Nurses will put up with double shifts, low pay, disrespect and squeamish "procedures" that could drop the toughest Marine like a sack of sand. But the best ones draw a line at patient safety.

"The last thing I wanted to do was quit a job I truly loved and enjoyed doing, but standing by helplessly while the residents you love are not receiving the proper care they need and deserve is unbearable," said Traci McCarty, former nursing manager at Southwest Ohio Developmental Center in Batavia.

Her words were amplified by five other nurses who have quit or are thinking of leaving the 109-bed state-run facility for patients with mental retardation, psychiatric problems or both.

"I don't think anyone there feels they are working in a safe environment," said Connie Ostrander, who quit in February. "I cried because I truly cared about those people," she said. "But I just wanted the hell out. I knew my license - something was going to happen."

Barb Wager of Amelia resigned after more than 19 years, because nurses were stretched too thin and nurse aides were unable to help in "code" emergencies. "They would either freeze or just stand there and cry," she said. "They were doing their best, but they don't have the medical background."

A tough job

I interviewed six RNs and LPNs; three still work at the center and fear retaliation. They all said low staffing and morale have jeopardized the safety of patients and nurses.

These are not ordinary nurses. Taking care of profoundly retarded residents is a tough job.

"You would be amazed at how many nurses worked one day and left,'' Ostrander said. "I told them, 'Don't be surprised if on your first day you are bit, kicked, slapped, cursed and spit on."

Unruly patients are part of the job, she said. What the nurses could not handle was a new superintendent who took over 18 months ago.

When Nancy McAvoy arrived, "it went down the tubes," Ostrander said. The nurses said McAvoy was abusive and demeaning. "She didn't know the difference between an oxygen mask and a catheter," said one nurse.

Morale hit bottom and nurses bailed out, they said.

Of 19 positions for RNs and LPNs, "Eight nurses have resigned in the past 12 weeks and four others went out on extended medical leaves in an effort to save their positions, but not jeopardize their nursing licenses," said McCarty, the former nursing manager.

McAvoy says staffing has never been unsafe. She said there are 10 nursing vacancies, but seven nurses are being hired and temps are filling in. McAvoy, former deputy director of community services for the Ohio Department of MRDD in Columbus, is a licensed social worker.

She blamed the staff hemorrhage on a nurse shortage.

Nancy Smeltzer of the Ohio MRDD, which supervises the center, agreed. "Turnover is always a problem in urban areas with lots of competition for wages.''

But three of the nurses I spoke to left after years at the center, without new jobs lined up.

McAvoy was reprimanded in late March by the Ohio MRDD after an investigation of employee complaints. The reason was "inadvertently creating an unproductive work environment," Smeltzer said. "She is undergoing training in effective communication styles and team-building skills."

Ostrander said the state "just did what they had to do to make everybody shut up and keep the peace."

What standards?

McAvoy said she was shocked by the staff complaints. "My method is extraordinarily hands-on and direct. They thought I was the worst damn battle-axe that ever came along."

McAvoy says the only staffing standard is "adequate to meet the needs.''

But Smeltzer said Medicaid minimums are three nurses on day shifts, two on evenings and one on midnights.All of the nurses I talked to said staffing has sometimes dipped below those minimums.

Ohio Legal Rights Service investigated a complaint by a patient's family. "There were problems with a nursing shortage," Legal Director Michael Kirkman said. "But we found no evidence of harm to individual patients." He did not know McAvoy had been reprimanded.

The state should look again. If the nurses say the Southwest Ohio Developmental Center is unsafe, I'd trust the nurses.

E-mail pbronson@enquirer.com or call 768-8301