Comment: What Providence’s treatment of nurses means for patients

By Angela Kokinakos / For The Herald

Providence Regional Medical Center Everett’s negotiator reportedly described her experience during talks as “the most frustrating experience.” She wouldn’t last as a nurse at the hospital.

Providence asserts its offer will attract and retain nurses, while simultaneously disregarding its failure to meet regional standards or other Providence hospitals. A nurse mused, “Why do we have to bargain to make just as much as our affiliate? It should have automatically been offered to us. They should appreciate all the hard work we have given, but they don’t.”

Providence asserts that staffing language won’t make a difference, while simultaneously reducing travel nurse rates by $19 an hour. This caused a sudden decrease in travel nurses and a subsequent staffing crisis. These conditions are counterproductive to building staff. Nurses feel blamed for patient suffering and poor outcomes. Another Providence nurse said, “They push us too hard. Providence is responsible for not providing what we need. They expect us to do more with less.”

Providence’s current solution is a “collaborative care model,” featuring one nurse responsible for six to eight patients, twice the typical patient load. Accepted nursing evidence finds that each additional patient per nurse increases the likelihood of death. Hospitals with higher nurse-to- patient ratios have fewer patient deaths. If the quantity of nurses directly affects their ability to keep patients alive, why would Providence propose a staffing model that does not represent these standards or promote patient safety?

The American Nurses Association supports minimum nurse-to-patient ratios for every hospital.

“Nurses are expected to provide excellent care, but they often work in conditions that make that exceedingly difficult. They do not get paid enough and are stretched thin in their roles and responsibilities,” said ANA President Jennifer Mensik Kennedy.

Providence did nothing while other area hospitals provided unprompted raises in 2022 to all nurses outside of their bargaining process. One nurse observed that, “Overlake (in Bellevue) and Evergreen (in Kirkland) just gave across-the-board raises, without negotiations. That’s valuing your people to make them want to stay.”

At Providence, staff do not feel valued nor respected. In my eight years as a Providence nurse, I felt mere lip service paid to nurses’ concerns. The inadequate parking and suggestion that staff should simply take public transportation when such routes do not exist epitomizes how much they care. The inability for staff to take breaks and the limited food service available show they don’t care how or what staff eat during the 13-plus hours trapped inside during a shift.

I’ve never worked anywhere that treated employees so poorly, and I worked on cruise ships, an industry notorious for employees compared to “indentured servants.”

Providence was the only job where I’ve wet my pants because I simply could not get away in time, where I routinely ate food in the bathroom, and where I shed tears of despair in the car because of the moral injury or injustice done to colleagues and patients. The way Providence seems to ignore established nursing evidence about safe practices while gaslighting nurses for identifying problems is making Florence Nightingale roll over in her grave.

The relationship Providence has with its nurses reminds me of an emotionally abusive relationship wherein one partner has a disproportionate amount of power and uses it to control and manipulate the other to achieve their needs without any concern for the partner. As a psychiatric nurse practitioner, I can identify abusive behaviors. Besides gaslighting, I’ve noticed triangulation, moving goalposts, generalizations, changing the subject, passive-aggressiveness, victim blaming, guilt trips, and the silent treatment.

“I’m really disappointed that Prov will not go back to the bargaining table like Kaiser (Permanente) did after their strike 10-day notification,” one nurse told me.

The only way nurses regain some power is through refusing to tolerate abusive behavior from their employer. Nurses’ requirements are not unprecedented; PRMCE is the third Providence hospital in the Northwest to strike. Providence Portland and Seaside went on strike in August, yet representatives for Providence Everett seem to act as if that didn’t happen.

The negotiator asked why the hospital’s offer wasn’t enough this time when it was good enough last time. The truth is, it wasn’t good enough last time. That so many seasoned nurses left in 2020-22 and never returned suggests problems bigger than covid. While the virus was terrifying, the way staff felt mistreated was worse. Staff buckled down during the pandemic, believing that we’d get through it and return to “normal.” Nurses put their differences aside in the last contract negotiation so they could get on with patient care. However, it felt like when Providence found they could get nurses to do more for less, they just kept on squeezing. Now, nurses’ professional ethics are being used as a weapon against them.

Billionaire entrepreneur Richard Branson, whom I had the pleasure of meeting, told me he attributed his success to his employees, his most important asset. He described his foundational principle was care for his employees and support in their jobs, that happy employees made healthy businesses. “Can you imagine what a different world we will live in when businesses do what’s right for the communities and the environment in everything they do?” he said.

Branson recognized that, “by putting the employee first, the customer effectively comes first by default, and in the end, the shareholder comes first as well,” and “being a good listener is absolutely critical to being a good leader. You have to listen to the people who are on the front line.”

Consider Providence by comparison, the antithesis of Branson’s advice. Providence nurses have reasonable demands consistent with best nursing evidence and businesses practice. Providence implies that nurses want too much; I’d like to assert that it’s still not enough.

What’s missing is genuine respect for staff and recognition that without nurses, there is no hospital. Providence must treat staff as if they matter. See us on the sidewalks.

Angela Kokinakos is an advanced registered nurse practitioner and board-certified doctor of nursing practice-psychiatric mental health practitioner. She worked at Providence Regional Medical Center Everett from 2016 to 2022.

Correction: Because of an editing error, Angela Kokinakos employment history at Providence Regional Medical Center Everett was miststated in an earlier version of this commentary.