Nurses at HCA's Mission Hospital in Asheville, North Carolina. Photo from the National Nurses Organizing Committee/National Nurses United.
Nurses at HCA's Mission Hospital in Asheville, North Carolina. Photo from the National Nurses Organizing Committee/National Nurses United.

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Even amid a global pandemic, at a time of increased attacks on workers, lack of protections for healthcare workers, and political uncertainty, victories that previously seemed impossible are taking place.

Mission Hospital in Asheville, North Carolina, just saw the largest union victory at a nonunion hospital in the South since 1975, making it the first private sector hospital union win ever in North Carolina.

In mid-September, less than two years after the largest hospital corporation in the country, HCA Healthcare, struck a a $1.5 billion deal to purchase the hospital, nurses voted by a landslide for representation by the union National Nurses United.

HCA fought back, but now, NNU will bargain on behalf of some 1,800 nurses who work at the hospital. While COVID-19 was cited as a catalyst for action, the roots of employee mistreatment at Mission can be traced back to shifting management and leadership over the years.

Scalawag Contributing Editor Zaina Alsous spoke with Mission Hospital nurses Kelley Tyler, Jill Rabideau, and Susan Fischer about what inspired their involvement, how they accomplished their recent historic union victory, and why nurses across the South need to unionize.

This interview has been edited and condensed for clarity. 

Zaina Alsous: Can you all share a little about your roles at Mission Hospital in Asheville, and what conditions have been like for you as nurses before and during this pandemic? 

Kelley Tyler: I've been at Mission 35 years, it'll be 36 in February. I just remember what a family Mission Hospital was. When I had both my kids at Mission Hospital, I was told I needed to pay like 75 bucks for one of them to be born. We had 13 free days at the hospital at that time—one of our employee benefits was 13 days in the hospital free every single year.

"We are pushed to meet metrics and standards, and it's very much looking more like a factory—like we have to make X number of carpet squares or pieces of paper, and a human body is just not like that."

At the time I thought I shouldn't have to pay anything for my son to be born, and had to pay that $75 check, and it was less than two weeks before I got a refund and letter from the then CEO apologizing. That's how family oriented the hospital was. Now we have people roaming around taking money and checks and credit cards from these little old people that are injured and just desperate to get well. This is now the culture, and it just blows my mind. I've seen team nursing, primary care nursing, and back to team nursing, and just really felt like we were a family up until about 10 years ago.

We had a CEO who was short-lived, and you could see that medicine was changing, and it just felt removed at that point. We were all about buying surrounding clinics and the focus wasn't nearly as much on the hospital and the care that we were able to give there. Within the last five years it has been all about meeting numbers—'a knee replacement takes x number of days'—etc. Knowing we can't give the bedside care now that patients deserve in the short time periods we have them is just sad. We are pushed to meet metrics and standards, and it's very much looking more like a factory—like we have to make X number of carpet squares or pieces of paper, and a human body is just not like that. 

Jill Rabideau: This is the sad reality of the health care system currently in America, it is more profit driven than patient driven. I'm in nursing support services. We fill gaps in staffing, we serve 20 units in the hospital. I get my assignments at around 5:30 a.m. and I fill all the gaps needed for the day. When you fall short, or make a mistake, it ultimately falls on nursing. You can't do what you're supposed to do to the best of your ability in these situations. Ultimately, mistakes are made.

I came to Mission Hospital in 2002 from the Pacific Northwest. I made less money but was willing to do that because Mission was so great. With the HCA Healthcare takeover, things started to change. One straw that broke the camel's back was one nurse in the oncology unit had a day where she had five chemotherapy patients, and she drew blood, and had back to back calls, so she accidentally put the blood in the tube system without a label on it. Common sense would be the lab just telling her, 'Hey, we've got this blood but there's no label on it so whoever sent this needs to do it again.' Instead, she was written up for that and pulled from her five patients. And that is soul crushing—when you are working your hardest, and you know that it's a lot.

Now I think they have five or six patients every day, and that was not something that happened back then. She got written up for a mistake she made because of the load she was carrying. They have these expectations that we're expected to meet but they have no idea of the reality of the environments we are operating in. Staff satisfaction and strong patient outcomes go hand in hand, and it's impossible to have one without the other. 

Susan Fischer: It's been a journey. Back in March, like most of the hospital systems, they were telling their employees at the time not to wear masks, saying it was going to scare the patients. NNU is all about action, and protecting patients and nurses, so we signed petitions and we got out there and marched demanding appropriate PPE. I had my first patient die of COVID-19, and I couldn't get an N95 mask. I was using a mask from a good friend of mine who gave them to me.

"It sounds crazy, but as shitty as things are it's comforting to know there's other people in your position, and it bonds you."

I did not find out about him being positive until I saw an article in the newspaper about him, I was never notified by the hospital. I took care of him for two full nights without proper equipment issued by the hospital. Even Nursing Unit Supervisors couldn't get into the manager's office to obtain the N95s for us. 

ZA: What were some of the conversations you had with your co-workers like about why you all needed to form and join this union? 

