registered nurse

nursing assistant

registered nurse - medical / surgical

paramedic

patient care technician

Mission Health

The two biggest problems are staffing and unreasonable policies that--when combined--make the job untenable. First, staffing:

The staffing grid is almost never met. Typically we are short 1-2 nurses and frequently have no CNAs. Staff is frequently floated to other units, and aides if you have them often become 1-on-1 sitters. Days are long at about 13.5 hours average and there is very high turnover. High numbers of traveling nurses and new grad nurses need constant help. Charge nurses have their own patients and have to answer the phone, so they frequently cannot help. Nurses rarely get any kind of break, including lunch, and even the most efficient go home at least an hour after shift change. Days can easily stretch out to 14+ hours.

Policies make the job extremely difficult. Nurses carry a mobile phone they are expected to answer at all times, even if during a sterile procedure or a med pass. The phone rings constantly. Every time a tele unit needs a battery replaced or the leads reattached it's the RN's job. If not done in 5-minutes the tech calls a rapid response on that patient. As the tele units are frequently faulty one is constantly running to different room to fix the units, some of which are unfixable. Confused, demented, non-compliant, and/or behaviorally challenged patients constantly screw up their tele units. Centrally monitored pulse ox constantly needs fixing (cold fingers, comes off, etc.).

Narcotics have to be given within 30-minutes of being pulled, including gabapentin. If you have a medical emergency, a patient falls (or will fall) if you don't answer the bathroom call (because you have no CNA or your CNA is at lunch and they don't cover for each other in the unlikely event there is more than 1 of them), well that's tough luck, you will be written up. You are supposed to go and wait in line at the Pixis to return the narc...which you don't have time to do. Antibiotics have to be given within 30 minutes of the admin time or you will be written up. If pharmacy doesn't send the antibiotic in time, or the patient is a tough stick, has one IV site, and has three incompatible antibiotics with long run times and one maintenance fluid, well, tough luck. you will be written up. Pharmacy decided having drawers in the carts leads to med errors so those were disabled. So now it's harder to organize your stuff and trips to get supplies are much more frequent. Nurses schlepp plastic bags around jammed with supplies.

Adding to the stress is that you get spread so thin and and are going so fast for so long that you inevitably miss something. Management does not work the floor and has no idea what you are really up against, so anything you miss you are called in for to discuss. This happens during a shift when you have no time for such discussions. Because of all the travelers, new grads, and new hires, shift report often takes a long time which further robs you of valuable minutes. Continuing ed and checking email are supposed to happen during your shift when there is no time to do so. ER does not give report on the patients you get so you have to research them. When a patient leaves the nurse is supposed to break down all the equipment and take it to the dirty room "because housekeeping is too busy to do that". Nurses are expected to round with doctors, which can also take a lot of time you don't have. If you don't come in 15 to 30 minutes early to organize and research your patients before you start your day your goose is going to be cooked. You are not paid for this time, which further adds to the length of your day.

You had better chart everything and annotate everything because when management is picking you apart, the context of what was going on will otherwise be lost. But...that is also very time consuming.

I expect nursing to be a tough job, and have worked the hardest floors on other hospitals. But the combination of the poor staffing, the insane policies, and the stressful/punitive culture make this something else entirely. Don't say I didn't warn you...I am currently looking for a new job and most of my co-workers have already left.

I've worked here for almost 2 years, on nights, PRN. I started out on a small unit which was later merged with a larger unit. For many in the "trenches" of these two units the merge was not an intuitive marriage made with the patient demographics in mind or with the input of those who do the work every day...unfortunately this "top-down" decision cost both units a huge exodus of staff which seems like it probably cost more than an initially more thoughtful merger would have. The mid-level and unit management & co-workers/staff members (as a whole) are incredible & hard-working. Unit-level staff otherwise feel out of touch with anyone beyond their own nurse manager. Over the years I have found out that: PRN staff don't get reviews (& thus no pay raises), PRN staff don't automatically get a PRN differential like some hospitals offer (you have to commit to working a certain number of hours per pay period for either a 10%, 20% or 30% above base pay amount), benefited staff only inconsistently get raises (& not to "cost of living" appropriate). Often it is incredibly difficult to find out with whom to solve anything administrative with (particularly on nights). It often seems that overwhelmed unit managers can't get to all the needs of every staff member (& probably don't get paid enough for the hours and energy they give). Unit Managers don't seem to be given much real influence beyond every day tasks (largely dominated by budget to-do lists) and thus have their hands tied when it comes to advocating for their staff. Overall the hospital runs efficiently in terms of safety and cleanliness. Most patient report having great nursing staff and decent overall experiences (not terrible, nothing special). I have been a nurse for a total of 6 years and have never felt too stressed by assignments/patient loads on the unit I work for (or like understaffing was a huge issue beyond what is normal for all units) like I had at my previous hospital--though I work only nights now and PRN. Many other nurses and staff members (especially full time or on days) express frustration with high patient loads and/or understaffing. This is especially true for New Grads who are trying to get their bearings & can feel burnt out already coming into full time work from nursing school and getting 6+ patients of high acuity nearly every shift (this RN to Patient ratio being on Med-Surg Units). Progressive and step-down units also feel like their patient load is often too high for patient acuity levels. The patients and my co-workers are literally the only thing that make working here worth it. Benefits to "benefited staff" are nothing great (except maybe having a job throughout the Pandemic...not so for PRN staff). Pay is WAY below the cost of living in this area. And if you are PRN and switch to a benefited position (part time or full time) you don't get credit for any of the years you worked for Mission as a PRN staff member. It would almost be better to leave Mission and then return...but what a waste of resources if we are thinking in terms of cost for the hospital. It would be better if Mission would just overall pay staff more appropriately, provide consistent raises, and, for PRN staff, guarantee that their years of work and loyalty don't go down the drain if they were to move to a committed Part or Full time position. That seems reasonable to me. But, then again, I'm just one of the foot soldiers... merely taking care of patients every shift I work. ...maybe someday, somewhere up there, they will hear us from down here.

