By Andrew R. Jones
Mission Hospital is significantly reducing pay for nurses who work only weekends, a move that is already causing departures and that will require other nurses to work those shifts to improve staffing levels.
The HCA Healthcare-owned hospital has reduced the hourly pay by $25 for at least 63 nurses who are part of the hospital’s Weekender Program, according to interviews with nurses as well as staffing and contract documents and emails obtained by Asheville Watchdog. Many of those nurses, known as weekenders, were hired last year in the wake of the hospital being placed in immediate jeopardy, the most severe federal sanction a hospital can face.
The money was cut from a premium shift differential bonus – special extra hourly pay for employees who work outside of normal business hours. That hourly bonus dropped from $40 to $15, according to a copy of the new Weekender Program contract and emails obtained by The Watchdog.
The Weekender Program is not covered by the collective bargaining agreement between management and Mission Nurses United, the nurses union.
Some weekend nurses were given until Friday, March 7, to sign the diminished contract or be moved to a regular RN role, according to a text message nurses shared with The Watchdog. The regular RN role does not have guaranteed differential pay for every shift.
Documents obtained by The Watchdog show Mission never indicated that it would lower the pay within months of hiring weekenders.
The Watchdog reached out to Mission spokesperson Nancy Lindell with questions about the pay cut.
“Employees who join the Weekender Program commit to working specific weekend shifts and, in return, receive their regular base pay plus an additional $15 per hour; and an additional amount for working the night shift if colleagues work weekend nights,” Lindell said. “The current contract – as agreed upon by the union – does not restrict the hospital in adjusting this additional pay rate as needed. While the union initially proposed including the Weekender Program in the contract, they later agreed to withdraw that proposal. However, the contract does include language specifying the number of weekend shifts a typical RN is required to work, which is now being implemented to help improve weekend staffing levels.”
Union members said the hospital was weaponizing the union contract.
“I would say that they’re manipulating our [collective bargaining agreement] to use it against us,” union representative and registered nurse Molly Zenker told The Watchdog. “We have a maximum of [52] weekend shifts that a nurse should be working. But that doesn’t mean we think that nurses should be having to sacrifice their weekends all the time. Now that they’re pulling back on offering incentives to nurses to work the weekends, they’re trying to find a way to justify forcing nurses into working shifts that they don’t have to.”
Five weekenders spoke to The Watchdog about the change, four of whom requested anonymity because they feared risking future employment opportunities.
They expressed anger and said the company lied to them or misrepresented the job by not stipulating how long the $40 differential would last. Some moved from other states, bought houses, paid off debt and made plans based on their new income, which totaled about $80 an hour for many before the reduction.
Emergency room weekenders said HCA persistently recruited them in early 2024 and never mentioned the possibility that differential pay would dip.
“I was heavily recruited to Mission,” said one such nurse, who said a Mission recruiter told her the position was for two years and featured the $40 differential.
“So I signed on, I asked … my recruiter, ‘What are the chances that this doesn’t last two years?’ And she was like, ‘Oh, that won’t happen.’”
Some nurses were making more at previous jobs than they are under the slimmed contract, they said. At least five have resigned, Zenker said, and others may soon follow.
Many said they first heard of the reduction when Mission Chief Nursing Officer Melanie Wetmore sent out a newsletter on Jan. 28 briefly mentioning weekend shifts.
“RNs who are currently enrolled in the Weekend Plan Agreement should expect to re-sign commitment at a new, competitive contract rate upon current contract expiration,” Wetmore wrote.
Some weekenders said they didn’t know what that meant until their managers asked them to sign a new contract, which may last for six months.
Recruiting followed immediate jeopardy
In 2023, North Carolina Department of Health and Human Services investigators found that 18 Mission patients had been harmed, including four who died, because the hospital failed to meet federal standards of care.
In February 2024, the U.S. Centers for Medicare & Medicaid Services put the hospital in immediate jeopardy. Shortly afterward, CMS released Mission’s plan of correction, which briefly mentioned efforts to hire more staff, and lifted the immediate jeopardy finding.
“Mission Hospital is continuously recruiting and making efforts to retain current employees,” the plan of correction stated. “Year to date (2024) Mission hospital ED has hired 17 RN positions, 2 CNC (clinical nurse consultant) positions, and 4 StaRN (New Nurse) positions.”
Initially, Mission paid a nearly $36-per-hour base for emergency department weekend jobs, plus the $40 differential. There were additional smaller amounts of hourly pay for nights and evening work.
Sign-on bonuses for the emergency department jobs were at least $15,000, according to a job posting obtained by The Watchdog and interviews with nurses.
The job posting advertised the position as being “Eligible for an additional $40/hour on top of base pay” and “Eligible for a $15K sign on with a 2-year commitment to Mission Health.”
“Sign-on bonus will be paid out in your first paycheck!” the posting stated.
New pay leads to life changes
Many nurses said they made life changes based on the new pay, believing it would continue.
Convinced the job would be a good fit and excited about a significant pay increase over her current job, one nurse moved to Asheville from Nashville. Another bought a house. Another moved from the Northwest and paid off thousands of dollars in debt. Another, Jimmy Kowalcszyk, has three children and worries about making two monthly car payments.
“The car payments at this reduced rate will put a lot of stress on our family,” Kowalcszyk said. “But some people are in much worse positions than me.”
One emergency department nurse who said recruiters told her the position was permanent purchased a bigger house closer to Asheville. Another who works on a medical surgery floor said she is paying off two mortgages and considered becoming a travel nurse to make ends meet, but doesn’t want to leave the region.
“This is where I grew up,” the nurse said. “Most native people are having to sell and leave because they can’t afford the cost of living anymore.”
Weekenders said they think the pay drop will ultimately drive talent from the hospital. Some The Watchdog spoke to are already moving to other departments.
“Most of us have said that we will be leaving,” said an emergency department nurse who was one of at least seven who came on staff in early 2024. “Some of us plan to stay till March just to get the second portion of the bonus, because they pay it out in six-month increments. But if they lose us, they’re losing a lot of their experienced nurses …. It’s going to be pretty detrimental to patient care.”
Another nurse said he was astounded by the consequences of the pay decrease.
“There’s a lot of nurses quitting, and so this is actually putting patients even more in danger,” he said.
Fewer nurses on floors means more patients assigned to a single nurse. Crowded departments and thin nursing staff in areas like the emergency room can be risky for acutely ill patients.
On the night of Feb. 13, an emergency room patient died after his call for help from a bathroom went unanswered for as long as 12-15 minutes.
Nurses told The Watchdog that they thought staffing levels were inadequate that evening, which they described as extremely busy with a full waiting room and a line at the triage desk, and led to the man’s call not receiving an immediate response.
In the wake of the death, nurses gathered Thursday outside Mission to call for safer staffing levels. They distributed a petition that called for immediate reinstatement of the $40 weekend differential.
Lindell, the Mission spokesperson, said the hospital had investigated the death, determined training protocols weren’t followed, and fired one employee.
NCDHHS told The Watchdog that it is working to gather more information about the death.
Crowding on these units makes nurses feel at risk when doing their jobs, one of the emergency department weekenders said.
“I talked to another nurse who has been an ER nurse for 36 years and she’s a traveler, and she told me, ‘I have never been so scared, and I have never felt like this when I came to work,’” said one nurse.
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