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Providence nursing staff stands up for themselves and their patients

For over a year, health care workers at Providence hospitals across the state have been negotiating with their employer on staffing levels, sick leave and compensation. Hospital administrators, under directives from their multimillion dollar corporate executives, refuse to budge on staffing levels and seek to eliminate hours of earned leave. Matt Chrichton talked with Jacob Kostecka, a charge nurse at St. Pete’s and a member of the union bargaining team.

Jacob M. Kostecka in his scrubs at Providence St. Peter Hospital.
Jacob M. Kostecka in his scrubs at Providence St. Peter Hospital.

MC – How did you get into nursing?

JK – I struggled with what I wanted to do with my life for a while. I have a degree in environmental studies from Evergreen, and have been an environmental educator, but that didn’t pay well. I had a child, and needed a career that was stable and could support my family. I thought about becoming a teacher. Education and nursing attract people with similar personality types–people that want to serve and help. Just the thought of a classroom full of kids made me tired. My sister called me one day and said, “Hey, I just got into nursing school. I’m going to be a nurse.” I thought, I should be a nurse.

It made perfect sense. I was an environmental educator. I had my wilderness first responder certification. I was always fascinated with how the body works. I like to help people in emergencies. My dad was in the hospital for a while when I was a kid and. I remember thinking, wow these nurses have it pretty cool –they get to walk around in pajamas. It made sense: I can help people, there’s a lot of opportunity. You can’t be outsourced. And there’s a shortage, so I’ll never have to worry about getting laid off.

I’m also pretty physically active, and I couldn’t imagine myself sitting in a cubicle or office. I have to be moving around. Being a nurse involves many different things: hands-on, physical work and moving around most of the time. There is charting on the computer. You have to understand medication dosage and time. Critical thinking is involved. When you look at a patient, you need to know if they’re sick or stable, and have the confidence to trust your experience and gut.

Where have you worked as a nurse?

I’ve been a nurse for 13 years and worked in critical care that entire time. I got my nursing degree from the University of Southern Maine, in Portland, Maine. After I graduated, we came back to Olympia — I’m from Washington. I worked at Capital Medical Center for a year and at St. Pete’s for 12 years. All my work has been in intensive and cardiac care units.

What kinds of nursing have you done?

I’ve taken care of trauma patients; neuro patients with craniotomies and external ventricular drains. I really like doing cardiac work. I enjoy doing open heart recovery.

I’m a charge nurse at St. Pete’s in the CCU. I do a lot of leadership. I train other nurses. Currently I’m working with a new nurse who just joined us.

I’m also a rapid response nurse. When I’m in that role, I wander through the entire hospital. I’m responsible for putting out fires, troubleshooting equipment, educating other nurses and running codes. If someone goes into cardio-pulmonary arrest, I help manage that until the doctors arrive. Ideally with the rapid response role, our goal is to prevent patients from arresting. If the situation is getting beyond what the attending nurse is comfortable with, they call the rapid response team. We assess the patient and determine if we can troubleshoot, or take them to a different location so that we can appropriately treat them.

I tell new nurses in ICU that it can take three years to feel like you’re really a nurse. The first year you’re just trying to keep your head above water. The second year, you have time management and you’re becoming more proficient in understanding how things work. The third year, you start to put it all together. Not only are you competent and efficient, but you can notice things ahead of time.

At St. Pete’s we’re split between the neuro unit and the cardiac unit. I’m in charge of the neuro unit. When I’m on the floor I work in the cardiac unit. I prefer that. For nurses that want to be proficient in everything it can take about five years.

Best and worst things about being a nurse?

I like helping people in a tangible way. When somebody comes in with a condition that’s treatable, we can get them back on their feet. They can get on with their lives, and have their life ahead of them. That’s a wonderful feeling. You think to yourself, 40 years ago they would have been dead. Now we can do certain things, and they can go on living another 50, 60 years. That’s a really special thing.

There’s a camaraderie among healthcare providers and our staff. On a daily basis we are dealing with life and death situations. We connect on a level that can be much deeper than people working in cubicles. I’d say we’re a family, and that includes the weird uncle that can be kind of awkward at times.

On the flip side, medical technology has advanced faster than the ethics behind it. That is tough. We deal a lot with unrealistic expectations. People watch television, and they think things should be like TV. It almost never is. Out of all cardiac arrests, about 8% of patients survive.

People come in with all types of conditions, and we do what we can. Many times family members aren’t quite ready to accept the reality that their loved one isn’t going to make it.