Mission as with other hospitals have had a difficult time compensating for the reduction in payback from the government.  In turn, expectations of employees have become demanding related to staff shortages, lack of experienced staff and meeting new government regulations.  Unfortunately, much of the management are chosen from a clinical setting rather than a management setting.  This staff maybe knowledgeable in clinical procedures and processes but lack of ability to effectively manage staff.  Staff morale, in my opinion, is at an all time low. Mission is based on a management style of fear rather than appreciation.  Employees do not share concerns for the fear of being labeled as a trouble maker and their position eliminated, this has happened before.
Mission does have a excellent clinical structure regarding policies and procedures. Mission has attracted many talented personnel but   because of the staff demands, these refined procedures are left in the hands of inexperienced, under qualified clinical staff members while the pressure of a safe outcome to the patients are left to the experienced.  
Mission has hired the most new RN graduates the last year to bridge this gap and this will continue and expand.  This is very cost effective.  Mission also is developing a teaching network for PA's and MD's.. This is very cost effective.  Understandable, everyone needs to learn and someone most start somewhere.  I would like to see Mission's retention, years of experience and staff satisfaction numbers.  
When the focus is money and not people, the goal and focus is lost and the patient ultimately suffers. When the CEO never observes operations other than from the rose colored glasses of his management, he has lost the reality of the human element.  Mission is nothing more that a machine consistently to be fined tuned.  People are tools: some break, some are not made as well as others, some must be disposed.  On the outside, the perception is confidence perpetuated by a stellar marketing department. On the inside, under that shell of protection, Mission is falling short of it potential to provide the best care to its patients.  The future of healthcare? Maybe. The future of decision making inside of the Mission establishment?  They will not survive. 

So....  If you are willing to forego the politics and are willing to work within this management structure.  Mission is for you! They need your help.

When I began working for this organization back in 2007, the health system was growing, but at a controllable pace.  At that time, it appeared that upper management genuinely respected and valued their employees - including their suggestions & observations. The morale was good and the main focus was on quality of care and patient satisfaction, the way healthcare should be. Then there was a change in leadership.  A new CEO took control and that main focus and work environment was completely redirected.  Revenue became the #1 objective and a health system that was once a wonderful organization to work for, became a negative stressful revenue driven environment.  There was a restructuring of the organization and jobs were lost. There was a hold on raises for 3 years. PTO was taken from employees. Friday weekend staff pay was taken from full time weekend employees.  Workloads significantly increased and regardless of your high evaluations & reviews, your pay remained the same. Contract employees were highered with no organizational benefits.  Positions in the CBO were eliminated and outsourced to a company in India. Care Management was restructured and workloads were increased. The list goes on.  I wish, I could give this organization a wonderful review, but that would be dishonest.  I can't recommend this organization as a stable positive working environment.  You are taking a huge risk, if you accept a position at this organization and base your income exclusively on the stability of your position with this organization.  This review is honest and based on actual events.

A typical day in the Finance department begins when you enter the building. My timely distribution of information directly impacts various departments within the organization. Co-workers from various departments throughout the hospital are in constant need of information to assist in their strategic planning. Assisting with the purchase of capital assets is one of the roles I am involved with. I have learned to be readily available to assist in time sensitive matters. Follow up is a key factor to the overall success of the department. My co-workers and I form a coherent team critical to the successful financial management of the hospital. We work unified to provide the needed outcome. The hardest part of the job is sometimes piecing together segregated information to determine what is actually needed. The most enjoyable part of the job is the knowledge gained and the comraderie between myself and my immediate co-workers and the staff throughout the organization. We are truly a caring group of people who assist with the many difficult decisions to be made during these trying times.

