National Nurses United

20 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G O C T O B E R | N O V E M B E R | D E C E M B E R 2 0 2 4 Kittelson, RN in the postpartum unit there. Everything from lab results to pharmacy orders to patient discharges were delayed as nurses picked up the slack created by the down systems, and patients noticed. "All of our patients were well aware of the chaos occurring out- side of their doors," Kittelson remembers. "It was really a hospital-wide learning experience. Everyone had something new in their unit they had to figure out." Despite this, nurses across Ascension described a sense of togeth- erness forged in the crisis. "The nurses in my unit definitely helped each other out. It reminded me a little bit of the Covid days. We were a huge team, but my unit has always been a team," says Watson, emphasizing the word team. A mainstay of the St. Francis intensive care unit for 19 years, Watson saw firsthand how nurses picked up the slack for each other as information was being dished out in a hospital without computers. Test results that would normally come in by computer were instead all printed on one printer that nurses had to make time for between patients. Meanwhile, doctors who could normally be paged about results had to be chased down through phone calls. "We definitely are a team, but it definitely brought us even closer together," said Watson. "The only thing we could do is hang on to our coworkers." Download issues Several Ascension nurses said that information from management was sparse, both in the early days of the attack and as its impacts continued. While information was circulating in group chats, man- agement was sparse with details on the hack, but kept rolling out new protocols. In some cases, nurses said they felt like they had just learned a new system for basic work tasks when, the next day, they'd find it had been completely overhauled again. For many nurses, Ascension's lack of planning for this kind of scenario was the biggest frustration of the entire experience. "I think we need to be better prepared for something like this," said Samsel. "Ascension needs to be more prepared," agreed Watson. "They're a reactive organization, not a proactive organization." Nurses during and after the worst of the attack have taken action themselves, including updates to the paper materials in every unit that are to be used during downtime. At St. Joseph, Samsel says what was a simple cardboard file box has expanded into a larger plastic tub with the new changes they've made for downtime preparation. At St. Francis, Watson says a downtime workgroup has worked to update the mate- rials in downtime binders and nurses have carts with all these materials in their units. In Austin, nurses also took action through their professional practice committee (PPC). "We actually met with our CNO at the time. We called an emer- gency PPC meeting with her and had a table of downtime information on what is not working and what we would suggest and a lot of movement came from that," Kittelson remembers. As a result of that emergency meeting with their professional practice commit- tee, a new committee was established at their Austin hospital, which is working to update and standardize downtime binders across units, so that, in the event of another cyberattack, the paper charting can operate more seamlessly. Reminders of the outage linger in patients' charts and in nurses' concerns about their own personal data as employees. But so, too, do the lessons learned. "I can't imagine what it would've looked like if we wouldn't have been able to call that meeting with our CNO and make these changes or be able to speak up," Kittelson from Austin says, reflect- ing on how the hack came just months after nurses ratified their first union contract at their hospital, giving nurses options like their PPC to hold management accountable. "I can't imagine what the experi- ence would've been without that being possible." Lucy Diavolo is a communications specialist for National Nurses United. "I can't imagine what it would've looked like if we wouldn't have been able to call that meeting with our CNO and make these changes or be able to speak up."

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