KT: My dad helped start the paper mill union here in town. There's pictures of him holding me when I was 2 or 3 years old at the time, maybe around 1967. I really never knew that there was life without a union. Back in the '80s he was telling me we needed to start a union and I told him, 'Daddy, I'll get fired!' Lo and behold by the end of this union campaign I had gotten nearly my whole unit involved. 

JR: I needed some hope that we can make this better because it's not what it should be. It was a lot of asking people, 'What do you think about what's going on?' and when you realize that other people are seeing what you're seeing, it sounds crazy but as shitty as things are it's comforting to know there's other people in your position, and it bonds you. I knew from the get go that we all come to the table with different life experiences. I don't identify as a political person. If you can think of another route I'm all in, but I don't know another way to get there.

It's not going to be a magic bullet but I want to shout to the mountaintops that we have a foundation to build on now. We can build this and make it what it's going to be, and we're going to have to. It's not going to be easy. What I said to my manager once during lunch in the break room is that the only way to have any sort of control over safe floating guidelines is through a union contract. There's no more direct way to protect ourselves at this point. Is it going to be perfect? No. But at least we will have some infrastructure to protect ourselves. And I also told my manager, that I hope the next time you go to leadership and try to stand up for us like you did and they say 'No, that's not the HCA way, this is the new normal,' that you can look right across the table and say 'My nurses aren't going to stand for that,' and it'll mean something. 

ZA: As you all well know this organizing victory is the largest at a nonunion hospital in the South since 1975, and is the first private sector hospital union win ever in North Carolina. How do you all feel about being part of such a historic union victory, especially in the South? 

KT: It's still just surreal to me. I remember I was on my way to a meeting early one morning and I thought about how I would know that this is the right thing. In my heart I feel like this is what I'm supposed to be doing. I just put my head down on the steering wheel and I said a prayer—'Daddy, I know you're in heaven and you're watching this, and you gotta give me a sign to know that this is my goal, this is my purpose, and this is what I'm supposed to be doing.' When I raised my head, and looked up, there was the brightest red cardinal in front of me and I knew, I knew at that point that this was our purpose and that we were going to do this and that this was what we needed. 

SF: I feel blessed. Being from the Midwest I had my doubts, because I know how it is in North Carolina especially. I think we maybe have 3 percent of businesses unionized. The Veterans Affairs are the only hospital system unionized in North Carolina, so we are the very first one. Not only that, it was a challenge. We have 1700 nurses, it's not like this small hospital with a few hundred. When the count came in the other night and we started reaching six or seven hundred, it hit me—oh my gosh, we are going to win this, and not only are we going to win, we might win this pretty big. It was amazing. I thought we were going to win but I didn't know we would win over 70 percent of the votes. I've always wanted my whole life to be part of a change to make the world better and I found it and I did it. 

JR: It's very humbling when I look back on when it first hit me what a huge undertaking this was. There were so many times when I wished I didn't care. There were many times when we felt defeated, and many times when we felt low. We've picked each other up so many times. When you look at a patient in the bed who has been there for nine days and they haven't been washed, you realize what's at stake.

"Their union at the paper mill really was their family, and that's where my daddy thinks he is now, at the union hall having coffee and telling lies. I understand that sense of belonging now."

We're healers, but we need to have what we need to be able to do that. There's something in all of us that chooses this profession, we're a pretty tough lot. Honestly, I hope we make a rumble that is felt from the mountains to the coast, and I really think we will. This is the most important work I've ever done—not just for my patients, but for the nursing profession in the South. For someone who was really not politically in tune and was pretty isolated, I never thought this would be my purpose, I never thought that I would have the skills needed to be able to do this but something gives me the words when I need the words. My dad was a worker at the paper mill too. He has Alzheimer's disease now and I haven't been able to see him since March, but I know he would be so proud. Their union at the paper mill really was their family, and that's where my daddy thinks he is now, at the union hall having coffee and telling lies. I understand that sense of belonging now. 

ZA: What advice would you share with other nurses across the South who are feeling exploited, exhausted, and unsure of how to change their conditions in this moment? 

SF: The main reason we did it was for our patients and our community. I knew I wanted to be a nurse since I was young. And I knew I wanted to take good care of people. We saw the deterioration of the care of our patients, and after being a nurse for 26 years, you have to stand up, that's what I've done my whole life for my patients. I've always advocated for them, and if that meant unionizing, that's what I was going to do. 

KT: I was told with my years of experience that with HCA coming in I would have a target on my back, that they would want to get rid of experienced nurses and their higher wages. Being vocal with the union gave me a shield of protection, I found my voice again. 

JR: I would say you have to decide within yourself what you're willing to do to facilitate change in your environment. I was willing to lose my job. Everybody has to think about if they're willing to stand up for something and be very smart about it. You are more alike than you are different, and they don't want us talking to each other, so are you willing to put in the time and effort to talk to each other to make a difference? That's where it starts. Our campaign started with four nurses at a table, and here we are. 

Zaina Alsous

Zaina Alsous is an editor at Scalawag magazine, a movement worker in South Florida, and the author of A Theory of Birds (University of Arkansas Press).