UW nurses say the chaotic conditions at the height of COVID never eased. Now, they're set to strike in an effort to form a union.

Every evening, overnight charge nurse Colin Gillis sends out an SOS, asking nurses to come to the rescue and staff the COVID-19 unit at UW Health in Madison.

Depending on the direness of the staffing levels, he can offer an extra $35, $50 or $75 an hour — bumping up the rate on some shifts to more than $100 an hour.

Plenty of his requests go unanswered.

“It’s no fun coming to work knowing you will be working short-staffed," Gillis said. "And nurses are all so burned out."

This latest hospital incentive plan comes after a program that paid nurses an additional $100 an hour if they signed a contract agreeing to work extra shifts on different units — essentially becoming internal traveling nurses. Picking up even a few extra 12-hour shifts translated into thousands of dollars.

But that incentive waned.

Gilles watched nurses take extra shifts for weeks at a time. The first week, they were motivated, excited by the extra money.

"By week six, they were falling asleep while charting and feeling like they hadn't been outside for weeks," Gillis said. "But they paid off their car."

Hundreds of UW Health nurses will take part in a strike, seek to form union

On Tuesday, Gillis will join several hundred nurses on the picket line for a three-day strike watched closely by health care workers and administrators across the state and beyond.

Nurses have complained for years — and with increasing fervor since the COVID-19 pandemic — that staffing shortages and unrealistic expectations have led to burnout and compromised patient care. They see recognition of their union as the only route to obtain leverage for meaningful change.

The hospital administration counters that it is doing everything possible to get nurses more compensation, more benefits and more support. It also contends the passage of Act 10 in 2011 stated collective bargaining is not a constitutional right, but a statutory right, and there is no statute that provides for it.

"The question is not where is collective bargaining prohibited (in state law), it is where is it explicitly given," said Emily Kumlien, a UW Health spokeswoman, in a statement sent Friday to the Milwaukee Journal Sentinel. 

Both sides now agree the matter will likely be decided in court.

"We believe the only way to provide a definite answer to what the law requires or allows is through the courts, with the Wisconsin Supreme Court being the ultimate decision-maker," Kumlien said. "The state Legislature could also provide clarification."

The strike could end up being a painful episode in an internal squabble, or a watershed moment in the industry.

Frustrations have been mounting for nurses, patients

Tami Burns wasn’t hired by UW Health to be a float nurse. But plenty of days, that's what she ends up doing.

During a 12-hour shift, she can be reassigned from her job on the heart and vascular progressive care unit up to three times, moving from understaffed unit to understaffed unit every four hours.

Typically, nurses should have about 30 minutes at the start of a shift to go over their patients' charts, learning their history, their medications and their most recent developments. That's not possible, she said.  

“By the time you get your third group, you still have the first two groups bouncing around in your head. There are safeguards we take to avoid problems — scan the patient's wrist ban, then scan the medication — to prevent medication errors," Burns said. "But it doesn’t make up for the time lost trying to learn a new unit, a new set of patients, multiple times in a shift.”

Another problem is that supplies are in different places on different floors. Looking for something as simple as bandages or a catheter kit can turn into a minutes-long search because float nurses don't know where things are located — precious time when pressure is already high.

Patients notice.

"Earlier this week I had three patients ask me if I would be coming back in the morning," Burns said. "They all want that continuity. And we do, too."

Amelia Zepnick, a UW Health nurse for three years, said the safety of patients and nurses are being potentially compromised because of the staffing shortages. 

For example, the hospital alerts staff to patients with aggressive behavior — determined by repeat episodes of the patient lashing out — by adding an icon to their online chart and putting a small sign on their door, alerting everyone from food service staff to therapists to first come to the nursing station before entering the room. Staffers then enter the room in pairs.

"This is a great policy. It was designed to de-escalate patients before they harm themselves, and to keep us safe," Zepnick said. "But it is often not followed because it can't be followed. There are not enough staff members for nurses to quickly pair up with another nurse who has free time to enter a room with you."

UW Health responds to all this by saying its efforts to retain ample staff and experienced nurses include yearly evaluations of market rates to offer competitive compensation and benefit packages; mental health support through the creation of a new nurse wellbeing council; and more flexible scheduling options. 

"Nursing leaders continue talking with nurses to see if they want more variability in their schedules by offering different shift length options, and breaking out of the old mindset of only eight- or 12-hour shifts," said Rudy Jackson, UW Health's chief nurse executive.

Conditions during early days of COVID-19 highlighted many of the issues in Wisconsin's hospitals 

While the tension between nurses and management is not new, the pandemic elevated it dramatically.

Gillis said the first time he took care of a COVID-19 patient, he and other nurses were wearing N95 masks, which provide the highest level of protection against the airborne virus. Nurses took new masks into each room, and discarded them as they walked out.

Soon, mask shortages became a widespread concern.

