Tacoma General registered nurses Matthew Dustin, who works in neuro trauma and the ICU, and Liana Delacorte, who works in the Emergency Department, talk to WSNA about their jobs, magical moments, and working with ratios.
Both came to nursing as a second career. Delacorte spent eight years as an emergency medical technician, and Dustin enlisted in the Army and then worked as a housekeeper and nurse technician at Tacoma General before becoming a nurse.
The WSNA contract with Tacoma General includes requirements for staffing ratios. During negotiations for a new contract in December 2022, the management at MultiCare, Tacoma General’s parent corporation, wanted to take ratios off the table. That was a hard “no” for the bargaining team. They fought hard to get them in 2012, and they said they would strike if those ratios were taken away. The ratios stayed.
Have you had a magical moment in nursing?
I took care of a patient this last year who came in as a trauma. He had fallen, hit his head, and had a brain bleed. He couldn’t move an entire side of body. He couldn’t recognize his wife. He was 50 years old. It was so heart wrenching to see him not know his wife. I thought he would be disabled for life. Six weeks later, he came back and was normal.
I was able to be 1:1 with him. I didn’t leave his side in the emergency room. I was able to give him meds as soon as they were ordered, and I could notice any status changes. With the process of care at the hospital (neurosurgery and nursing), he’s normal and back to life.
It was pretty magical. I didn’t think he was going to make it. We do make a difference.
Why ER nursing?
I love the variety of my department. ER is a different world. It’s a free for all when the phone rings. I do love being a trauma nurse and watching trauma surgeons and assisting them with critical patients and then being amazed when we can put people back together that are completely broken.
What is it like working with ratios?
In my department, the ratio is 4:1 because it’s in our contract. If we get a critically sick patient, that ratio drops to 2:1. This ensures we have the resources to take care of these critically sick patients and not abandon other patients. You never know what is going to walk in the front door.
What would it be like without ratios?
I would be very worried about my license and outcome of my patients.
As an EMT, I saw nurses scramble to check on noncritical patients if there was a CPR in progress. … It’s not just big-picture scary. It’s as basic as passing out meal trays. Not having time to clean up a dirty brief on an incontinent patient. Discharge paperwork, pain meds are going to be late.
What did you think when MultiCare wanted to take away ratios during bargaining?
At first, I couldn’t believe what I was hearing. It was a slap in the face after working through the pandemic pregnant and literally putting my life and my family’s life in danger.
This request brought the entire bargaining team together overnight. We thought, going into bargaining, what a huge resource for recruiting nurses. Hearing the horror stories coming out of New York, we wondered, “Have you (management) not been paying attention?”
Have you had a magical moment in nursing you would like to share?
I took care of a dying patient. He had no control over his sickness or health. He was frustrated. I just sat down with the guy and talked with him and said, “It seems like you are frustrated. What’s going on?” He said, “I don’t have control over anything anymore.” Before he was discharged, he wrote me a note. “Matt, you are the best. Thank you for understanding.”
Why neuro ICU?
It’s the autonomy, the utilization of nursing skills, and the ability to grow and build off nursing knowledge and enhance that. I work with septic patients, COVID-19 patients, patients who have head-on car accidents. We do everything besides burns at Tacoma General. We are a tertiary care center and get patients from Olympia, Centralia, Grays Harbor, and Eastern Washington.
I can’t think of a day where I have looked at my watch. You are busy all the time.
What’s it like working with ratios?
When I first came to MultiCare, I was hired in ICU, and we were in active negotiations (2011-2012) with management. The big thing was ratios.
As a brand-new nurse, I was taking upwards of three severely sick patients, and it was horrible because I was just starting out, and I was having a hard time with time management — caring for a patient and charting. Charting is what legally keeps you protected. If you haven’t charted, you didn’t do it.
We eased into ratios six to seven months after the contract was ratified. Now in ICU, I have one or two patients with qualifiers for a patient’s condition. If a patient needs ECMO, open heart surgery, continuous renal replacement therapy, or if we are doing organ donations, the ratio is 1:1 or 2:1.
What was it like when MultiCare wanted to take away ratios?
We had a hard line on ratios. We fought hard for these ratios years ago. And we were not letting these go. We said we will strike over this.
Our workload is increasing. Charting is more complex, and patients are getting sicker and sicker.
The worst thing for a nurse is having a patient that needs your help and you can’t do anything.
Management didn’t give a reason for being opposed to ratios. But being in the industry long enough, I can say the healthcare industry is killing the healthcare profession. There are more profits without ratios. I get it, you need to make margins. But hospitals are making money off people’s health.