The investigation follows a complaint about whether the hospital is complying with state law regarding the rights of hospitalized patients.
The Department for Disabilities, Aging, and Independent Living received approval to investigate the complaint from the Vermont Department of Health, according to a letter from March 3. The nurses union at the hospital was involved in the complaint.
The director of the Division of Licensing and Protection was out of the office Wednesday, and staff did not confirm the investigation. The Department of Health said Vermont law prevents it from confirming details of investigations or whether they are happening.
Deb Snell, the vice president of the Vermont Federation of Nurses and Health Professionals, the union that represents nurses at the hospital and is seeking to get licensed nursing assistants to join, is aware of the underlying complaint.
Licensed nursing assistants at the hospital have complained for months that they are understaffed and overworked. They continue to seek permission from the hospital’s administration to join the nurses’ union so they can bargain collectively for better working conditions.
Snell said the union sought public data in January on how many registered nurses, licensed practical nurses, and licensed nursing assistants have worked on each floor during each shift, reports that are required under Vermont law.
“They are required by law to post these numbers (in the hospital), and we wanted to see what the staffing really looked like,” Snell said. “There were a lot of units with missing data, units where the numbers didn’t really seem consistent,” and units that were understaffed.
“Even though they’re not always posted in the most obvious places, any member of the community who has a loved one in the hospital … has the right to be able to see what the staffing levels are on that unit to make sure there are enough staff nurses and enough LNAs to take care of the patients on that unit appropriately,” Snell said.
Data obtained by VTDigger show that, for a six-month period in the first half of 2016, UVM Medical Center reported having exactly two LNAs on staff during three different shifts, every day of the week, in the Surgical Intensive Care Unit. During that time period, there were up to 26 patients in the unit.
During a five-month period in 2016, the hospital reported 34 different shifts that had zero LNAs on a floor called “rehab.” During the shifts on the “rehab” floor without LNAs, the hospital reported between 19 and 32 patients in the unit, the data show.
Kate FitzPatrick, the chief nursing officer for UVM Medical Center, said in an email that the data contained in the reports are correct. Additionally, she said the shifts with no LNAs represent less than 1 percent of all shifts during that five-month period.
“The rehab unit had shifts in which LNAs were not included as a direct care team member,” FitzPatrick said. “In those shifts, LNAs function as 1:1 patient observers, providing direct safety care for patients. These hours are not included in direct care hours.”
Snell, a registered nurse at the hospital, said data on staffing levels are important. She said the union has already negotiated for the registered nurses to make sure they are only responsible for between four and seven patients, depending on which shift they work.
“When I started there, I would have 10, 11, 12 patients on night shift,” Snell said.
“The problem with the LNAs is there are no specific staffing ratios.”
Heather Lambert, an LNA serving patients in orthopedics and neurology, said there are days when her floor will have 32 patients and 2 LNAs. She once worked by herself, and another time worked with only one other person.
“There is a day when they staff us to five, but we’re always short-staffed,” Lambert said. “Even four LNAs for 40 patients is too much. The floor is just way too busy and we have a lot of heavy patients.”
FitzPatrick said the hospital just completed “a full evaluation of our patient care needs, including registered nurses and support staff” and is both actively recruiting new LNAs and recruiting people to participate in the hospital’s licensing program for people to become LNAs.
“We have also brought in temporary resources, through a partnership with a local vendor and school of nursing, to augment patient care support needs while we recruit and adequately train all new staff,” she said.
With regard to the ongoing effort to unionize the LNAs and mental health technicians, Snell said the hospital is not working with the union. She said the hospital has noticed staffing issues and hired external staffing agencies to bring in people who will sit with certain patients who need to be supervised.
“We’re just wondering why the hospital is pushing back so hard against these employees—who are not paid particularly well, and mostly women—why are they so concerned about this group having a voice at work,” she said.
FitzPatrick disagrees: “We actively and openly work with all of our front-line staff to improve the work environment so that we can continue to provide safe, quality care to our communities.”
“We routinely hold forums to learn about opportunities for improvement, as well as include front-line staff in continuous improvement task forces focused on a host of priorities including staffing,” she said.
“We are most excited to have a group of LNAs leading a formalized council to focus on how they work together, collaborate with the care team, and standardize how they provide care across the medical center,” she said.
The licensed nursing assistants and other support staff are holding a protest Thursday at 5 p.m. at the UVM Medical Center board of trustees meeting on the third floor of the ambulatory care center to discuss the alleged staffing issues.