Largo hospital nurses protest understaffing they say puts patients at risk

When Keosha Morris started at HCA Florida Largo Hospital in 2018, nurses working the surgical-medical wards were supposed to be assigned no more than five patients, she said.

That changed drastically about two years ago when the hospital switched to a team nursing model that assigns up to 14 patients to a registered nurse teamed with a licensed practical nurse.

In theory, the duo is supposed to share the workload. But licensed practical nurses are not qualified to perform certain tasks such as initial patients’ assessments or to initiate blood products for patients. That leaves the registered nurse with an impractical workload made worse by having to supervise a licensed practical nurse, Morris said.

Frustrated that their concerns are not being listened to, close to two dozen nurses protested Monday morning outside the Largo hospital hoping to bring attention to a practice they say compromises patient care and safety and is causing burnout of registered nurses.

“The (registered nurses) are increasingly overwhelmed,” Morris said. “The only way we can bring attention to the issue we face inside is to come out into the street and into the community.”

The rally was one of several at HCA hospitals across Florida, including HCA Florida Oak Hill in Brooksville, that were coordinated by National Nurses United. The union represents nurses in eight HCA Florida hospitals. The protests were timed to put pressure on the heath care company, which reported $5.2 billion in profit in 2023, as it begins annual bargaining with the union.

HCA officials declined to answer questions about how many of their hospitals are using team nursing. In an email, spokesperson Debra McKell said the protests against HCA are no different to ones that National Nurses United has organized against other hospital chains across the United States.

HCA’s west Florida division hired more than more than 2,800 registered nurses in 2023 and also added more than 2,000 support staff, she said. The division also spent $6 million last year on equipment and resources and close to $40 million on pay increases over the past three years.

“As we enter negotiations for a new contract, we expect that this labor union will continue with various antics and making unfounded claims about our hospitals and the quality care that we provide,” McKell said in an email. “Our staffing is safe and appropriate, and we are proud of the quality care we provide, which has been recognized by independent third party patient safety ratings organizations like Healthgrades.”

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Team nursing was a common approach in the 1970s and ‘80s but was gradually phased out in favor of primary nursing, where nurses care for fewer patients and can provide a more individualized level of care.

But the pandemic saw some hospitals revive the team nursing model to cope with the influx of infected patients.

“By its definition, it’s substandard care,” said Michelle Mahon, the union’s assistant director of nursing practices. “It sacrifices quality patient care for the primary goal of cost saving and increasing profit margins.”

California is the only state that has passed laws specifying nurse-patient ratios. But several studies have concluded that assigning too many patients to a nurse increases the likelihood of longer hospital stays and patient death.

That includes a 2021 study published in the British Medical Journal that examined patient outcomes in Illinois hospitals. It found that the odds of a death within 30 days of a hospital stay increased by 16% for each additional patient added to the nurse’s workload.

National Nurses United is not the only union to question HCA’s staffing levels.

A Service Employees International Union 2021 report found that staffing at HCA’s 180 hospitals across the United States was 30% lower than the national average in 2020. In Florida, where HCA operates about 45 hospitals, the union reported that staffing levels were 32% below the average of other hospitals across the state.

Judy Preuss, a registered nurse who works in the intensive care unit at HCA Florida Oak Hill hospital in Brooksville, was among nurses who rallied there Monday.

Nurses in the unit should only be assigned two patients, since they require a high level of care. But Preuss said it’s common at Oak Hill for nurses to be assigned three patients, especially on night shifts.

“It creates moral distress when you leave at the end of your shift and you hope you haven’t missed anything that could contribute to your patient’s downfall,” she said.

Preuss has worked at the Brooksville hospital for almost 20 years and lives close by. She’s thought about leaving but doesn’t want to give up on an institution that plays such an important role in her community.

“This is where my family will go if they need care,” she said. “I want to make the hospital I work at the very best I can.”