HCA Mission Hospital

RN Patient Advocacy Strategies for Hospitalized Patients at HCA Hospital, Asheville, NC

January 23, 2024, 6:30pm to 8:30pm, AVL Watchdog Panel, AB Tech, Asheville, NC

“HCA-Mission at Five Years: What Can We Do to Restore Better Healthcare in WNC?” 

Many thanks to co-panelists Peter Lewis, AVL Watchdog, Clay Ballantine, MD, Bruce Kelly, MD, Maureen Copelof, Mayor, Brevard, NC, and Julie Mayfield, Senator, North Carolina’s 49th District, for their wisdom and heartfelt concern about the patient care concerns at HCA Mission, Asheville, NC.

My name is Karen Sanders, and I am a Holistic RN Patient Advocate in Private Practice.  

Many thanks to the hundreds of dedicated professionals and staff at Mission who are working in very difficult conditions.

I have been a nurse for 45 years of which 37 years were working in large tertiary care referral centers in Virginia and North Carolina. My time working in hospitals included critical care, Med/surg, Case Management Clinical informatics, and Nursing Administration.

For 15 years, I worked as a contract educator for the North Carolina Board of Nursing helping disciplined nurses take the mandatory Ethical-Legal Decision-Making course. Nurses make catastrophic career ending mistakes when they are stressed at home and when they are stressed at work.

4 Pillars of Nursing Practice

In North Carolina, Registered Nurses are held accountable to 4 Pillars of Nursing Practice:

  1. North Carolina Nurse Practice Act
  2. American Nurses Association Code of Ethics
  3. Patient Bill of Rights for each specific hospital
  4. Standards of Practice for Clinical Performance in Specific Units for Similar Size, Similar Service Hospitals

Nurses working in hospitals become most stressed when they are short staffed. Short staffing means that the acuity of the assigned patient load is too high or the volume of patients to whom they are assigned is too large or both reasons.

When there is chronic short staffing, or not enough staff on a unit for days or months or years, nurses become very tired, stressed, and overwhelmed. Nurses succumb to Moral Injury.

Moral Injury

Moral Injury is “A deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.  Routine, incessant betrayals of patient care and trust are examples of “death by a thousand cuts.”

Talbot, S. G. (2018, July 26). Physicians aren’t “burning out.” They’re suffering from moral injury. STAT. https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/

Staffing Shortages

When there is ongoing staffing shortages each day for a nurse, he or she feels as if they are not able to adhere to their nursing practice standards as defined by the North Carolina Nurse Practice Act. They might say often, “I am violating my practice act and I am leaving because I can’t give the right nursing care to each patient. I am putting my nursing license in jeopardy.” No Nurse wants to lose their license. This means loss of income and inability to take care of their families and provide for food and housing. Nurses are leaving Mission because of chronic staffing shortages.

Holististic RN Patient Advocates

I started my own practice as a Holistic RN Patient Advocate to help patients and families navigate our dysfunctional, silo driven, technologically difficult healthcare system with less stress and more peace of mind. I have worked in this role for the last 8 years.

I became a Board-Certified Nurse Coach to help disciplined nurses find their way back to nursing with peace, acceptance and purpose without shame or guilt or negativity.

If we want to make changes in the way our healthcare is delivered at HCA hospital. We all must become advocates.

A patient advocate is someone who “stands up” and “speaks on behalf of” a Patient or family. If we do not speak up, someone else may or will be making decisions for us.

When should we speak up as an advocate? When there is any concern, harm, to a patient or family in a hospital.

  • HCA is the first and only hospital in which I have ever worked that has 9 pending Immediate Jeopardy issues regarding patient harm or deaths as issued by the Department of Health and Human Services.
  • All of our voices in this region must be the tools we choose to report these unacceptable patient outcomes.

Call to Action as a Patient Advocate

  • 1. You must always Advocate for yourself or Loved Ones for your Healthcare in the Hospital.
  • 2. Always have a second person to act as your advocate in the hospital with a notebook to document your healthcare and when asking for help from the hospital staff. The second person can be a family member, friend, neighbor or professional advocate.
  • 3. Obtain a copy of your medical records which is your source of truth for what happened to you in the hospital.
  • 4. Call the NC Divisions of Healthcare complaint and Investigation for all patient care complaints that are confidential 800-624-3004
  • 5. Call the AVL Watchdog for confidential stories and complaints at 828-423-0534

In Conclusion, I am now addressing Retired Nurses:

Potential WNC Retired Nurse Corp members – if you are interested in learning to advocate for patient and families as retired nurses, please sign on this clipboard after the presentation or call me at 828-778-8882.

Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Sally Kestin is a Pulitzer Prize-winning investigative reporter. Email skestin@avlwatchdog.org. To show your support for this vital public service go to avlwatchdog.org/donate.

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nurse staffing, nursing practice

Karen Sanders, MSN, RN, AHN-BC, HWNC-BC

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