North Carolina Nurses Are Risking Their Lives, and They Want a Union

Nurses at Mission Health in Asheville, North Carolina want a union. The pandemic only makes them more certain that one is necessary.

Nurses, patients, and their supporters say conditions have deteriorated significantly since HCA Healthcare took over the nonprofit Mission Health system, which covers much of western North Carolina. HCA is the largest for-profit hospital chain in the country, and local leaders including Asheville Mayor Esther Manheimer have been increasingly critical of HCA’s practices since the buyout in early 2019.

“With HCA heavily focused on the bottom line, there have been numerous, aggressive staff cuts over the past year, putting patient safety at risk,” Manheimer wrote in a local op-ed, which was signed by several more local officials including the county commission chair.

“Certified Nurse Assistants and unit secretaries have been cut dramatically or eliminated altogether, putting new pressure on nurses. Patient to nursing staff ratios have also increased and some departments have seen an exodus of nurses, further stressing the remaining nurses.”

At a public meeting in February, nurse Jennifer Kirby fought back tears as she described the situation.

“Every single department in the hospital that is designed to help the patient get out and toward wellness is critical and unethically and inhumanely understaffed,” Kirby said, according to the Asheville Citizen-Times. “I used to be really proud of where I work, and I’m not anymore.”

That’s why a “supermajority” of nurses at Mission Health in Asheville — most of them working at Mission Hospital — signed on with National Nurses United, Bradley Van Waus, the union’s Southern Regional Director, told Cardinal & Pine. In early March, nurses announced the unionization effort and filed for a formal vote with the National Labor Relations Board. 

And then, COVID-19 arrived.

One Mission Hospital nurse — who asked to remain anonymous for fear of reprisal — told Courier that the hospital administration wasn’t taking coronavirus seriously enough or protecting employee safety.

“Management was discouraging staff from wearing masks ‘due to the shortage’ and also because it was ‘scaring the patients,’” she said. “The information bedside staff was receiving was scarce in regards to the plans Mission was making to handle the crisis. Education for how to care for these patients was practically nonexistent.”

The nurse, who has worked at Mission Hospital for nearly two decades, said she joined the union campaign for a variety of reasons including short staffing, a drop in the quality of supplies and equipment since HCA took over, and what she described as the administration’s repeated unwillingness to hear their concerns.

Mission Hospital did not respond to repeated requests for comment. In a public statement shared by local press, hospital CEO Chad Patrick encouraged nurses to vote against the union.

“Simply put, we don’t believe union representation is right for nurses at Mission Hospital,” he wrote. “I say that not out of disrespect to nurses who support the union, but out of my firm belief that unions can be divisive and undermine the very relationships that strengthen our patient care teams.”

The statement acknowledged that there has been “a great deal of change” at the hospital since HCA’s takeover. “It is clear that we have more to do to explain our vision and the path we are taking to get there,” Patrick wrote, although he did not elaborate on either subject.

Another nurse who works the night shift at Mission Hospital told Cardinal & Pine that the pandemic has only underscored longstanding problems at the hospital. This nurse also wished to remain anonymous for fear of reprisal.

“I wish I could say that this was a crisis that HCA and Mission management could rise to the occasion and show how well they can advocate for us,” he said. “There have been some positive things. The CEO is donating money to a COVID relief fund [and] compensation for missing work due to… COVID-19 has improved. Largely, though, from our perspective, management has remained poorly communicative and absent as ever.”

He supports the union because he wants “safe nurse-to-patient staffing ratios” and because he wants nurses to have “an advocate.”

“I wish unions were unnecessary, but I wish police departments were unnecessary, too,” he said. “Unions are not perfect, but the option right now is between an imperfect advocate and no advocate at all. I do not trust management at this time. I do not trust them to do the right thing, especially when the stakes are high.”

On April 2, several nurses delivered a petition calling on the hospital to adjust procedures, communicate more clearly, provide protective gear and training, adequately prepare for a surge of COVID-19 patients, and “cease all anti-union meetings and focus on preparation for COVID-19 emergency,” among other demands.

Van Waus, the union representative, said the action was taken in conjunction with nurses at 15 HCA hospitals across the country where nurses are represented by National Nurses United.

“We’d been getting reports that people were reusing [protective] gowns and masks, which is dangerous practice,” he said. “[HCA] has no plan to increase staffing.”

And yet despite the coronavirus outbreak, Mission Hospital administrators have been pulling nurses from disparate units into the same anti-union meetings, Van Waus said, and even “bringing in union busters from out of state” at a time when social distancing is paramount. 

Nurses held another protest over the hospital’s coronavirus preparedness on April 9, according to the union, carefully practicing social distancing while doing so.

Mission Health spokesperson Nancy Lindell told the Asheville Citizen-Times that the union was trying to capitalize on the pandemic for its own benefit.

“Mission Health has frequently stated our position on unions, but the union’s behavior during a crisis shows exactly why we believe a union is wrong for Mission Health and Asheville,” Lindell reportedly said in a statement. “It’s unfortunate that the union is attempting to turn a crisis into a publicity event designed to promote the union’s own agenda and spreading fear and misinformation.” 

COVID-19 is impacting the union efforts in other ways as well. Organizers postponed a hearing to determine which of the more than 1,500 registered nurses at Mission Health in Asheville would be covered, Van Waus said. Once the size and scope of the bargaining unit is determined, a formal vote to unionize could be held, requiring a simple majority for victory. 

If the pro-union nurses are successful, they’d join 10,000 counterparts at 19 HCA-owned hospitals around the country who are represented by National Nurses United, the largest union of registered nurses in the country. As the Carolinas have the lowest union membership rates in the nation — at around 2.3% in both states last year, according to the U.S. Bureau of Labor Statistics — the nurses’ decision will reverberate across the region.

But first, they’ll have to weather this storm.