I'm paid well at Mission. Benefits aren't bad, but they aren't great either, and you pay through the nose for them. I love the people I work with, & my immediate supervisor is doing his level best with a bad situation, but I've been here 30 years in various nursing jobs and the management culture has gone from decent to freaking awful. I don't trust upper management as far as I can spit a dingo. They pay lip service to caring about employees, but they don't. Culture is quite punitive. You're treated like a child who's constantly trying to get away with something rather than a grown adult doing your best to do a good job. I expect it to only get worse once we're absorbed by the Borg. I mean HCA, the big boy for-profit guys. I'm tired of it all, and I'm ready to get out.

All that said, I do think a person can begin and grow a career here, if you're smart about it. Maybe. In my bedside nursing days they strongly supported nurses learning, getting specialty certifications, advancing their careers, etc. I hope they still do. If you're thinking of applying to Mission as an RN, make sure to ask what the pay increase is for specialty certification, if they still pay for you to go to school for a higher degree, if they will send you to nursing conferences, etc.

My only complaint was the fact that they drug tested me on the first day of my new daytime schedule after I told my Nursing Unit Supervisor that I had only slept 2 hours so I may be drowsy.  I was never able to give my prescription meds to anyone and contacted HR and my direct supervisor more than once to ask when I would be able to give that info.  Each time I was told they would ask when they needed it.  I had explained that I received the Rx (they were aware of my health issues, I had FMLA) on the previous day after 4pm (only taken 1 tablet that evening after they were filled, and the next morning I clocked in before 6am and worked until 1400-1500 before they called me for the drug test that was warranted for “sleeping” at the desk.  We had been extremely busy that day (so much so that I don’t mind to admit that I could barely keep up and the only time I went to the restroom, I had my headset and received a call and had to write the patients info and procedure info on my pants) and although I may have closed my eyes for a long blink while listening to a caller, there’s absolutely no way that “sleeping” would have been possible at all and if they felt I was impaired to such an extent that I needed to be tested then why did they wait until 1400-1500 to pull me? That would be irresponsible in any area of the hospital but especially so in the department that i worked in.

The camp is only for one week. It runs like any other camp would run. Three meals a day, sports, rock climbing, swimming, dances, talent shows, fishing, camping. The difference in this camp is that it is specifically for children with diabetes. As the counselor I have to make sure that the campers are taking care of their blood sugar and eating the right foods. In the middle of the night I would have to check their numbers while they are sleeping to monitor them. Along with the regular activities that happen at a summer camp, we also hold diabetes classes with specialists to teach the campers about the latest technologies that help them to manage their diabetes as well as dietitian classes to teach about healthy diets. I absolutely love working with kids and being a person with diabetes myself, I have a better connection with them. I was a camper myself when I was younger and have grown up with my fellow co-workers. Even the directors that put the camp together have been like family to me for years. The hardest thing to with at this camp is dealing with the kids who get home sick. There are not many of them but each one is different when the case occurs. Knowing how to handle it in the best way is very important.

I was an employee for over 10 yrs, over 45, and because I care about the patients more than administration does,I no longer work there. This wasnt what I went to nursing school for. As for others in my position including myself we now can't get hired elsewhere. Some have been unemployed for over 2 years. This organization owns 1/2 of the county and town. Insurance is a disgrace for a healthcare organization and even the physicians in town have said so. You can't be advanced or gain any rank or increases unless you are a yes person or sell your soul to them. There are new grads that are hired in at almost my salary and some younger less experienced nurses at higher salaries. At my time, experience, and education, I should have been at a higher position instead of a entry level floor nurse position. I was always passed up and given to someone younger and less experienced or something they came up with would make me ineligible to transfer. VERY UNFAIR WORKING CONDITIONS! Save yourself the stress and go ANYWHERE BUT MISSION HOSPITALS IN ASHEVILLE, NC!!!!

Mission Hospital sold to HCA. What does is done. Previous days at Mission were people who worked towards a goal of patients. It was an environment of Just Culture and postivity. It was not perfect, but we worked hard and we continued to try to be better. We sold. This experience has been terrible. Management should be embarrassed about the lack of planning for transition that occurred. On top of this, our leader who we followed for years and trusted, disappeared during our hardest times, yet was still part of the organization? WHAT? I liken this experience to Game of Thrones. We now go to work and wait for our heads to be chopped off. We are supposed to take a knee. It is about placing blame on others. The person that has the most power is the CFO. You go to work and are constantly wondering who you can trust and who you should align with. Training has been none to none. Professionals with years of experience are made to feel worthless. Strangers are coming into our lands without care or regard. Yet, we love our team and we try to believe this will change. We continue to be nice and do our best. What will happen? I guess we will have to wait until the last episode. If I did not have this insurance, I would definitely seek another hospital. Who knows...your head could be next! Lol

Top Job Titles	Average Salary
Registered nurse 86 salaries reported	$36.35 per hour
Nursing assistant 61 salaries reported	$18.47 per hour
Registered nurse - medical / surgical 21 salaries reported	$35.45 per hour
Paramedic 28 salaries reported	$21.85 per hour
Patient care technician 5 salaries reported	$18.50 per hour

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