One hard thing is seeing so many chronically ill people. We start to question quality of life. The person is going to be on a ventilator fed through tubes for the rest of their life, lying in a bed in a nursing home. What are we doing to this person? It feels like torture. For myself and my coworkers, we never wanted to get into a profession where we felt like we were torturing people. A 95-year-old grandma should not have CPR, but the family wants that. All we are going to do is break her ribs. Then she is going to die anyway. That’s hard. That’s really hard. That takes a toll on caregivers.

The level of trauma we see on a daily basis is sometimes more than we can mentally deal with. If a lot of care providers seem to have a dark sense of humor. It’s not because we don’t care — it’s because we care too much. It’s the mechanism by which we protect ourselves. That’s one of the hardest parts for me. There’s a lot of work with families and their role. We have had ethical dilemmas. A lot of caregivers feel that stress on a daily basis.

I come home and I never talk about work. I don’t want to think about it. I have my work life and my home life, and I want to keep those separate. If I meet another nurse, or care provider, a doctor, or even a CNA, we just kind of have an understanding. It’s like veterans who say, “You don’t understand unless you were in the war.” If you were there, you don’t need to talk about it. Healthcare providers share that same kind of sense. Of course, being in the military, and having someone trying to shoot you is a completely different thing. The fact that we all deal with different levels of trauma and how we cope with that, that’s the shared thing.

One or two big changes you’ve seen in nursing?

One change is the shift to electronic medical records. Everything is computerized now, which can be good. My regular doctor, or the hospital, or wherever, can all have access to my records, which makes for smooth transitions, and fewer errors. A lot of care providers, whether nurses or doctors, have to be on the computer a lot, charting. Patients feel we’re more distracted, because we are focused on charting and not as directly on them.

A patient in my unit needs to be turned regularly to prevent bed sores. They need their medications on time. Some of these medications need to be given on a regular basis. They need to have their teeth brushed. That’s something that people don’t think of. They need to get bathed every day. We need to check their IVs. There’s a lot that goes on, and if I’m spending the bulk of my time on the computer, it takes away from the patient’s experience. Medical errors remain the third leading cause of death in the United States. Heart attacks, cancer, then medical errors. Nurses have to be mindful.

MCHas Providence diverged from its stated mission?

(The mission, from “As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable. Our values: Compassion, Dignity, Justice, Excellence, Integrity.”)

JKProvidence was started by Mother Joseph and her nuns. If you go to the state capital in Olympia, there is a statue of Mother Joseph near the Governor’s office. She is a hero in Washington State because, from scratch, she built this hospital designed to help people in need.

As her hospital grew, the sisters of Providence realized they couldn’t continue to run the organization. They decided to hand it off to a more corporate model–a CEO and a CFO, etc. In 2012, Providence merged with Swedish Hospital in Seattle. Part of that agreement was that the CEO of Swedish, Rod Hochman, would become the new CEO of the combined Providence system.

Swedish was also a non-profit organization, but it was never “mission driven.” They had a whole different model. Hochman brought that model with him. Being “non-profit” doesn’t mean a company doesn’t make profits. It doesn’t mean they are required to break even every year. They can reinvest “profit” back into the organization, or they can give themselves huge bonuses, obscene salaries.

In 2012, Hochman made about one million dollars. Over the next five-year period, his personal compensation ballooned over 600% to $10.5 million. He turned this organization into his own personal ATM.

In this same year, the top several executives made $40 million. If you run that out over a ten year period, Hochman is making $105 million, and the other execs are making over $400 million. In the same period, the leadership started to cut the amount of charity care the hospital performed. This is the start of divergence from the stated mission, when they begin to enrich themselves personally.

In 2017 (the most recent data we have), Providence hired on the CFO from Microsoft, whom they acquired through a headhunter agency. He was known for mergers and acquisitions. That’s just what Providence has done since then. In 2017, they merged with St. Joseph’s Health, and they have since grown and grown..

Providence has gone from a tiny little Pacific Northwest charity, to the third largest healthcare organization in the country. They are massive.

Now they are coming after caregivers’ personal benefits–like nurse’s paid leave. In the 12 years that I’ve been with Providence, I’ve seen the loss of our pensions, we’ve already lost a bunch of our healthcare benefits.

This is what our big fight is about, and what I met with the Governor about recently. Under the company proposal, I personally stand to lose 58 hours per year of paid leave. Providence is coming after caregivers, trying to siphon money directly out of our pockets. Providence is so focused on mergers and growth and obscene executive compensation, they’ve turned away from their mission.

What does “charity care” mean?

