Blog WSH

July 15, 2014 DSHS Proposal to Close Wards to Fund PERT Team

Western State Hospital received a safety grant which allowed one year funding for the implementation of a Psychiatric Emergency Response Team (PERT).  That grant funding will end in January 2015 if the Legislature does not provide funding for PERT to continue.  Since implementing PERT, safety statistics have indicated positive results.  

As a result, DSHS has created a State Hospital Safety and Enhanced Community Treatment Proposal which includes the plan to close two wards in order to fund PERT past January 2015.

Although PERT has produced positive safety results, there are many issues that remain to be ironed out at WSH:

  • PERT does not consistently record into clinical records the therapeutic interventions which produced a positive result.  Thus treatment teams have not received consistent PERT documentation of how clinical approaches can be modified within the patients’ treatment plan.  Clinical documentation in medical records by PERT is almost nil.  

  • Physicians and RN’s report that lack of collegial interaction with PERT is chronic.  RN’s (and MD’s) are blamed by the CEO when an emergent event requires that clinical intervention be initiated. PERT has claimed they were not informed with sufficient notice to prevent many emergent events from occurring.  While doctors and nurses MUST document interventions in detail, no documentation is required by PERT as yet.  Thus doctors and nurses WILL be second guessed while PERT cannot be.

  • PERT has no accountability for completing regular ward rounds or for having any assigned ward jurisdiction.  There is no current form of milieu documentation process for PERT to track when ward rounds were made and when actions to prevent emergent events were taken or what those actions were.  This data must be tracked to support the current statistical results.  

  • Currently ward personnel are not informed of which PERT members are on duty each day.

  • Was PERT responsible for the positive results or was greater milieu awareness and intervention training of medical personnel what ACTUALLY resulted in the positive safety statistics?  That has not yet been determined. 

In order to address the above problems, SEIU filed an information request to get redacted documents for the past month regarding medical record documentation completed by PERT.  Weeks have passed, no documentation as yet has been produced by WSH.  This is very concerning.   It is an indicator that when PERT was created, additional training in milieu management was provided to care providers which may have actually resulted in the positive safety statistics change, instead of this being the direct result of only PERT itself.  Clinical documents will identify which was responsible for the positive changes.  

Now DSHS wishes to shut down two wards in order to retain funding for PERT.  Thus accountable medical personnel who specialize in the care of traumatic brain injury and older adult care (sixty patient beds) will be eliminated in order to retain minimally medical credentialed personnel to act as (currently unaccountable) PERT milieu monitors.  The exchange of services that DSHS proposes will hurt the community as well as further minimize traumatic brain injury resources that are available in Washington.  PERT as a program has much to offer for WSH and DSHS, but the price that DSHS is proposing to pay (closure of two wards with a total of sixty beds that specialize in traumatic brain injury and older adult care) is not worth it.  

I look forward to working with the Traumatic Brain Injury (TBI) Counsel to defeat this ill-advised DSHS proposal by informing the public of the true losses in community services that this proposal represents.   

I urge that you contact your Legislator to prevent the further eroding of Traumatic Brain Injury resources and older adult care within Washington.


WSH Administrative Grade

I have now had a chance to observe how this new Administration operates and listens to its employee and labor input.  I have observed the following first hand:

  • WSH hiring is generally pre-determined.  Temp appointments (of Administrative choosing) are placed into positions.  The next step Administration takes is to draft a permanent posting with qualifications that mirror the Administration placed non-perm candidate.  Panel interviews do not happen, rather Administration creates written documents indicating that transfer RN’s were interviewed.  In one case five candidates that were not interviewed for a specific position had files created by Administration outlining why they were NOT selected because they did not meet the criteria.  What was really telling was that the non-perm did not meet the specifications either when placed into the non-perm position.  At WSH, true qualification have nothing to do with position placement.

  • I have participated on two CEO level Administrative hiring panels.  In both panels, the majority of the panel voted for hire of a candidate that was NOT selected by the CEO.  The good old boy network is alive and well at WSH.

  • The WSH step one level of the grievance process is a joke.  In ALL cases of first level grievance responses, presented facts are not mentioned and the employee (regardless of merit) has no chance of a fair unbiased outcome.

  • RN’s are treated with GREAT disrespect at meetings with Administration at all levels.  The CEO appears to be unable to detect when his actions are demeaning and inappropriate.  What is worse, when HR and other upper administrative personnel observe this conduct they take no action.

  • This CEO’s first official action was to eliminate an RN2 position (EE71).  WSH is currently short of RN2’s by 96 full time positions.

  • It took that past two years to make the Joint Nurse Staffing Committee comply with Article 40 in WSH, ESH, & CSTC.  A grievance was filed and two summit meetings were held.  When a process was established for submitting recommendations, there was resistance.  Now DSHS has hired the NASH group to supplant the Joint Nurse Staffing Committee in this years annual plan submission.  I have been unsuccessful in having Administration collaboratively co-draft the plan for Joint Nurse Staffing Committee consensus vote and approval.  

  • WSH is using RN3’s as an RN2 float pool in lieu of retaining voluntary overtime.  Supervisory duties are now impossible to perform within WSH.  Performance coaching and counseling is now nonexistent.  Employees are not getting feedback nor the help that they require to be successful.  Administration takes these actions knowingly, then blame supervision for administrations actions.

  • To amplify the supervisory disfunction, RN3’s are directed to get report by Administration on a SINGLE ward when they may be covering multiple wards.  When covering multiple wards RN3’s do so without ANY form of report.  By taking this action Administration is KNOWINGLY preventing RN3’s from mentoring each other as well as preventing communication between different shift supervisors.  Causing supervisory disfunction appears to be the goal of this process.  WSH Administration has succeeded in undermining its entire nursing supervisory class.

