This article was reported with the support of a fellowship from the Alicia Patterson Foundation.
Jessica Wheeler works the night shift as an oncology nurse at Wilkes-Barre General Hospital in northeastern Pennsylvania—but her patients are usually wide awake. “When they have a new cancer diagnosis or they’re going to have a biopsy in the morning, they don’t sleep,” says the 25-year-old Wheeler (which is not her real name). “They’re scared.” Other patients are in their final hours of life, surrounded by grieving family. What she wants is to be there to comfort them, to talk them through those difficult hours, to hold their hands and attend to their pain. But, mostly, she can’t.
According to hospital policy, night nurses on her floor should care for no more than six and a half patients, but they typically have ten. When things go bad with one or two, the floor quickly tips into chaos.
Wheeler recalls one night when she had a patient who couldn’t breathe and several others under her care. “I called the supervisor to ask for anybody—a nursing assistant, anybody! And I didn’t get it, and my patient ended up coding.” Another night, Wheeler had a post-op patient who required constant attention; the patient was confused and sick, and she soon escaped her restraints and pulled out her drains, spraying fecal matter all over the wall. Early the next morning, her heartbeat became irregular just as another patient was dying. “Those nights are scary,” Wheeler says. “I think I’ve seen everybody on our floor cry.”
Another young nurse describes a shift when she had only been on the job a few months and was saddled with ten patients, including one whose incision was leaking badly, requiring her to administer blood all night long. “I was drowning,” the nurse says. She called for help multiple times, but it never came. At the 7 am shift change, she confused two patients’ blood-sugar numbers and medicated the wrong one.
Wilkes-Barre was not always this out of control. For decades, it was a nonprofit community hospital serving the onetime coal town. It was bought in 2009 by what is now the nation’s largest for-profit healthcare chain, Tennessee-based Community Health Systems, which operates 207 hospitals in twenty-nine states. The Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP), the nurses’ union, counts fifty-one fewer nurses since the CHS acquisition, a reduction of more than 10 percent—and that’s on top of the elimination of dozens of nursing aides and secretaries. The nurses are not only juggling more patients, says Fran Prusinski, a critical-care nurse who’s been at the hospital for thirty years, but “they have to change the linens, empty the garbage and answer the phones.”