Patients who are uninsured or underinsured and can’t afford to pay the bills are provided hospital care free of charge, and the hospital writes off the expense. Socialized medicine in America gets a bad rap. We already have socialized medicine, it’s just inefficient. If you don’t have insurance, and you don’t have money, we are still going to treat you. I still get paid, the doctor still gets paid. Who pays for that? All the people with insurance pay for that. Lately, the health care systems, including Providence, will go after individual people. They’ll put a lien on your home. They’ll garnish wages from your employer.

What got you interested in being part of the bargaining team?

Six years ago, we had a contract that was coming up. There were some issues that I had concerns with and wanted to see resolved. I was a latecomer to the process, but I really wanted to be a part of it. I learned a lot that first round of contract negotiations. After that, I was asked by one of the bargaining team leaders to join the labor management committee. It’s a group made up of union representatives, a couple of union nurses and hospital leadership. We talk about labor issues, contract issues and put out small fires before they become bigger issues. I’ve been on that committee and working with the union ever since. I’m one of the leaders of the nurses on our bargaining team.

Best part and worst parts of being on the bargaining team?

The best part is knowing that working hard, working together through unity and vocalizing and organizing, will help nurses get good contracts for ourselves. When I started there was a lot of apathy among nurses. We were discombobulated and not very organized.

People didn’t know who the union representative was. They didn’t understand how unions work. Our grandfathers and grandmothers formed unions because they had to. Daddy Warbucks was on top. He was going to squeeze them for every penny he could. Our parents generation didn’t have to fight so hard because they had these good contracts that were built over time and struggle.

Through the 80s and 90s you started to see corporations outsourcing and moving overseas and the slow destruction of unions. People lost touch with how the unions came to be in the first place.

Now we are in a period of resurgence. I really encourage people to stand up for themselves. People don’t understand how much power they actually have. I have a funny expression I use with my members. They’ll say, “My manager did this.” I’ll say, “that’s illegal.” They’ll say they did it anyway. I’ll say, “Yeah, well they’re not supposed to punch you in the face either. If they do that and you do nothing, you just got punched in the face.”

I encourage people to understand how much power they actually have, to take responsibility for themselves, to seize their power.

The worst thing about being on the bargaining team is the time involved. As I get older, I realize more and more that my time is the thing I care most about. I’ve spent about six years in a grassroots effort to mobilize and activate people, to get people to understand the importance and become involved. That’s happened now.

People’s involvement now is incredible, but it has taken so much of my time and that’s hard. My kids need me to be their father. My partner needs me to be her boyfriend. If I’m spending all this time fighting for a fair contract, I don’t have time to be there for them. That’s been tough. It’s something I believe in, and it needs to happen.

My hope is that, although it’s been tough and taken time and an emotional toll, the membership will be more active and motivated, and I can step back.

We’ve had to go through a lot of changes and growing pains. We are all union members, and we pay dues to the union. That means the union is also accountable to us. We pay money to receive a service, and if we’re not getting served, we need to hold them accountable. I’ve had conversations with the union president. I’m kind of known for being pushy. If I see something that’s not being done, I’ll keep harping on it until it gets done. That helps to make us stronger in the long run.

Right now, the struggle with Providence is unprecedented. We estimate this strike within Providence would affect 40% to 50% of the regional medical systems. All told, it’s about 14,000 workers, and about 8,000 nurses, who have given strike authorization in Washington State.

The strike involves over three unions–SEIU, WSNA, UFCW. I am currently represented by UFCW. Back in the 80s there was a period called “the nurse wars.” There were union raidings; stealing members. That created a lot of distrust. Since then unions haven’t liked to work together very often.

Some newer staff not present during that time are trying to move past that saying, “we have to work together.” We’re dealing with the third largest healthcare organization in the nation now. My hospital only has 1200 nurses, and we can’t take them on by ourselves.

As of 2017, the Providence system had $24.4 billion in operating revenue. How can we, one hospital, take them on? We can’t. We have to remain united. We have to stick together. We have to work together, or they will just pick us off, one at a time. Putting aside the past, and working together in coalition, is only going to benefit all of us now and in the future.

We’re at a critical juncture in our country. I look at the big picture. Nurses are the last of the middle class and we’re fighting to keep our place in that middle class of America. You hear about the widening wealth gap, and then you see a CEO getting a 600% increase in pay at a “nonprofit charity” — while they’re trying to cut benefits of their workers. That only pushes the gap even wider. Providence doesn’t care.

