There were plenty of things Sarah Mittelman, 48, loved about her job as a charge nurse at the Unity Center for Behavioral Health, Portland’s psychiatric hospital.

Managing operations and patient flow was a good fit for her personality and skills. She adored her coworkers — nurses, doctors, counselors, and social workers. And she liked getting to know patients as people, the human beings behind the mental illness.

But in the end, the good didn’t outweigh the bad. After working at Unity for seven years, Mittelman quit in June.

“Bedside nursing is really wearing,” said Mittelman, who was bargaining unit chair for Oregon Nurses Association (ONA) at Unity. “This has been a long time coming.”

Mittelman had personal reasons for leaving Unity. But her resignation is also representative of a broader trend as a record number of nurses around the country leave the profession due to burnout, stress, and retirement.

“That feeling of being just a resource, just bodies, less professionals — that really happens to nurses,” said Mittelman, who quit one week before Providence Portland nurses went on strike to protest working conditions and staffing issues.

Mittelman reflected on the highs and lows of her 25 years as a nurse and active ONA member. Her story illustrates the challenges facing the nursing profession, as well as ongoing tensions at the Unity facility as Portland’s mental health and addiction crises worsen.

Mittelman, an Oregon native, comes from a long line of nurses. Her four aunts were nurses. So was her mother, who worked at the former Bess Kaiser hospital. Her grandmother worked in the intensive care unit at Portland’s Veteran’s Administration Hospital.

“Nobody said I had to be a nurse,” Mittelman said. “It was just something I always wanted to do.”

Before going to Unity, Mittelman worked at OHSU’s emergency room and psych unit for 16 years. She took the job with Unity in 2017, the same year it opened as a collaboration between OHSU, Kaiser Permanente, Adventist Health, and Legacy Health, which runs the facility.

The consolidation that created Unity eliminated OHSU’s psych unit, and that’s one of the reasons Mittelman decided to take the job at Unity. An avid bike commuter, she liked the fact that Unity was closer to her home in Vancouver, Washington.

Unity treats patients with drug and alcohol problems, as well as medical and mental health issues. The center sees around 10,000 patients per year.

As a charge nurse, Mittelman’s job was to move patients through the system of care, from the moment they came in until they were discharged.

On any given day, she saw a wide spectrum of patients, from those who were deeply depressed and suicidal to those who were highly psychotic, individuals suffering from schizophrenia and stimulant misuse.

“They come in, maybe very dysregulated, and 24 hours later you are talking to a person,” Mittelman. She liked hearing patients’ stories about what they were doing before illness set in and what their futures could look like.

There’s a lot of stigma and misunderstanding attached to mental illness, Mittelman said.

She doesn’t believe in addressing Portland’s mental health and homeless crises through return to the era of institutionalization.

“How do you house mentally ill people?” she said. “I think we can do this with supportive housing and rehab.”

Mittelman enjoyed engaging with different care units at Unity and ensuring patients moved efficiently through the system. “My team was phenomenal,” she said. ”We provided good collaborative care.”

From the day it opened, Unity faced huge problems, including complaints of worker shortages, mismanagement, sexual assault, and staff and patient injuries and deaths. At one point the center nearly lost its federal funding.

One of the few nurses who had come to Unity from a unionized workplace (OHSU), Mittelman spearheaded ONA’s successful effort to unionize Unity nurses soon after she started working there.

The year-and-a-half union campaign was grueling — and exhilarating. Mittelman did outreach when her shifts were over, often staying up until midnight to hear nurses’ concerns and raise awareness about the benefits of forming a union.

She recalled a pivotal point in the campaign, when Legacy challenged the nurses’ right to organize. After a hearing and a week of deliberations, the National Labor Relations Board ruled in ONA’s favor, affirming their right to hold a union election.

“That was an incredible moment,” Mittelman said. “We had all this power around our voice.”

Yet four years later, staffing and safety problems persist.

Mittelman described an incident that occurred not long before she quit. The facility didn’t have the appropriate mix of nurses, and a travel nurse who had been put in the charge position was unable to provide a meal or rest period to the triage nurse, because the travel nurse lacked specialized triage training.

Mittelman said she often filled in on these occasions, meaning she didn’t get meal or rest breaks either.

There are no beds or private rooms for Unity psychiatric emergency room patients, and it wasn’t uncommon for the center to see repeat patients within 24 hours of being treated. “We want to help patients so much, so having to discharge people knowing they are going to come back is difficult.”

Many patients are violent, she added, and Unity doesn’t have enough staff to keep the workers safe.

During the recent legislative session, Oregon lawmakers approved a new minimum staffing standard for hospitals. This was a big win for nurses, but the standard won’t apply to behavioral health facilities. Psychiatric centers will only be required to create a staffing plan.

However, legislators did approve more than $75 million to expand mental health and addiction treatment.

Exit strategy

Mittelman is the mother of two children, ages 10 and 12, and she’s looking forward to spending more time with her family.  As part of a longterm exit strategy, she enrolled in a graduate school program to become a psych nurse. She’d eventually like to move into private practice. And she’d like to teach.

Earlier this year, Mittelman asked her supervisor if she could take a summer leave. The request was declined. That was the point Mittelman decided it was time to quit. A week later she left for the annual meeting of the American Nurses Association in Washington, D.C. She’s spending the summer in Central America, a long-awaited vacation.

“I remember a time when you could go to work, and your employer would try to do what was right,” Mittelman said. “They understood you have a life — kids graduation, birthdays — and if you wanted a day off you could work your schedule around it.”

For most nurses, those human touches are completely gone, she said.

“It’s, ‘Come in. We’ll work short and won’t give you the resources you need to move patients efficiently through a plan of care. And it’s great for us, because your patients will leave and not be well and come back and we’ll make another dollar and do it all over again.’”

“There is very little hope to achieve better.”


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