Nursing Struggles at Unity Center for Behavioral Health

By Daniel Perez-Crouse

Unity Center for Behavioral Health, founded in 2017, is a 24-hour mental health services center and a joint effort by Legacy Health, OHSU, Kaiser Permanente and Adventist Health. It provides immediate psychiatric care and recovery services for adults and adolescents experiencing a mental health crisis. 

Despite a NOVA Award for hospital-led collaborative efforts and anecdotes of good work done there, the facility has been plagued with issues over the years.

A state investigation in 2018 revealed numerous safety concerns and Unity risked losing federal certification in the process. Last year, The Oregonian detailed complaints around the facility’s lackluster COVID-19 protocols. 

Issues supposedly persist to this day with staff shortages and turnover becoming an issue piling on its other challenges, as noted in a report published by the Oregon Nurses Association (ONA). In speaking with the Lund Report, Melissa Eckstein, President of Unity, vocally opposed most of what is alleged.

Registered nurses Sherrie Neff and Christine Allen on Unity’s ONA bargaining team, shared experiences and insights related to Unity’s past and present. 

Both spoke to what they felt was a rocky beginning, with Allen acknowledging the challenges of opening a new hospital and having staff arrive from different facilities. 

“Nurses came from Adventist, OHSU and the Legacy units and, in the process, there wasn’t a lot of time for team building. It was very chaotic.”

Neff said, “When we got there, everything was not organized. We were told just figure it out and do what you want.” 

Despite attempts to change and improve since the 2018 review, Neff feels they are regressing. Hence their acknowledgment of current staffing issues. 

“My unit can hold a mass of 24 patients. We have not been able to fill that because of staffing for many months now,” said Allen. 

She elaborated by saying this leads to an issue where emergency rooms are filling up with patients. 

Allen feels there is a lot of pressure from above to admit patients when they don’t have enough staff to safely do so and discharging patients when they aren’t necessarily ready. They mainly attribute this problem to an occasionally dangerous environment (as reported by other outlets).

Allen explains that patients have their own spaces and are encouraged to be in open areas. However, she says, they can be “agitated, yelling and throwing stuff. Imagine that you have 20 of those people in one space. It takes a lot of creativity from staff to engage them and keep them from hurting themselves and other people. We have a lot of assaults that happen to staff.” 

She says this can be especially challenging for newer nurses who haven’t experienced this before. 

“It’s hard emotionally and we have a hard time maintaining accurate staffing levels because of that.” 

“I got hurt personally when someone tried to hit me in the face. It’s part of the job and you know it’s coming,” said Neff. “We are losing a ton of staff because they are tired of getting hurt and tired of seeing people get hurt.” 

This is compounded by what they feel is management that does not listen to feedback and makes changes that are sometimes detrimental. 

For example, phones used to be permitted in the facility. However, some were breaking rules associated with them and they were not allowed anymore. Allen felt this should have been a “case-by-case” scenario rather than an outright ban. 

Allen said recently facility iPads (with cameras disabled) that allowed patients to use various apps for leisure and professional purposes were removed. This was because people could still record audio with them and potentially release personal health information. 

“It was a tool for when they were agitated to have them listen to music or give them a movie to watch, but not only do you not have a tool to make your job easier, but the patients have something else taken from them.” 

Neff said patients’ “boredom” led to another, unexpected problem revolving around food as something to do. 

“They are eating constantly and we have managers saying you give them what they want. We’ve had men and women gain 40-60 pounds. So now, we are adding another problem to their problem,” Neff said. Her unit struggled with management to change this, limit their food and give them healthier options.

She also said behavioral health therapists are being removed and social workers are quitting. As a result, her work suffers. 

“What I feel like is a holding tank. I just give them (the patients) meds and try to talk to them, but I can only really give all my attention to two patients and I just feel inefficient.” 

They and other staff, since unionizing almost two years ago, are still in a stalemate to secure a contract that would give staff a voice in staffing, policy and potentially, quality of life improvements, like a 45-minute break. 

“Nurses are the largest workforce at Unity. There are just under 200 of us. We really are what’s going to make Unity great and we just want a contract where our voice can be heard,” Allen said. 

They feel if staff are adequately taken care of, heard and protected, then there will be less turnover and superior aid for an in-need population. 

“We all want to help Legacy. They are honestly a good hospital. And we want to help them be better, but everything we try to do to help them, they just shoot it down,” said Neff.  

Nursing Struggles at Unity Center for Behavioral Health

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