What can be done to improve care at this South Florida hospital? Nurses call for a change
A South Florida hospital is struggling with supplies, staffing and broken equipment four months after new managers swooped in and took over amid a bankruptcy deal, according to health workers on the front lines.
Nurses at Palmetto General Hospital in Hialeah say not much has changed at the Hialeah campus with the new operators.
Palmetto General continues to face issues with “supplies, staffing, medical insurance, ever since the new company took over ... So we got rid of Steward, but we’re running into the same problems,” said Lazaro Garcia, a registered nurse who works in Palmetto’s ICU.
Garcia was one of more than a dozen blue-scrubbed registered nurses demonstrating outside the hospital Thursday to call for the hiring of more nurses, safe staffing on every shift and in every unit, and better equipment, pay and health insurance. The demonstration was one of several in Florida and other states by National Nurses United, a union that represents more than 224,000 registered nurses in the country.
The union’s local chapter at Palmetto General, which represents 650 nurses at the hospital, will be bargaining for new contracts this year with Healthcare Systems of America, or HSA. The health company took over hospital operations from cash-crunched Steward Health Care System in September.
HSA was initially tapped to be the hospital’s interim manager, running the day-to-day operations, but eventually became Palmetto’s permanent operator in October. The change was part of a deal Steward made with its landlord in court to thin debt after filing for Chapter 11 bankruptcy in May.
Doctors and nurses at Steward’s hospitals across the country had complained about cutbacks, layoffs, shutdowns and problems with supplies, equipment and delayed payments to vendors and workers, including in Miami-Dade and Broward counties.
North Shore Medical Center in North Miami-Dade last year closed its critical but costly labor and delivery, neonatal, and behavioral health units last year to try to slow the financial bleeding. At Florida Medical Center in Lauderdale Lakes, a lack of supplies and clinicians to provide on-call services to the ER forced the hospital to divert ambulances away for patient safety.
At Palmetto General, several key staff members resigned while it was still under Steward’s control. The hospital also saw fewer patients coming in last year during Steward’s bankruptcy process, with registered nurses sometimes told to work fewer hours or not come in at all, Garcia previously told the Miami Herald. Some had to pick up shifts at different hospitals to make up for lost wages.
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Garcia, who serves as Palmetto’s chief representative for National Nurses United, and registered nurse Barbara Garay are hopeful that HSA will work to improve the hospital. Besides Palmetto General, HSA will also have to address problems at four other former Steward hospitals in South Florida. They include Hialeah Hospital, Coral Gables Hospital, North Shore Medical Center in North Miami-Dade and Florida Medical Center in Lauderdale Lakes.
Aimee Gill, a spokesperson for Healthcare Systems of America, told the Miami Herald in September that the new operator’s “number one priority is to provide stability and rebuild trust with the community.” The Herald has contacted the company for comment on the hospital’s current conditions.
“This is the main hospital for this community. ... We need them to work on the actual hospital and make those changes so that we have the supplies, and so that we have the equipment we need, so we have the resources that we need, to give that 100% excellent care that we want to be able to give,” Garay said. The nurse said a problem she brought up related to an issue with the hospital’s charting system was fixed shortly after, which made her feel heard and was a “positive change.”
Better staffing needed, nurse union says
The calls for more staffing comes as the country is facing a nationwide nursing shortage, with hospitals competing to hire and retain nurses. The American Association of Colleges of Nursing says there’s a variety of factors causing the shortage, including nursing school enrollment not growing fast enough to meet projected demand, retirement, and insufficient staffing leading nurses to leave the profession due to high stress and lack of job satisfaction. Others like National Nurses United says the shortage isn’t because of a lack of nurses, but rather because nurses want better working conditions.
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Studies show that when registered nurses are forced to care for too many patients at one time, patients are at a higher risk for preventable medical errors, complications, falls, injuries and death. When a registered nurse has to care for more than four surgical patients at a time, for example, the risk of a patient dying within 30 days goes up by 7 percent, according to the union.
Yet there are no federal mandates regulating the number of patients a registered nurse can care for at one time in U.S. hospitals. Every hospital differs in the nurse-to-patient ratio they maintain.
In Florida, for example, nursing homes are required to have a certain minimum number of nurses based on the number of residents. But there are no state-mandated nurse-patient ratio requirements for Florida hospitals, similar to most other states. Hospitals set their own staffing guidelines. California is an exception and has mandated minimum nurse-to-patient ratios across all hospital units for years. Some states have begun to see nurse staffing laws gain traction, including in Oregon, New York and Massachusetts for certain hospital units.
Besides more staffing, nurses represented by National Nurses United at other hospitals are also calling for AI protections over concerns the new tech will hurt patient care and cut jobs.
Much of the new technology at U.S. hospitals is “unproven, it’s unregulated, and they’re actually using our patients and us as guinea pigs,” said Catherine Kennedy, president of National Nurses United.
Nurses call for AI protections
The use of technology in healthcare is on the rise. Hospital systems are looking to use more AI, robotics and virtual and augmented reality with the stated goal to help reduce paperwork and improve patient care. Medical schools are using tech to help train future doctors and nurses, too.
Nicklaus Children’s Hospital near South Miami, for example, is using virtual reality headsets to help reduce anxiety before, during and after procedures. UHealth is working with CLEAR, the company that powers the facial recognition technology some travelers use at the airport to go through TSA quicker, to make patient facial recognition possible at its facilities, including its urgent care centers. And Nova Southeastern University in Davie is using simulations, including with robots, holograms, and virtual and augmented reality to help teach students how to do surgery, assist in delivering babies and respond to medical emergencies.
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But AI is also being used at some hospitals across the country to predict how many registered nurses and other workers are needed to safely care for patients. That can sometimes lead to understaffing, according to Kennedy, who works as a registered nurse in California.
A 2024 survey conducted by National Nurses United found that 60% of more than 2,300 registered nurses and union members disagreed with the statement, “I trust my employer will implement AI with patient safety as the first priority.” The same survey found many nurses said their own assessments of patients did not match AI assessments.
“The thought of bringing in artificial intelligence to either de-skill us or even look to replace us, is problematic,” Kennedy told the Miami Herald in a phone interview.
At Palmetto General, AI is not a concern at the moment. Nurses say the hospital’s equipment is just too old.
“We’re having the opposite issue, where our equipment is very outdated,” Garay, one of Palmetto’s registered nurses, said. “Our beds are outdated. The rooms, a lot of the equipment. We need a complete overhaul in the opposite direction. We need to move into this century.”
And nurses — many of whom have worked at Palmetto General for years — have ideas on what changes the new operators can make too, including updating the hospital’s bed alarm system and integrating it into a call-light system to help nurses quickly respond to patients and reduce the risk of falls.
On the day of the demonstration, an attendant at one of the hospital’s parking lots was accepting cash only because the pay machine that accepts credit cards was broken.
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This story was originally published January 17, 2025 at 11:54 AM.
