Mirror photo by Patrick Waksmunski

UPMC Altoona needs more registered nurses, and is trying to hire them, but it’s not as simple as offering more money, because the nurses work under a union contract with fixed terms, and the contract doesn’t expire until year-end, according to hospital leadership.

The hospital offered in July to open negotiations on a new contract, so it can make nursing jobs at UPMC Altoona more attractive sooner — an offer the union has accepted.

Negotiations are scheduled to begin next week, according to SEIU Healthcare PA local President Kim Heverly.

Much of the blame for UPMC Altoona’s staffing problems has been its unwillingness to pay enough, according to the former president of the nurses union local, Paula Stellabotte.

But the hospital is willing to make adjustments to deal with the issue, which is national in scope, according to hospital leaders.

“We want to have competitive wages,” said UPMC Altoona President Jan Fisher. “This is a very competitive market.”

But it needs to be done “through the negotiating process,” Fisher said.

The hospital is looking for a contract both “good for the union and good for us,” Fisher said.

The union is looking for the “UPMC Altoona administration to fully commit to the much-needed investments in staffing, safety and nurse pay,” Heverly wrote in an email this week. “If management works with us to address these issues, we know we can reach a fair and timely resolution for nurses, patients and the Blair County community.”

The hospital currently employs about 500 registered nurses, not all of whom work at the bedside, according to Kitty Zelnosky, chief nursing officer at UPMC Altoona.

That is enough for safety, based on patient volumes, according to hospital spokeswoman Lisa Lombardo.

But the hospital would like to hire about 200 more staff RNs, Zelnosky said.

That would make it less dependent on travelers, Lombardo said.

Among registered nurses currently employed are about 110 travelers — 20 from a UPMC program and 90 from “external” agencies — down from a high of 150, Zelnosky said.

Agency nurses are far more expensive than regular staffers, having cost as much as $200 an hour, Zelnosky said.

That’s “hard to maintain,” she said.

Even if the hospital manages to hire 200 new staff nurses, it wouldn’t displace all the travelers – although if conditions were ideal, there’d be no need for agency nurses, according to hospital leaders.

Many constantly varying factors influence the hospital’s staffing needs, according to Lombardo.

“Patient volumes and staffing patterns fluctuate daily and hourly, 24 hours a day, 365 days a year,” Lombardo wrote in an email.

Variables include “the number of patients on a unit at a given time, the level of care required … for each patient (and) the physical staff available at that time,” coupled with the occurrence of emergencies, Lombardo wrote.

Those variables are especially prominent for hospitals like UPMC Altoona that provide specialized care for trauma and stroke, along with open heart surgery and neurosurgery, she wrote.

If there were more nurses, the hospital could open more beds, reducing the number and length of delays in admitting patients from the Emergency Department, thus eliminating a bottleneck.

The hospital’s staff shortages, coupled with a recent reduction in patient volume, has led to the closing of 44 beds on the 10th floor — a move that included “consolidation” of empty beds on other floors, Zelnosky said.

The hospital has adopted several strategies to help deal with the staff shortage, according to the leaders.

It replaced the physician’s assistant that used to lead the triage team in the Emergency Department with a physician, which will allow for patients not only to be evaluated and prioritized in triage, but to receive orders for lab tests, X-rays and for medications that will allow them to receive care, including IVs, while in the waiting room, according to Zelnosky and Fisher.

That provides a “head start” when the Emergency Department is full, Zelnosky said.

The hospital has created a “patient and family support” position in the Emergency Department, so someone will be available to answer questions from patients and their families about the patients’ status and how long they may need to wait for care.

“There’s a lot of frustration when patients are not able to reach out to someone,” Zelnosky said.

The hospital created the post based on feedback from patients and their families, so they can “stay in touch with what is happening … behind closed doors,” according to Fisher.

The prospective new occupant of that post can also provide practical help, like a blanket when a patient in the waiting room is cold, Fisher said.

“When we’re really busy, you don’t know what is going on in the back,” she said. “You wouldn’t know a trauma came in, and resources are being reallocated.”

The post will require someone who’s compassionate and a good communicator, Lombardo said.

A “customer service” person, Fisher said.

The post will not require clinical expertise and will be staffed around the clock.

The hospital has also instituted a program under which clinical directors — nurses who oversee the unit directors — “round” on “boarding” patients — those finished in the Emergency Department and waiting for beds to open upstairs, according to Zelnosky.

The visits are designed to expedite the “throughput process,” Zelnosky said.

The clinical directors try to help patients “understand their plans” and to ensure the patients will be placed in the proper units upstairs, according to Zelnosky.

The hospital has eliminated a bottleneck by creating a discharge lounge for patients, so that those waiting for an extended-care facility or home care slot to open can vacate their beds, freeing them for other patients, according to Lombardo.

