Nurses at UW Health in Madison escalated their call for the health care system to address staffing and related issues Thursday, submitting a stack of reports describing problems affecting patient care to the Wisconsin Department of Health Services (DHS).

The reports, which nurses said numbered about 100, described incidents they have encountered on the job in the last several months that they said represented potentially harmful situations that could compromise patient care.

UW Health officials said the reports are part of a pressure campaign around compensation, but nurses said the incidents illustrated the ongoing concerns about their working conditions and patient safety that helped spark their drive to unionize four years ago.

Nurses said those conditions have been driven by practices such as short staffing and exacerbated by what they contend is a failure to listen and respond to the concerns that they have been raising.

“They trust us enough to take care of the sickest, most vulnerable patients,” said Sara Booth, a veteran of nearly 13 years as an operating room nurse at UW Health. “But they don’t trust us enough to believe us when we say there’s a problem.”

The reports that nurses submitted to the state health department’s Division of Quality Assurance were recorded on forms that they and their union, UW Nurses United, created in July. Nurses said they submitted them to DHS after UW Health management had rebuffed their efforts to talk about them.

The forms “document assignments or conditions that could compromise patient and nurse safety and quality of care,” states a five-page cover letter submitted with the reports to DHS. A copy of the letter was obtained by the Wisconsin Examiner.

“The critical issues detailed in the forms include extreme understaffing, inadequate training, turnover, exhaustion and burnout of nurses. As stated on the forms, they may be used to notify government agencies with the goal of correcting these issues as we are doing today,” the letter states.

The letter alleges that accounts in the reports show potential violations of federal regulations under the Centers for Medicare & Medicaid Services (CMS). The regulations set federal standards for hospitals and other health care institutions taking part in federally funded programs such as Medicare and Medicaid and have been adopted as state regulations, too.

The nurses delivered the reports to the offices of DHS in Madison after a press conference in front of the agency’s office building.

It’s not clear what DHS will do with the reports. A spokesperson asked to explain the complaint-handling process said Thursday that the agency “cannot comment on complaints.”

Thursday’s action ratcheted up the confrontation between nurses who have been seeking union representation at UW Health facilities in Madison in a campaign that began in 2019.

UW Nurses United, affiliated with SEIU Healthcare Wisconsin, and UW Health have been conferring in a process they call “meet and discuss” since September 2022. The hospital’s management — after refusing to entertain any engagement with the union for nearly three years — and the union agreed to the process as part of a temporary resolution to forestall what would have been a three-day strike by nurses at the health care system.

UW Health responds

A UW Health spokesperson, Sara Benzel, told the Wisconsin Examiner in an email message Thursday that the the union “threatened to bring their concerns to DHS if we didn’t meet their compensation demands,” and that the forms “were explicitly tied to demands for compensation.”

UW Health’s CEO, Dr. Alan Kaplan, made a similar statement in an email message he sent to all UW Health employees on Sept. 25.

In the memo, which Benzel provided, Kaplan wrote that SEIU and “a small group of our nurses” had contacted the administration to report they had collected information on patient safety problems “and threatened to submit them to the Department of Health Services (DHS) if we did not meet their demands related to compensation.”

Kaplan added: “We told them that any compensation issues would be addressed through our normal processes and requested that the union share those patient safety issues with us so we could review them and take action to address any safety issues. They have so far refused to share them with us.”

Kaplan’s email was sent at 11:39 a.m. on Sept. 25.

Twenty-one minutes earlier, at 11:18 a.m., an SEIU union representative emailed a 14-page summary that included dozens of anecdotes and incidents described in reports nurses had collected to UW Health’s chief compliance officer, Troy Lepien. The Wisconsin Examiner obtained a copy of the email.

“This is a summary of what has been reported so that you are able to track the heart of the safety concerns in each of the areas that we shared with you at the September Meet & Discuss session,” stated the email, signed by union representative Claiborne Hill.

“We continue to hope that you will work with us on finding much needed solutions to these ongoing and serious concerns,” Hill wrote. “We firmly believe that we need to be in more regular communication about issues facing RNs and their patients, and continue to leave the door open for genuine collaboration.”

In his memo, Kaplan said use of the hospital system’s internal reporting system of “potential safety issues” has increased 24% compared with 2022, signifying, he said, “that we all share this commitment to safety.”

Mary Jorgensen, one of the UW Nurses United leaders, said Thursday that she and her colleagues didn’t see evidence of any impact from the hospital’s reports. “The internal reporting system in the hospital doesn’t do anything,” she said.

Conflicting accounts of turnover

Benzel of UW Health said turnover at UW Health for nurses is 11.3%, “significantly below the national median of 19.9%,” and that the turnover for operating room nurses in the system is 9.9%.

Union nurses contend the turnover rate in the OR is much higher, at about 23%, which Benzel said is not accurate.

Nurse Shari Signer said there had been an attempt to eliminate a group of emergency response nurses known as “Save Our Shift,” or “SOS.” She described them as “critical care generalists” available to move around to handle different emergencies over the course of a shift. That plan was put on hold, she said, but the future for that group appears uncertain.

Benzel of UW Health said the hospital system’s intent was “to update and strengthen that role” rather than eliminate it. The system has made other changes, such as creating teams specializing in placing IV lines, she said, and the addition of new groups of critical care nurses.

But some nurses are skeptical. At the union’s press conference, nurses said they’re seeing firsthand the departure of more experienced nurses.

“The experience has left the building,” said Booth, who will mark her 13th year as a UW Health operating room nurse in early 2024. “You can’t teach insight — that comes with experience.”

In the operating rooms, “we have new nurses training new nurses, and our surgeries are too complex to have brand new people training brand new people,” Jorgensen said.

“It’s also like this constant turnover,” said nurse Ryann Streicher. It takes six months to train a newly hired nurse on the job, she explained, adding that it’s not unusual to see them leave after working for just a year. “I think it has to do with the lack of veteran nurses,” she said.

At the same time, she added, the number of nursing students is declining, reducing the pipeline of new nurses. “There’s going to come a time when you can’t replace us,” Streicher said.

Among the areas where the problems are most acute are the emergency room at the main UW Hospital on Madison’s west side and in the operating rooms, according to nurses who work in those departments.

With a shortage of surgical technicians — a separate profession with its own two-year educational track and credential — nurses sometimes have to double up on those tasks, said Booth.

“We do the best job we can, but patient care is suffering, and it shouldn’t be this hard,” said Mariah Clark, an emergency room nurse. “I hate the fact that feeling like a good nurse is so rare anymore, because our staffing prevents us from taking the time and care we need … to provide emotional and physical support to our patients.”