Just a few months ago, Providence announced they were laying off 700 workers in Renton. These were all administrative workers — those jobs all went overseas to the Philippines! That was a total economic decision. A CFO from Microsoft would decide, Providence can save $500,000 so let’s do this. There was no thought or consideration for how the loss of 700 jobs would affect the local economy. We live in a world economy, which I totally understand and respect, but these are our neighbors. There are two nurses who I know personally in my unit that have relatives that lost their jobs because of that decision. That affects us all.

Two or three main reasons the hospital nurses union is striking?

One reason is the attack on our benefits — our paid leave program. Washington recently passed the Washington Paid Family Medical Leave Act.Providence is trying to ride the coattails the PFMLA, saying: “You’ve got this program now, so you don’t need your time off.”

I spoke previously about medical errors being the third leading cause of death in the United States. If we, as primary care providers, do not get the time that we need to recover mentally and physically from our work, we will be working tired and sick. Every person in this community will eventually be a patient at our hospital, or the loved one of a patient. We’re going to go to work and we won’t be on our A-game. We’re not going to be effective. We’re not going to be as safe.

More errors will occur; more people will be injured or die. Nurses face incredible burnout because of the demands of this job.. I’ve had to take care of people I knew personally. You don’t have a choice. I’m a care provider, and when somebody comes through my doors in desperate need of help, and I’m there, I will help them. We’re not allowed to talk about what we’ve seen. Sometimes it’s horrific. It’s tough. We need that downtime to do our jobs effectively and safely.

The other big reason for errors is staffing levels. We’re dealing with a massive nurse shortage. In my critical care unit, we have 15 open positions we can’t fill. No federal or state law dictates staffing levels in Washington. Only California prescribes levels. In the last round of our contract talks, Providence agreed to adhere to the California standards — but they never have.

Patients are sicker..Nurses get injured, as we try to move patients, move loads. I’ve frequently seen patients who weigh 400-600 pounds. Nurses are injured on the job at higher rates than other professions, including construction workers and truck drivers. We also face unprecedented levels of violence in the workplace. I know nurses who have been stabbed in the neck with a ballpoint pen; nurses who have been choked, pushed, punched. I’ve seen patients take out multiple nurses.

It’s scary but it’s the nature of our work. Some people are confused, or going through drug or alcohol withdrawal. Sometimes they are just violent. Family members who are stressed get upset. I’ve seen it all. This is why we’re pushing Washington state to mandate staffing committees.

State law mandates that we have workplace “violence prevention committees.” We feel these committees are impotent. Nurses give feedback and management will nod and smile but they don’t do anything to fix the problems. We want somebody at that table with the power to help set the agenda and push for real reform. We’ve been pushing at St. Pete’s to have a person chosen by the union on the committee. Providence responded hard and fast: no way.

Providence is very anti-union. We used to have our general membership meetings in classrooms in the hospital. About three years ago the administration refused to let us use those rooms, so we have to use public areas. Our membership meetings are now in the cafeteria. Since negotiations started the administration has tried to stop this. When they threatened to call the police, we told them to go ahead, because we had a right to be there.

Because of such illegal acts of intimidation and sabotage, we filed unfair labor practice charges with the National Labor Relations Board. Administrators will push and push and as long as people let them get away with it. Ultimately we have the law on our side. It’s a matter of reassuring our members, my coworkers — you don’t have to be afraid.

There are laws that protect us. We can stand together and make appropriate changes to the system. Right now the healthcare system is completely broken. Real change is not going to come from top administrators making tens of millions of dollars. Those of us who understand the problems and understand what’s going on–we’re the ones who are going to bring about change.

How do you see care changing if the strike takes effect?

The strike-ready group includes nurses, CNA’s, environmental service workers, pharmacists and physical therapists. We have hospitals in Spokane, Richland, Walla Walla, Centralia, Providence Everett, all of Swedish (about 8,000 caregivers), which includes Issaquah, First Hill and Cherry Hill in Seattle, Ballard, Edmonds, Redmond, Mill Creek. St. Pete’s has about 1,100 nurses. It amounts to about 14,000 people total, with about 8,000 nurses.

A strike would be devastating, honestly. It would be a huge blow to our communities. We don’t want to go on strike. I never thought Providence executives would be so arrogant. Even if administrators at the hospitals want to settle right now, they cannot. They are operating under a mandate from Rod Hochman and other executives, who basically told them: don’t blink.

Administrators are not protected by unions. If they make a deal with us tomorrow, they’re all fired. We feel like we’re negotiating with a brick wall; they don’t have the power to bargain in good faith. The only way this will end is if the Providence executives realize they’ve bitten off more than they can chew. If we end up striking, we’re all going to do it together, and we will have a huge impact.

