Nurses With 1:53 Staffing Ratio Confront Admin in Viral TikTok, State Investigates

A comprehensive emergency psychiatric program (CPEP) at ECMC Hospital in Buffalo, New York reportedly has been forcing nurses to work with a patient-nurse ratio of 1:53. And after news of the shocking conditions went viral on social media, the New York State Health Department is now launching an investigation into the hospital. 

"The Department has launched an investigation into this matter," Health Department spokesperson Monica Pomeroy said in a statement Friday afternoon. "As this is an ongoing investigation, the Department cannot comment further at this time.

The Power of Social Media

A Reddit thread with a video posted by u/Traveling_Ariesx3 spread the video and it quickly went viral.

The video shows what appears to be a nurse calmly speaking to a hospital administrator about what plan is in place to address the fact that she is the only RN scheduled to care for 50-plus patients alone. 

 

“We need something now,” a woman who appears to be a nurse dressed in scrubs in a hallway speaking to what looks like some kind of administrator who is on her phone. “What is the plan for this week coming up? Do we have a plan for this week? That's the question…”

Another healthcare worker interrupts to add, “I mean 50 patients by myself for one hour, one RN, from three to seven…”

The nurse appears to continue: “50 people for this week Saturday, do you have an actual plan?”

The woman and a group of healthcare workers then go upstairs apparently to HR to try to speak to an administrator. Another man explains that the “normal” staffing ratio is closer to “1 to 20; 1 to 23, 1 to 27.” The video then cuts to another healthcare worker in scrubs who describes how workers in CPEP are regularly assaulted. 

When no one in HR answers them knocking at the door, the group then goes to another office to talk to someone named Charlene, the Director of Nursing (DON)—but they are told that she is on vacation. “Just to make this abundantly clear, we're trying to fix the staffing, and Charlene (last name not clear), who is the DON, is on vacation while we're dealing with 1:53 ratios and double-digit ratios. 

She goes through a list of other people to speak to, including Cindy and Thom, before apparently getting a chance to speak to Charlene on the phone. 

 

Charlene is speaking when the nurse interrupts her, saying:

“Charlene. I don't mean to interrupt you. I'm sorry. But you know, we've had these conversations. Do you have a plan for this weekend? Do you have a plan for this weekend to cover the nurses in CPEP?”

Charlene begins to respond that there are 133 physicians who work in CPEP, but the nurse again interrupts her, saying: “But do you have a plan for this week?”

The video then ends with the nurse explaining, “There is no plan, no actual plan in place.”

Unsafe Staffing Conditions

According to Buffalo News, ECMC’s CPEP is the only CPEP is the only behavioral health emergency department in the region and sees an average of 10-11,000 patients every year, so its services are crucial. It serves everyone from children to adults and is one of the largest in the entire state of New York. 

The paper interviewed several people who claimed to have been patients, family members, or advocates of those who had been patients of the center, and many of them described chilling conditions, especially in a unit that has seen increased demand and may have high-need patients. 

They described patients being stuffed into rooms sometimes dozens together, waiting days to see a psychiatrist, and a lack of communication with loved ones once in the hospital. 

“It’s like a jail cell, but scarier,” one former patient who had been taken to the facility following a suicide attempt, told Buffalo News “It's like a cattle room. You go in there, you don't know who's in charge of anything and there's no privacy.”

The TikTok video also listed alleged patient experiences that painted a dangerous situation for workers and patients alike. 

A Larger Issue

The staffing crisis at the ECMC CPEP reflects the staffing challenges happening on a larger scale across the state of New York. And the New York State Nurses Association got involved, posting on their Facebook page that the nurses in the TikTok video are also members of their union. 

The NYSNA has been negotiating on behalf of 1,300 nurses at ECMC for better contracts, including addressing staffing. 

"We continue to be frustrated by management's lack of urgency and lack of a real plan to hire and retain the nurses we need to deliver safe patient care," Steve Bailey, a registered nurse at ECMC's Terrace View Long-Term Care Facility and Western New York regional director of the Nurses Association, said in a statement. "As nurses, we are committed to delivering safe, quality care to every patient. At this point, we are sending an SOS to management that we need the nurses and resources to be able to do our best for our patients – and we need them now.

In June of 2022, the NYSNA reported that a Safe Staffing Bil was signed into law, which stated that in January of 2023, it’s required for there to be a process for setting and enforcing staffing standards at every hospital and nursing home—regardless of whether the facility is public or private, not-for-profit or for-profit, union or non-union.

Until the staffing guidelines go into law, there isn’t a clear standard for what “safe staffing” should be, nor are the legalities surrounding a nurse having to accept an assignment that requires them to take care of 53 patients alone. According to the New York State Education Department, there are some situations that would not be considered patient abandonment, such as if a nurse is “too exhausted” to properly provide care after working a shift in an emergency or if the nurse is not given adequate training or shift modifications. 

The Hospital’s Response

Buffalo News also reported that the hospital released a statement on Friday that said:

"Due to our inability to discharge patients to state-supported programs, coupled with inadequate Medicaid reimbursements, ECMC continues to experience high patient volume challenges in our Comprehensive Psychiatric Emergency Program (CPEP)." 

ECMC spokesperson Peter Cutler told the paper CPEP has 180 staff members. (If 133 of them are doctors, per the video, that means less than 50 are other types of healthcare workers providing direct patient care.) 

The hospital is reportedly continuing negotiations with the NYSNA to address the staffing and finalize a contract. In the meantime, it announced it plans to hire agency nurses to help relieve staffing shortages. "We will temporarily hire travel agency nurses to fill those other vacancies until the remaining nurses complete their orientation and start working in CPEP," ECMC said. "To date, we have been having ongoing conversations with our NYSNA representatives; it is unfortunate that some misinformation has been disseminated on this subject."

ECMC Hospital’s news and media page does not have a statement about the staffing but shows announcements about accreditations and recent administration promotions, including two new vice president positions. 

Nurse.org contacted ECMC Hospital for a comment and will update this article once a statement is available.