It has been a year since Hospital Corporation of America (HCA) bought the Health Midwest system in Kansas City, Mo., and a new survey by Nurses United for Improved Patient Care finds that all is not well.

Most HCA nurses who responded to the May survey said the quality of patient care has declined and they have less time to spend with each patient. Nearly half said they are considering leaving HCA.

“These alarming results are especially distressing because of the expectation that things would get better,” says Mary Nash, president of Nurses United, which represents registered nurses at three of the 12 hospitals in the former Health Midwest system. “HCA had positioned itself as the white knight who would turn things around for patients and nurses. Reality, unfortunately, undercuts HCA’s repeated public pronouncements that their goal is quality patient care.”

Nurses United distributed surveys to more than 2,100 HCA registered nurses in April, and 355 nurses—more than 16 percent—responded. Many expressed their dissatisfaction with conditions over the past 13 months. The nurses said conditions were bad when HCA took over and many were upset that things either have stayed the same or actually worsened.

“Unable to give quality patient care due to increased patient load,” wrote an RN. “I was hoping things would improve.”

“No improvement noted since HCA took over,” another RN said.

“Don’t have time to spend with the patients,” commented a third.

Nurses United will pursue state legislation calling for mandatory nurse-to-patient staffing ratios to ensure safe patient loads; whistleblower legislation to protect nurses who report dangerous conditions; and disclosure requirements to inform the public of staffing levels and other quality indicators.

Major survey findings:

• 57 percent of respondents said the quality of patient care has declined during the past year. Another 35 percent said it has stayed the same. “Emphasis is on going faster and faster, never better,” one RN wrote. “If you have high acuity [very sick] patients and no decrease in the number of patients, someone gets poor care,” said another RN.
• 58 percent of respondents said the time spent with each patient has decreased in the past year. Another 34 percent said it has stayed the same. “Patients no longer get one-on-one care during labor—some nurses are monitoring three to five fetal monitors at the same time. This is unsafe and management doesn’t seem to care,” said an RN. “I could provide better patient care if I were given more time … to spend with each patient,” said another nurse.
• 65 percent of respondents said the number of support staff, such as nursing assistants, unit secretaries, housekeeping, respiratory therapists and pharmacists, has decreased. And 48 percent of respondents said the availability of supplies has eroded under HCA ownership. “We are always running out of things, and it takes days to get more,” said a nurse.