This creates moral distress. None of us wants to walk out. We want to be there for our communities. It’s who we are. This is what we feel like we were born to do; to care for our community. We’re not asking for the moon, we just want to keep what we’ve always had. They want to take so much away. We can’t let them do that.

My first responsibility is to my family. Because Providence owns so much market share in Washington, and has grown to become the third largest healthcare organization in the country, the outcome of this event is going to affect how healthcare and caregivers are compensated and how healthcare is structured across this state now and into the future.

This will become the model. For example, at St. Pete’s, if we agree to all the takeaways, Capital Medical Center across town will push for those same takeaways. This is how they start chipping away, how nurses start losing their place in the middle class. When you have a career, or a profession with such a shortage, and so many levels of burnout, the last thing you should be doing is cutting benefits. What person is going to want to join that profession?

MC – You mentioned earlier you were on the management committee at Providence. The Olympian ran an op-ed by Medrice Coluccio saying Providence is committed to partnerships. As a member of the committee, did you ever feel there was a partnership?

JK – The piece in the Olympian is word for word the same piece that appeared in the Spokesman-Review, in the Centralia paper, in the Tri-Cities and in Richland. It’s a canned piece with Medrice’s name on it but she didn’t write it. I believe Providence has hired a PR firm to manage its effort to undermine their nurses and our position. Some managers have told me in private that they do not approve of what Providence is doing..

When 14,000 caregivers vote to strike together, there is clearly something wrong. That is a major red flag. We’re not out there every other year striking, saying, “We want this. We want that.” We are focused on caring for our patients. To have this many people across the state, and from multiple unions rise up together, is alarming! It’s a clear signal that something is not right within the organization.

I believe there was a time when we had partnerships. Providence St. Peter Hospital currently has Magnet Certification, given by the American Nurses Credentialing Center (ANCC) to an outstanding hospital. It’s for a hospital that is so progressive and invests so much in its staff and the workers are so happy, that nurses are drawn to it like a magnet.

When I came back to Olympia, I was really pleased to discover that Providence St. Peter Hospital was trying really hard to become a magnet facility. It’s not easy. At that time, only about 2 or 3 percent of hospitals nationwide had magnet certification. Today, 13 years later, 6-8 percent of hospitals nationwide have achieved certification. Part of having magnet status involves developing “shared governance,” meaning that workers have an active role in governing the institution.

We have “unit based councils” (UBCs)) that help dictate unit policies regarding time off, scheduling, things that increase worker health and satisfaction. We achieved magnet by developing these things. But once we got magnet we got lazy. Some of the original people who worked hard to obtain magnet certification left or retired. We got new people who didn’t understand everything that went into it.

New managers or directors start to say, “The Unit Based Council doesn’t need to decide on a particular thing any longer — It’s easier if I just dictate how things are going to be.” It’s always easier to be a dictator. Working together is harder. I’m not saying managers are mean, but It’s easier for them when they exercise control themselves. We’ve lost touch, in some units, of how working together should actually happen.

The merger with St. Joseph’s Health exacerbated the problem. Providence St. Peter Hospital has always been a special place. It’s beautiful, with a large wooded campus, wetlands and ponds. It’s my understanding that Sisters of Providence signed over the hospital with the agreement that no more trees would be cut down. We always felt special. The nurses at St. Peter felt like we belonged to a special organization. We were proud of the fact that we were a magnet.

St. Pete’s is up for recertification soon, and I don’t know a single nurse who thinks that we are going to retain certification. Everyone thinks we will lose magnet status.

It’s not because the quality of nursing care has gone down or the nurses don’t care. It’s because Providence St. Joseph Health executives don’t care if St. Peter has magnet status. They don’t care about joint leadership or shared governance. They care about imposing their corporate model across the system, so that everything is the same. It’s not easy for them if one hospital stands out, and is special, and has a different model.

You don’t maintain magnet status by cutting nurses’ paid leave by a week and half a year for everyone. You don’t maintain magnet status by threatening to arrest union members meeting in the cafeteria to talk about their contract. You don’t maintain magnet status by approaching dedicated nurses serving as union leaders and sticking your finger in their face and yelling that they are trespassing. That is not magnet. That is not cooperative leadership. At one time, we used to have a partnership. I don’t believe it’s that way anymore, and I think it’s sad.

Jacob M. Kostecka BSN, RN, CCRN is a Charge Nurse in Critical Care, UFCW 21 Union Steward, member of Providence St. Peter Hospital Labor Management Committee who serves on the nurses’ bargaining team.

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