  • At Labor/Management meetings this Administration recently placed NOTHING on its agenda.  Nothing in this Administration is transparent.  No action taken by this Administration should be taken at face value.  Trust does not exist.  This Administration openly mocks the labor process through its repeated actions.

  • When a promise has been made by Administration, it has been REPEATEDLY broken.  The “word” of this administration is NOT good.  I have determined that unofficial meetings are worthless.

  • When this Administration implements a process that the CEO wishes to pursue, there can be no discourse or recommendations for improvement.  Any input is viewed as being a hostile action by employees and is met with threats and inappropriate conduct.  There is no “give and take” with this Administration.  Their thimble of knowledge is full.

  • WSH RN’s are understaffed and at WSH RN’s are EXPECTED to work with a 30 patient to 1 RN ratio regularly.  RN workloads exceed all reason at this time, WSH is a difficult if not completely hostile work environment for RN’s.  The only thing keeping RN’s at WSH is their retirement benefit and medical plan.  But now things have reached such a hostile level, even senior RN’s are looking at options to leave the WSH hostile environment.

  • WSH does not meet accreditation standards and the “books are cooked” to make it appear that published base staffing levels are maintained.  Medication passing standards requires that at least two licensed personnel must be present on a ward AT ALL TIMES… This includes all break and lunch periods that are run.  Thus, in order to meet this standard, three licensed staff are required for all wards and all shifts.  WSH has insufficient full time staffing to meet this requirement.  WSH does NOT retain overtime to meet this standard.  This will be the root cause of a sentinel event in the future…  It may be the true root cause of many sentinel events in the past.

  • This Administration is working hard to prevent RN’s from having ANY say over their work schedules.  Administration wants to have a centralized staffing office rotate RN’s days off weekly.  If Administration succeeds, other than for pre-approved annual leave, RN’s will have zero say over their work schedules.  This must not be allowed to happen.

  • Several wards at WSH have no seclusion rooms.  The Safety Committee has recommended that this tool be made available for all wards, but the CEO (acting ALONE) prevents this from occurring.  I have been present at meetings where the CEO has stated that he opposes this.  This is the equivalent of stating that several wards should not have fire extinguishers because the CEO is opposed to fires.  WSH does NOT have a culture of safety because of the behavior that is being modeled by the CEO.

  • In CFS the CEO has implemented his pet project, the PERT team.  The concept is a positive one that, if implemented appropriately, offers much to the therapeutic care that WSH can provide.  The CEO has implied threats to RN’s that implement seclusion and restraint processes during emergent situations because this would interfere with a positive statistical outcome regarding the implementation of the PERT team.  In the past week I have taken issues that RN’s have presented and conveyed them to the CEO.  I had done an information request that would illustrate RN concerns…  NONE of the information was made available last week.  Even though this information was promised, I do not know when (or if) it will be made ultimately available.  This is very concerning.

I must say that the previous interim CEO was the best CEO WSH has had in my past 30 years of my experience.  She single handedly arranged for new processes that allowed unions and employees to have open input and influence over Administrative actions.  Employees felt that they were part of the process and their input was heard, even if those inputs were NOT implemented.  When the CEO took actions that were oppositional to her counsel and input, she explained in detail why the decision was made.  This CEO was a true leader.  I valued her opinions and decisions even though those actions would not necessarily have been ones that I would have personally taken.  This CEO was solely responsible for getting the creation of the Scheduler program within months, yet she never congratulated herself…  Rather many employees were awarded from their efforts in assisting to create this program.  This is leadership. 

The current CEO does the complete opposite…  Input is discounted immediately, instead of listening, the CEO states his point of view PRIOR to listening to the entire presentation.  Opposing the CEO’s personal point of view will result in unprofessional conduct towards the employee…  Often in front of other Administrative personnel.  “I” and “my” are the first words presented by this CEO when input is provided.  Rarely is there any observable contemplation of presented ideas noted, only an “I” or “my” statement.  This is not leadership.  When recommendations are made, there has been a consistent oppositional response element.  Apparently (from observed interactions) this CEO feels that regardless of the merits of any issue, an oppositional response is required for labor.  I have observed a pattern of behavior…  Rapid implementation with a knowing attempt to obfuscate labor negotiation processes.  I believe that this pattern of behavior is deeply ingrained and not subject to change.

We are at a crossroads with regard to this Administration.  I have found that the only way to address serious issues at WSH is through oversight authorities like the Joint Commission, CMS, State Auditor, Human Rights Commission, EEOC, Executive Ethics Board, Department of Health, Labor & Industries, and civil court.   Although internal processes will continue, the future focus of dealing with issues will be different.

The grade for this administration:  Failure.  

For RN’s contemplating work at WSH…  You will be treated differently than other employees.  Other employees work eight full work days (in hours worked) LESS per year than RN’s.  Timekeeping records are falsified so as to compensate 7.75 hour employees for 8 hours of wages.  At WSH, RN’s are treated as a second class citizen.  RN2’s are treated with consistent disrespect, to the point now that WSH is attempting to prevent any control over scheduling.  RN2’s work under clinical conditions that violate WSH policies and accreditation standards, as a result place the RN’s own credentials at risk by working at WSH.  As an RN2 you will be working as the lone RN2 for most days of the week with an average of 30 patients.  On most days of the week there will be insufficient licensed staff to run breaks while maintaining accreditation standards.  Getting approved leave is difficult under the current understaffing situation.  If you do decide to work at WSH, get RN malpractice insurance (you will need it).  

I am aware that stating the TRUTH will impact our recruitment and retention numbers.  At least the truth is being made available.  

© Paul Vilja 2017