as they could while encouraging my learning during those last months of nursing school. 

I was honored to take a registered nurse position back on my home unit, Mother-Baby in June of 2001. Within 6 months of being hired as a registered nurse on Mother Baby, I was being asked to take on the role of relief charge nurse and preceptor to other new employees of our unit. I felt honored to be entrusted with the care of our unit. I took my role seriously and wanted to be the best teacher and leader I could when placed in these roles. 

Mission Hospital was once such a beacon for our community. I remember how involved the staff was in volunteer work and fundraising for the March of Dimes. I remember the days when they had big events like The Ducky Derby held at the Asheville Malls supporting our NICU babies. I remember having bake sales and volunteer days at local community outreach centers such as the Manna Food Bank. The hospital held special appreciation lunch events for the staff that were quite lovely with food, music, and token appreciation gifts. My co-workers and I truly felt cared for by the hospital management and the community. We were a community.

I am someone who takes pride in the cleanliness of my space whether that be at home or at work. I was always so impressed with how clean and nice our hospital was. We were blessed to have the equipment replaced when needed and in a timely manner. The rooms, hallways, nursing stations, and lounge areas were always comfortable and clean. I gave birth to each of my children at Mission and never had to worry about the cleanliness of any of my rooms. I knew that the hospital was always aiming to better itself. We were able to confidently give good care, in a clean, and comfortable environment. 

I was proud to be an employee of Mission Hospital, and knew that when I needed to take some time away to be with my third child, as my husband and I adjusted to being outnumbered, that I would be able to return with open arms to my second home, the Mother-Baby Unit. I returned in February of 2007. It was hard to be away from my family at home, but good to be back with an amazing work family that supported me through the transition. I quickly jumped right back in and was able to use the gifts that God has blessed me with as I cared for our new mamas and babies of WNC.

I can't deny that society has been changing, the economy has been changing, politics are changing and therefore healthcare is changing. Mission has not been able to escape this. I know that medical professionals all over the country have experienced this over the past several years, but to experience a nonprofit hospital being taken over by an enormous money-making corporation has been devastating.  

Mission Health was previously a nonprofit community hospital. Today it is a for-profit hospital making the HCA corporation a lot of money. How does a business make money one might ask? Well, you cut costs at the bottom so you have more profit at the top. I learned this very simple concept in a business class that I took a few years ago as my husband and I started our own small business. HCA is doing this very thing, and to an extreme. This corporation has employees literally making 10's of millions of dollars a year, while the employees that do the actual physical and mental work caring for patients are experiencing cuts like never before. The nursing staff was promised at the very beginning of this take over that our nurse-to-patient ratios would not change. That remained true for only about 3 months. 

HCA started by taking our support staff. Our unit secretaries were removed from the units and we were told that they were being helped to find new jobs. Our CNA's were either moved to other areas of the hospital, let go or placed in the secretary position so they could now take on both the role of the secretary and nursing assistant. For our Mother-Baby Unit that meant we took one person off of the floor that played a vital role in giving smooth and timely care to our patients. Our unit requires having a secretary at the desk at all times as their role is a very busy one. Letting patients and visitors in and out of our locked unit, answering phone calls, answering call bells for 34 rooms, making charts for all of our new patients, breaking down charts for all of our discharged patients, retrieving items from our tube system, making sure the right nurse receives the items sent, sending off important lab work to the state, entering information into our computer system, and answering the questions of countless people approaching the front desk as the secretary is the first smiling face you see as you enter our unit. These are just some of the extremely important tasks our secretaries are responsible for. So unfortunately now, our CNA's can no longer do the many important and time-consuming tasks they previously helped with on our unit.  

Our CNA’s helped us bathe our tiny newborn patients, draw labs, and helped watch them when a mother or family member was unable to. They helped mothers to the restroom, set up rooms for new patients, stocked the unit with necessary equipment, they wheeled patients out to their cars at the time of discharge, and helped with many other tasks. Not having their vital support has definitely added strain to the workload of our nurses. 

In May of 2019, I noticed that our staffing grid had changed. I am frequently placed in the relief charge nurse position, so I am responsible for making the assignments on days that I am in this role. The grid decreased the number of nursing staff allowed for the number of patients on the unit. Staffing has been made into a numbers game. Unfortunately, assigning nurses to care for patients is not something that can simply be determined by the number of patients you have. Patients have unique care needs and their acuity must be taken into consideration as you determine the number of nurses needed to safely care for the unit. Our core staffing numbers decreased, so keep in mind that we don't even schedule enough nurses to adequately staff our unit when we are full. We used to care for no more than 6 patients at a time. In recent days our nurses are caring for as many as 10 patients at a time. This is absolutely unsafe and has led to our nurses and unit staff feeling burnt out and defeated. We are taking on heavier patient loads, have less support staff, and have new tasks regularly being added to our list of things to do. So, as you would probably expect, our nurses are tired and don’t want to work at Mission anymore. Nurses are quitting, and we have fewer and fewer nurses to staff our unit. The Mother-Baby Unit has experienced a loss of over 18 nurses in a span of about 6 months.