Jeff Pothof, UW Health's chief quality officer, described the situation at the time as "kind of like a controlled pandemonium," in a March 2020 Milwaukee Journal Sentinel article.

Float nurses like Zepnick began noticing that as more units opened to accommodate the growing number of COVID patients, there were differences in protective equipment. Nurses in some COVID units were wearing powered air-purifying respirators; others were still hunting for masks. 

"We were so siloed and so busy that we didn’t have time to compare notes," Zepnick said. "That broke my trust. I adored my unit manager, but it really made me second guess everything from the top, down."

By the second month of the pandemic, nurses were allowed to use only surgical masks, Gillis said. They were told the switch had to be made "to ration N95s." Soon, they were told to reuse masks — a concern because masks degrade the longer you wear them and can become contaminated when you reuse them.

Nurses knew what they were being asked to do wasn't normal protocol and it wasn't safe.

"We knew that, and administrators knew that," Gillis said. "Conditions during COVID really hit a fever pitch."

Dr. Dan Shirley, UW Health's medical director of infection prevention, said in Friday's hospital statement that from the beginning of the pandemic, UW Health followed "rigorous infection prevention practices based on the most recent data and recommendations from leading organizations such as the Centers for Disease Control and Prevention."

He said UW Health maintained the protective equipment that staff and patients needed to minimize risk and stay safe in the hospitals and clinics.

But nurses said the "controlled pandemonium" of the worst days of COVID has never really eased.

"We did what we had to do to get through the pandemic," Zepnick said. "You are working short, and with sicker patients. The content of the work is different. That is past and we are still cutting corners. And there is just no end in sight. We are reaching the point where the pandemic is becoming an endemic, but we are still triaging care like we are in a battle field, but it feels like from administration it is the new normal." 

Mary Jorgensen, a registered nurse with 26 years of experience, has spent the last 17 as an in-patient operating room nurse with UW Health. Operating room nurses all take turns on a call team, and when an operating room is short-staffed, they are called in to work. By law, nurses are allowed to work up to 16 hours in a day, meaning a 7 a.m.-to-7 p.m. shift could stretch to 11 p.m., if surgeries are scheduled, or emergencies occur. 

Those nurses might be back on duty at 11 a.m. the next morning. It is a cycle that contributes to burnout, Jorgensen said. 

"These problems were there before the pandemic. The pandemic just exacerbated them," she said. "We are still hemorrhaging nurses."

UW Health claims shared governance program means nurses do have a say

UW Health cites its system of shared governance as proof that nurses do have a seat at the decision-making table.

The hospital launched its shared governance system in 2005, around the same time hospitals across the country were implementing what The Journal of Nursing Administration in a 1995 article described as "an organization innovation that formally legitimizes nurses' decision-making control over professional practice and extends their influence to administrative areas previously controlled only by managers."

The UW Health system includes the support of nine system-level nursing councils, an oversight council and more than 75 unit- or clinic-level councils, all composed of direct-care nurses. 

It provided data to the Journal Sentinel from its "Stoplight Report" showing that from October 2021 to June 30, 2022, 31 tasks or issues had gone from red to yellow to green, meaning they were completed or resolved.

"The Stoplight Report is a great way to highlight all of that work — any issues, questions, or ideas brought forth by frontline nurses — and track the progress of each of them and share the successes and all outcomes with other nurses," Jackson said.

It also included supportive comments from staff members.

Foster Lake is chair of the UW Health Nursing Coordinating Council. His previous employers did not participate in a shared governance program. 

"I realized I actually had a voice in shaping nursing practice," Lake said in the UW statement. 

He said he saw the benefits and empowerment in how he could impact polices, procedures and practices that nurses use and implement daily.

"It was eye-opening," Lake said. "I felt I was part of something much bigger than my role as a bedside nurse."

Some nurses, however, have less faith in the system.

Because UW Health administrators have the final say on changes to policies or suggestions made by the nurses on the committees, the system is "not fair and does not work," Jorgensen said.

Strikers' top priority is nurse retention

Gillis said if a union is recognized, retention would be the top priority. 

He said the hospital doesn't see the problem in constantly looking for new nurses, and replacing experienced ones with newcomers to the field. His impression is that UW Health thinks "a nurse is a nurse is a nurse."

A union, he said, could push for competitive retention packages to keep nurses longer. Even five years instead of one or two would be a huge improvement, he said.

“UW Health has money. They are just choosing to spend it on short-term fixes,” he said, referring to the current incentive program and the earlier internal travelers program.

The hospital has 218 openings for bedside nurses, even after hiring 478 nurses this year, according to UW Health.

"We are doing this for quality patient care. This is about our community. This is about our neighbors. This is about ourselves being patients at UW," Jorgensen said. "We all went into nursing to take care of patients and UW isn't giving us the tools to do that. Our biggest thing is quality care and safe staffing ratios."

Jessica Van Egeren can be reached at jvanegeren@gannett.com or (920) 213-5695.