Oregon State Hospital employees were hit with bad news at the end of March.
An unprecedented 20% of the hospital’s full-time nursing staff was out on leave, marking the latest effects of the COVID-19 pandemic. And beginning April 1, another wave of workers from throughout the public psychiatric hospital would be required to assist with the day-to-day care and supervision of patients — roles for which many staffers had limited experience and training.
Employees have since reported increasingly dangerous working conditions as they have sustained frequent and severe injuries from patients and suffered exhaustion and burnout from working overtime. They’ve also started pressuring hospital leaders to take immediate action to ease the strain.
Meanwhile, administrators asked a judge Tuesday to halt new admissions for two weeks, citing a spike in people waiting to be admitted into the hospital.
State hospital administrators said they’re aware of staff complaints, and said they continue to focus on quality care and safety.
But employees say they’re growing increasingly concerned with conditions.
“It’s all been like sticking your finger in the holes in the dam,” said Kim Thoma, an administrative specialist and president of a union that represents many hospital employees.
“People are working double shifts, being mandated — they’re working so many hours to try and cover this need.”
Critical staff shortage
Low staffing has plagued the hospital for months.
While 116 staffers have contracted COVID-19 over the past year, more than 180 currently aren’t coming to work because they or a family member are medically fragile — or they’re unable to find childcare.
The hospital has been offering staff paid time off for childcare. But some staffers say that employees without children have taken the time off, and the hospital does not check whether employees using the time have children. Some staffers say that has created an increased burden on employees who don’t take the time off.
The state hospital did not immediately confirm details about staff using childcare time.
In order to deal with the staff shortage, the hospital in November launched an emergency staffing plan with five “waves” of staffing to replenish the ranks as the number of staffers on coronavirus-related leave grew.
The first three waves call for hospital staffers to be reassigned in order to fill vacancies. The fourth draws administrators from throughout the Oregon Health Authority to help staff the hospital floor. The fifth requires the hospital to call in the Oregon National Guard.
The hospital is currently in the third wave. But Superintendent Dolly Matteucci said Tuesday that administrators planned to meet this week to discuss whether to bring in health authority staffers earlier than anticipated.
“We have less available in-house resources than we thought we would when we constructed the plan,” she told The Oregonian/OregonLive. “We are engaging in those planning conversations currently.”
The shortage has also prompted administrators to “mandate” record numbers of employees, requiring them to keep working past the end of their shifts without prior warning.
Last weekend, for example, administrators required 52 employees to work beyond their scheduled hours. And even then, the extra help was still not enough to meet minimum staffing requirements.
In response to the shortages, the hospital’s SEIU Local 503 union chapter on Tuesday began circulating a petition calling for administrators to find an immediate solution to the growing problem.
“We are concerned that the Emergency Staffing Plan has put numerous people with limited experience in protecting residents and staff onto units creating a less safe environment,” states the petition, which had been signed by at east 140 hospital staffers as of Friday.
Problems stem not only from staffing shortages but also from abrupt changes to teams on the hospital floor.
Roberta O’Dell, who recently retired after a 31-year career at the hospital, said administrators gave members of her team less than a week of notice before splitting them up — a move she claimed hurt employees and their patients.
“I think morale is very low,” O’Dell said. “I’ve seen a lot of changes at that hospital, and these are not good.”
A worker from the hospital’s vocational services program — one of several employees interviewed by The Oregonian/OregonLive who asked not to be named for fear of retaliation from administrators — said there are often as few as four staffers on a unit with 20 or more patients.
The employee said she’s also worked overtime on units where she’s the only staffer familiar with the patients housed there.
The ideal number of trained staffers varies depending on the needs of patients in each unit. But O’Dell said administrators typically staff units with at least five employees who are both trained for the job and familiar with the group of patients.
The staffing shortage has also taken a physical toll on employees, who say they’ve experienced more frequent and serious assaults by patients over the past several months.
At least eight workers were injured last weekend alone, including three who required hospital treatment, according to staffers. In one case, an employee suffered facial lacerations from the sharp edge of a plastic chair wielded by a patient.
The state hospital confirmed that three staffers were hospitalized last weekend. Rebeka Gipson-King, a spokesperson for the hospital, said not every staff member who goes to the hospital reports their injuries.
Other assaults from past months have been similarly serious.
On March 19, a patient broke a staff member’s arm. And in December, a patient wrapped a piece of clothing around an employee’s neck — requiring two other workers to wrestle the patient away.
While such stories pour in, state hospital data shows the number of reported assault cases — ranging from a patient spitting at a staffer to a patient causing serious physical injury — has actually taken a slight downturn.
The hospital averaged nearly 55 assaults per month in 2020, as opposed to an average of 56.5 per month between January 2016 and December of last year.
Matteucci, the superintendent, acknowledged assaults have intensified because of the increased strain on patients.
She said part of the hospital’s solution is improving trainings and policies so employees can avoid getting hurt in the first place. The hospital also offers injured employees a peer-support program, which connects them with resources and offers them a platform to talk about their trauma.
“We’re trying to get people back into the classroom to practice what are truly perishable skills,” Matteucci said.
Moreover, Chief Medical Officer Dr. Sara Walker said it’s become more difficult to implement patients’ treatment plans because many patients rely on social workers or other therapeutic specialists who have been tapped to fill other roles.
“It’s hard enough to effectively implement that when you do have consistent staffing,” Walker said. “It’s virtually impossible when you’re dealing with folks who aren’t accustomed to that work or don’t know the patients well.”
But staffers are concerned administrators have shown little understanding of the problem, with one mental health technician calling their lack of response “absurd.”
“We’ve been drowning,” the technician said.
She said when staffers ask nursing administrators for more resources or tell them about assaults, they’re slow to take action.
“We have to wait till there’s another one — or something bigger,” she said.
The technician said nursing administrators began working the hospital floor this week, meaning directors who usually don’t work with patients are now helping with day-to-day care.
The move, which underscores staffing problems, frustrated the technician, who said bosses are just now beginning to experience the difficulties faced by others on the hospital floor for the past year.
O’Dell, the recent hospital retiree, said frequent changes in staffing are partly to blame for the worsening assaults.
“Patients aren’t familiar with these staff at all,” she said. “You don’t have a connection with the patients. You don’t know what their triggers are. You don’t know their propensity to either verbally or physically assault you.”
Patients, too, are feeling the strain.
Some tried to start a riot to demand better food privileges last weekend, according to another mental health technician.
“Apparently, patients are listening to staff talk about how we’re short and don’t have any staff, so they planned a moment when they were low and tried to start a riot,” the technician said in a text message.
The state hospital did not immediately confirm the attempted patient riot.
Employees worry that if their staffing problems worsen, a patient will kill or critically wound someone.
“Safety is not just a concern now, but COVID has put it under a microscope,” said Thoma, the SEIU Local 503 chapter president. “It’s so much bigger now because we don’t have the staff to do this.”