Not only is the nursing staff suffering. It appears the ancillary staff throughout the hospital are suffering as well. The hospital has never been as filthy and unkempt as it is now. Trash runs over and onto the floors in the patient rooms, nurses' stations, and lounges. Hazardous materials disposal containers have IV fluid bags and tubing pouring out into the medication room floor. Laundry bags pile up and run over onto the floors of our soiled utility rooms. Meal trays are constantly left behind in the patient rooms. Sinks and toilets aren't being kept clean, and most concerning leftover items from previous patients are being left in "clean" rooms and baby bassinets. So, why is this? Every time I ask what is going on I receive the same response "We are short staffed. We are doing the best we can." I know this is true and very unfortunate. Yet again, guess who gets to pick up the slack and take out the trays, empty the trash, and reclean the baby bassinets? The already overstretched and overly stressed nursing staff try to make sure that our patients don't directly feel the impact of this disaster, and we do it ourselves.

The nursing staff was approached by the Union shortly after HCA bought Mission Hospitals. Obviously, the nurses were seeking an answer, some support, or a way to turn things back around. I personally have felt skeptical about joining the union, because I felt it would take away from my being able to speak for myself and to have a direct relationship with my manager, whom I respect. I did not vote for the Union even though I knew there was a major need for change. I was hopeful that this could happen without such chaos and division. Regardless of my feelings, the nursing staff of Mission Health voted in the Union. The contract that has been agreed upon between HCA and the Union did not pan out well for some of the PRN staff that have dedicated many years to Mission.

Approximately 4 weeks ago I was contacted by my manager who gave me some bad news. She informed me that the PRN payment model was being changed and I needed to make a decision about which of the new tiers I wanted to commit to. I was told that a decision was needed that day. I do want to say that my manager did approach me with compassion and care about the situation. This did seem to be out of her hands. She gave me the facts that were available, but it was very difficult for me to understand as I had so many questions, and there were so few answers available.  It was a lose-lose situation for me. None of the new tier levels came close to reaching my base pay rate let alone my previous incentive pay of 20%. My best case scenario was a loss of 20% and my worst case scenario was a loss of 32% of my wages. Over a three-week period of time, I was approached 3 times with different information and was asked to make a decision over the phone about what tier I wanted to commit to. The second conversation was brought to me as good news and they found a way for PRN staff to be able to keep our pay. I was first informed that if I became a tier 1 PRN employee I would be able to keep my current pay rate. The following week I was contacted by my supervisor and told that I would actually have to commit to a tier 2 to keep my current rate. The new tier model does not equally reflect the hours and commitment to the previous percentage model. I was also informed that if I chose a lower tier that I would be taken back to the new PRN tier payment model losing my 20% and my previous base pay. If this all sounds confusing it's because it is confusing. Ultimately, the new tier 2 is a greater commitment than the previous commitment that I had made to receive the 20% incentive. I am unable and unwilling to commit to the new Tier 2. I also find it insulting that a new graduate and a nurse with 20 years experience are placed under the same payment model. We would be making the same wage. This is a win for the new graduate, but a devastating loss to me, a nurse, who has dedicated her whole adult life, and experience to one unit.

I understand and accept that my not being willing to commit to this new model will cause me to lose my previous 20% incentive. However, I do not accept nor do I understand the hospital being able to take away from the base pay that I have earned over the past 14+ years. I called and spoke to Mother-Baby Unit's human resources representative and her supervisor. They confirmed the information that was given to me by my supervisor and manager. I questioned how they could take away from my base pay rate as this consists of my cost of living raises and 3 MERIT raises that I had earned over the past 14 years. The response I received is that "this is a new model." I asked our representative why this was  happening and was informed that because of the new union contract "the money had to come from somewhere." I tearfully responded " so, I am being punished for a contract that I didn't even vote for?" and the human resource supervisor responded back to me "in theory, yes."

My pay rate has already been cut by 30.01% per my Lawson pay rate history as of July 17, 2021. This rate change occurred in the middle of a schedule that I signed up for while making my previous rate. The new commitment that I made to the hospital only requires me to sign up for 1 day every 60 days. I have worked 4 shifts since my pay rate was changed and have more than fulfilled my new commitment. I do not believe that I should be held accountable for the shifts that were committed to under a different agreement. I am especially upset about this because the hospital is offering any staff that works extra shifts an incentive of an extra $30/hr over their base pay rate. This includes housekeeping, dietary, and to my understanding anyone working in the patient care areas. I am making less money than any staff member receiving that incentive. I have been told that I am not eligible for this incentive as I am already on the schedule. I have asked for clarification and help with this matter and received no response. My last attempt was a phone call to the human resource supervisor on Thursday, August 12, 2021. I left a detailed message with my concerns and have not been contacted back.

I am a real person. I am a wife, a mama of 7, a soon-to-be grandmother, a friend, and I have been a loyal employee and nurse of Mission Health's Mother-Baby Unit for 20 of my 41 years of life. I was one of three nurses from Mission Hospitals that was honored as one of the Great 100 Nurses of NC in 2020. 

I have never been so disrespected or unappreciated in all of my working career as I have been in the past month. I am no longer willing to put my license, my reputation, or my physical and mental health on the line for a company that does not care about it's employees or the community it claims to serve.

I am truly sad to be leaving my unit. I know my fellow coworkers and work-family are hurting as they work through the most trying times we have ever experienced. To each of you, I am so very sorry.

I am praying for all of the staff of Mission Health. I am also praying for the community served by Mission Health. HCA is not who we are.

Sincerely,

Haley Ramsey RN