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American Family Children’s Hospital nurses plead for more help in neonatal ICU

nurse union protest

Hundreds of nurses protest outside of UW Health's emergency room at 600 Highland Ave. in February, demanding leadership recognize their union. 

Sarah Place often ends her workday at American Family Children’s Hospital in tears. 

As a pediatric float nurse, she is assigned to fill positions within units that are short-staffed. Lately, she’s found herself in the neonatal intensive care unit (NICU), where she said nurses have been “run ragged” trying to care for the hospital’s youngest and most at-risk patients. 

NICU nurse Courtney Younkle said the unit — which cares for premature newborns or babies with complex medical conditions — can be short four to six NICU nurses in a shift. At times, she said, the hospital has even had to turn away new admissions to the NICU due to the lack of nurses. 

“It’s been really hard with how short we are to be able to take care of our patients safely,” Younkle said. “There are nurses who leave the shift crying because they felt like no matter what they did, they couldn't take care of the patients the way they wanted to.” 

According to a report from the Wisconsin Hospital Association released last week, Wisconsin's nursing positions experienced unprecedented vacancy rates in 2021. 

The WHA tracks vacancy rates for 17 positions including certified nursing assistants, registered nurses, physician assistants and advanced practice nurses. From 2020 to 2021, vacancy rates increased in all but four of the positions the organization tracked. 

During the same time period, registered nurse vacancy rates also more than doubled to about 11% — hitting double digits for the first time since 2005. 

While the report attributes the trend to an aging workforce and a wave of resignations and retirements influenced by the COVID-19 pandemic, those working in the NICU said the nursing shortage had crept up even before then.

Nurses cite unsafe staff to patient ratios

In a statement to the Cap Times, UW Health press secretary Emily Kumlien claimed vacancy rates in the NICU at American Family Children’s Hospital are “very low,” ranging between 2.7% to 5% over the last year. 

But Megan Derrer, a third-year fellow in the NICU, who is in her last year of training to become a neonatologist, said the understaffing is undeniable. She added the problem is especially concerning in the NICU because the babies are “the most complex of our patients and need the most help.” 

American Family Children’s Hospital is also just one of two NICUs in the state which treats babies deemed “level IV” — the highest level, meaning they need the most acute care. Derrer described them as “our most vulnerable patients.” 

“Our patient population in the NICU is, of course, very fragile and they do require very dedicated care,” added Younkle, who has worked in the unit for nearly eight years. “When some shifts are short up to four to six NICU nurses, it's really hard to give them the attention that they require.” 

Sarah Hartlaub, another NICU nurse, said the unit has begun assigning as many as three patients to each nurse. Under normal circumstances, NICU nurses typically only take one to two patients because their complex conditions require a higher level of care. 

For Place, the pediatric float nurse, the high ratio has frequently put her in disconcerting situations both in the NICU and other departments throughout the children’s hospital. In one instance, she cared for a baby whose bedside she was not permitted to leave while also getting assigned to another patient. 

When Place was alerted that the other patient needed medication in an IV drip adjusted, it left her scrambling for help. Place signaled the other patient’s call light, which would typically send another nurse to their room. 

“But the call was never answered,” she said. The nurse in charge of the floor, who is normally not assigned to patients, was also caring for another person because there was not enough staff at the time. 

Finally, she called out to a nurse in the hallway to no avail — that employee was on their way to answer another alarm. 

“It was this moment of reckoning,” Place recalled. “It was the point where it's past poor morale, it’s past poor staffing — my license is on the line here.”

“I didn't know what to do. As a nurse, that's just such a crushing feeling. This is so unsafe. This is not the care you want to provide.”

A temporary solution

According to Kumlien, UW Health has implemented an “internal nursing traveler” program to incentivize workers to fill open shifts. 

Hartlaub said the initiative pays staff a higher wage to take on an extra shift every week, which has been “helpful in the short term but not very sustainable.” 

Some of those who have opted in are working 48 hours a week, she said, causing burn out. That also means those from outside of the NICU are filling in, some of whom are not specifically trained or have adequate experience to care for sick babies. 

Younkle explained that NICU patients are often intubated with specific types of ventilators, requiring one-on-one care that “we can’t always provide them.” They also have medications that need frequent titration and monitoring, which can be unfamiliar to nurses who do not have NICU training. 

“It makes it hard for them to do their jobs and for us to do our job safely,” she said. “We've already creatively staffed by tripling patients we normally wouldn't, but there are still times where we have to divert patients to other hospitals because there simply isn't the staff to take care of the patients.” 

Health care workers burn out

For some, the issue has additionally led to issues outside of the workplace. Place, for example, regularly sees a therapist to deal with her mental health. All four of the health care workers interviewed for this story said they experience stress and burnout or have seen their colleagues crying while on the job. 

“It just feels exhausting and some days it makes it really hard to come to work,” Hartlaub said. “It also means I'm not giving my full self to my patients and my families who deserve it.” 

Hartlaub’s account is in line with a SEIU Healthcare survey, conducted in January by a professional polling firm and the UW Health nurses union, which polled 920 Dane County health care workers. 

It found that 90% believe understaffing is having a major negative impact on patients. Another 86% reported experiencing stress or trauma during the pandemic, and 82% said they have considered leaving the health care field altogether. 

Place added she’s one of many who has thought about leaving American Family Children’s Hospital, which is part of the UW Health system. She began applying to other jobs, but ultimately decided to stay. 

“I didn't think I was going to get to this point in my career. There's points that I don't want to go to work sometimes,” she said. “I even cringe saying that out loud because I've always enjoyed my job so much. But the logistics have changed that for me.” 

Nurses demand union recognition

Place and other nurses said UW Health should work with the nurses union to address understaffing, overwhelming patient loads and high turnover rates that have stemmed from cost-cutting measures over the years.

While the union contract expired in 2014, nurses at UW Health have sought to revive it since 2019. 

UW Health administrators are also aware of the nurses’ grievances, but they argue the 2011 state law known as Act 10 — which eliminated collective bargaining rights for most public employees — leaves them with their hands tied.

Still, 1,500 nurses have already signed on in support of the effort, the union claimed. While UW Health said the number of union-eligible nurses is 3,400, the union said that figure is misleading because it includes nurse managers and nurse practitioners, who would not be included in the union. They claim the number of union-eligible nurses is 2,600.

The nurses also cite a memorandum from the Wisconsin Legislative Council, which says Act 10 "simply deleted the obligation" for the University of Wisconsin Hospitals and Clinics Authority to engage in collective bargaining. The law did not prohibit collective bargaining altogether — instead, employees may seek voluntary recognition by the UWHCA. 

Kumlien added UW Health’s shared governance system allows administrators to work with front-line nurses in making improvements and developing new approaches to the staffing crisis. 

But Hartlaub, who chairs one of the nursing councils, said little action has been taken. 

“It feels like false promises,” she said. “There are things that they have implemented, but it feels very few and far between. It doesn't feel like we're given appropriate input.” 

Without union recognition, Place said people will continue to leave the hospital — or worse, the profession. And despite the conditions, Younkle said nurses still try hard to make sure patients and families feel cared for. 

“I think everyone really is doing their best to provide the highest quality of care that they can without trying to alarm families who are already in a very fragile and scary position,” she said. “But it just feels like we have nothing more to draw from our reserve anymore.”

Editor's note: This story has been updated to include additional information from UW Health.

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