And the hospital has tried to make up for some of the staffing shortfall through a “helpers” program — with non-clinical workers assisting with non-clinical tasks, like folding towels, after they’ve put in their 40 hours a week, according to Lombardo.

The helpers get a flat wage unconnected with their ordinary salary, and not reflective of the normal time-and-a-half paid for overtime, Lombardo said.

Part of the recent challenge has been generally large patient volumes, according to the leaders.

About 44,000 patients came through the Emergency Department last year, 30 percent of whom were admitted to the hospital, Fisher said.

Of that 44,000, 1,700 were trauma patients, Fisher said.

UPMC Altoona provides full-scope tertiary care and it’s also a Level 2 trauma center, Fisher said.

It offers specialty services that smaller hospitals in the region don’t, she said.

Its trauma catchment area extends from Maryland to New York state.

The number of patients coming through the Emergency Department and the seriousness of their problems has been unprecedented in her experience, Fisher said.

COVID, moreover, exacerbated a nursing shortage that already existed.

The shortage is national in scope.

About 5% of the U.S. hospitals that report staffing levels are critically short of staff, and 14% are expecting to be short-staffed within a week, according to a recent article in Becker’s Hospital Review, which was provided by Lombardo.

In Pennsylvania, 16% of reporting hospitals are critically short-staffed, according to Becker’s.

Pennsylvania’s numbers are fifth worst in the nation, after South Carolina, Michigan, Nebraska and Vermont.

Hospitals that make up shortfalls with temporary staffers aren’t included in the listing, according to Becker’s.

Further exacerbating the staffing problem at UPMC Altoona has been a loss of volunteers because of COVID, according to Lombardo.

Many left because they were of an age that made them vulnerable to the virus, Lombardo said.

“These have been incredibly challenging times,” Fisher said.

Yet the hospital never “shut its lights off,” never went on “divert” — never turned patients away because of how busy it was, Fisher said.

Some of the blame for UPMC’s staffing problem is also due to the organization’s “culture,” which is heavy on “discipline,” according to Stellabote.

On the contrary, the hospital’s culture is actually “positive,” Fisher said.

Still, the hospital holds employees “accountable,” Zelnosky said.

“We adhere to core values,” based on “dignity and respect for all,” she said.

While leadership doesn’t want to operate with a “heavy hand,” it wants “to help individuals grow,” she said.

It’s a culture of “high performance,” Fisher said.

Generally, “feedback” is in the form of “coaching and mentoring,” Fisher said.

But there is discipline when necessary, according to Zelnosky.

The hospital’s goal is “consistent performance,” Fisher said.

Consistency and fairness are what most employees want from those to whom they answer, according to Fisher.

The hospital welcomes criticism from patients, according to Fisher.

It prefers to receive that criticism when patients are still in the hospital, and prefers not to receive the criticism anonymously, so that it can begin rectifying problems immediately, according to Fisher.

“We can have someone in leadership meet with you and address (the issues),” she said. “We’re more than willing to talk.”

All complaints that come from a known source trigger at least a phone call, and a formal complaint triggers a response letter that details the complaint and what is being done about it, according to Fisher.

“So we can track it and trend it,” Fisher said.

But the hospital accepts criticism from patients after discharge and also anonymously, according to Fisher.

While in the hospital or after discharge, patients dissatisfied with their care can call the Patient Experience Team at 814-889-3219, according to Lombardo.

Patients who wish to remain anonymous because they’re uncomfortable raising an issue can call the hotline number, 412-647-5774.

Patients in the hospital or their loved ones concerned about a change in the patient’s condition and unable to get the attention of a caregiver quickly can call the Condition Help number, 814-889-4000.

“Each and every patient grievance is investigated with thorough follow up,” Lombardo wrote. That enables the hospital to deal with the issues raised and helps prevent the problems occurring again, she wrote.

Concerns can include not only the quality of care, but the food and the temperature of the room, Fisher said.

“We don’t want you to leave here not having a good experience,” she said. “We take responsibility for the care we provide and will follow up.”

All criticisms go to a quality subcommittee of the hospital’s community board, as part of the hospital’s quality review program, according to Fisher.

Most comments from patients are actually complimentary, Zelnosky said.

“Nine times out of 10, it’s about recognition of staff,” Zelnosky said. “There’s nothing better for (them).”

The hospital “makes every effort” to forward such compliments and has various ways to formalize them, including handwritten notes that she writes, Fisher said.

The hospital also facilitates praise from worker to worker, she said.

Most of that involves appreciation from employees of one department for employees of another department like housekeeping, dietary and physical therapy, Fisher said.

Mirror Staff Writer William Kibler is at 814-949-7038.