This story was originally published in The Asheville Watchdog
Mission Hospital’s Staffing Plan Sparks Concerns Amid Expansion
Mission Hospital’s expansion plan, which includes adding 95 acute-care beds, has raised eyebrows due to its staffing strategy. The hospital’s application to the North Carolina Department of Health and Human Services (NCDHHS) reveals no intention to significantly increase staff in critical areas such as trauma care and nursing administration. This decision accompanies a projected 13 percent rise in patient capacity by 2031.
Despite being awarded conditional approval to expand capacity to 828 beds, Mission Hospital anticipates only a 3.7 percent increase in staffing over seven years. This contrasts with other healthcare providers such as AdventHealth Asheville and UNC Health West Medical Center, which have proposed more substantial staff increases relative to their bed expansions.
Mission’s Certificate of Need (CON) application, which sought 129 beds under the state’s 2025 State Medical Facilities Plan, was partly successful, receiving approval for 95 beds. However, the application highlighted a proposed 8 percent increase in full-time equivalent nurses, which is less than the growth in bed capacity.
North Carolina’s CON law mandates healthcare providers to obtain state approval before expanding capacity or services. In March, NCDHHS conditionally allocated 34 of the 129 beds to Novant Health for a new facility, with the remainder granted to Mission Hospital.
The staffing numbers outlined in Mission’s application reflect the total workforce available for day and night shifts across hospital units but do not specify nurse-to-patient ratios on shifts. For the projected 862 beds, Mission plans to employ 673.6 full-time equivalent nurses. In comparison, AdventHealth projects 368.88 nurses for 222 beds, while UNC anticipates 276.6 nurses for its 129-bed facility.
Mission Hospital’s expansion plan has sparked discussions about the adequacy of its staffing levels. State Sen. Julie Mayfield commented, “Right now Mission should be in the business of staffing up… perhaps they are still not understanding the connection between sufficient staffing and higher-quality care and patient experience.”
Staffing Levels Under Scrutiny
NCDHHS’s decision to award additional beds to Mission Hospital comes despite its track record. Since 2021, the hospital has faced scrutiny for incidents linked to inadequate staffing, which prompted federal regulators to place it in Immediate Jeopardy. This designation threatened its access to Medicare and Medicaid reimbursements, highlighting the financial risks associated with staffing issues.
The hospital’s recent hiring initiatives, including a drive to recruit 90 nurses in 90 days, reflect efforts to address staffing shortages. However, as of early May, 528 positions, including 184 nursing roles, remained open, according to HCA’s job portal.
Mission’s expansion includes plans to build additional floors on its “J tower” to accommodate more beds. Despite this growth, patient transportation services are not expected to see staff increases, prompting concerns about workflow efficiency and nurse workload.
HCA Healthcare CEO Sam Hazen acknowledged the staffing challenges at a recent shareholders meeting, stating, “We’re having to bring in labor – nursing (and) non-nursing – to support the demand.” The higher-than-anticipated patient influx in the region has compounded these issues.
Research underscores the critical impact of nurse-patient ratios on healthcare outcomes. Studies link higher patient loads per nurse to increased mortality, infection rates, and delays in care. Dr. Karen Lasater from the University of Pennsylvania emphasizes that “it’s not just a nursing issue; it affects all aspects of healthcare.”
Mission Hospital’s application acknowledges high occupancy rates, stating, “The demand for inpatient services has pushed the hospital well beyond the optimal operating threshold of 78% occupancy.” The hospital recorded over 219 days of exceeding 90 percent capacity in a recent period.
Concerns linger about the hospital’s ability to manage added beds without sufficient staffing. “It’s hard to imagine that they’ll be able to effectively staff 95 more beds when they can’t even staff the beds we have right now,” commented Alissa Gardner, a registered nurse at Mission.
Asheville Watchdog welcomes thoughtful reader comments on this story, which has been republished on our Facebook page. Please submit your comments there.
Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Ted Clifford is The Watchdog’s investigative reporter focusing on healthcare. He can be reached at tclifford@avlwatchdog.org. The Watchdog’s local reporting is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/support-our-publication/.
