When New Hanover County sold its hospital to Novant for roughly $2 billion, officials said it wasn’t just about the generous cash offer, or the promise of $3 billion in additional regional investments, but bringing the best possible healthcare to southeastern North Carolina.
Over the next several years, Novant struggled to do that. Attempting to bring New Hanover Regional Medical Center — itself a massive institution — into the Novant system would have created myriad logistical issues under the best circumstances. But Novant’s acquisition of NHRMC took place during a global pandemic, queuing up a chain reaction that led to overcrowding, staffing shortages, overreliance on traveling nurses, a breakdown in morale and — ultimately — safety.
In the summer of 2022, a patient died at NHRMC after waiting hours to be admitted, leading to the Centers for Medicare and Medicaid Services, or CMS, threatening to cut the hospital's Medicaid and Medicare contracts if conditions were not improved. That fall, John Gizdic, who shepherded NHRMC through the sale process as president and was later named a top Novant executive, told WHQR that Novant’s resources had helped NHRMC weather the pandemic better than it would have as a community-owned hospital. Still, Gizdic acknowledged the situation was “untenable.” He touted the massive influx of resources Novant was delivering to NHRMC, but also pointed to systemic problems across the healthcare system.
Related: A Novant Checkup (2023)
A year later, Novant officials said that while staffing remained an issue, NHRMC had been bringing traveling nurses into full-time employment, and leaning hard into recruiting efforts. The attitude was, broadly speaking, optimistic.
But over four years after the sale of NHRMC to Novant was officially approved, staffing is still a problem, and disheartening stories — from employees and patients — continue to make their way onto social media. It’s hard to rely entirely on anecdote, and it’s important to remember that sometimes bad things happen at hospitals even when no one is at fault. That’s especially the case for a facility like NHRMC, which, as one nurse told WHQR, gets “a higher concentration of all the bad [things],” the sickest chronic patients and most severe trauma cases.
Still, there’s an ambient concern about the quality of care at NHRMC. A review of emails to New Hanover County commissioners, who have limited leverage over Novant, also reveals frequent complaints about the state of the hospital.
To get a more operational view of things at NHRMC, WHQR spoke with six current and a dozen former employees, who put staffing at the heart of concerns about NHRMC’s current level of service. The employees, who agreed to speak on condition of anonymity for fear of retaliation from Novant, cited problems with hygiene and supplies, but also deeper issues with morale. They described a diminished esprit de corps and a culture that no longer supported mentorship and accountability the way it had in the past.
Anecdotes and anonymous sources help paint a picture, but there’s also the data-driven ratings of NHRMC from CMS and Leapfrog, a national nonprofit that focuses on hospital safety. CMS and Leapfrog have shown several safety and patient outcome trends going in the wrong direction over the last few years.
WHQR also interviewed NHRMC president Laurie Whalin, who took the reins earlier this year, working in partnership with former NHRMC president Ernie Bovio, who now heads up the broader coastal market for Novant. Whalin acknowledged concerns from employees, and said she wouldn’t “make excuses” for past safety scores. But she also said NHRMC is just finally finding its footing over the last year, and promised the public would see evidence of improvements they’ve already made in the coming years.
Employee concerns
Employees who spoke with WHQR cited a range of concerns, many of which came back to staffing. Several of the employees said they felt like Novant’s approach to staffing failed to take into account that NHRMC, as a regional hospital, was providing care for more and sicker patients than other hospitals, and needed proportionately more staffing based on that. One called it a “corporate mindset.”
“I think the common denominator for issues in healthcare is staffing. It seems they are finding an alternative route around doing what is safe, right for the patient. They choose money and providers' needs over patients and nurses,” a 12-year professional said.
That applied to concerns about the hospital’s cleanliness, several employees said, recounting stories about unkempt rooms and hallways. The latter has been a particular concern, when overcrowding in the emergency department has led to ad hoc patient areas being set up in corridors.
Several employees referenced a particular dead roach that had been on the floor in one spot for so long that he’d been named “Fred” by staff.
Another, grizzlier story, detailed staff checking on a patient with gastrointestinal issues in their room. One employee walked into the bathroom and found a significant amount of blood in the sink. Concerned that the patient might have been vomiting blood, staff immediately asked the patient about it — but they were told, no, that blood had been there when they were checked into the room.
NHRMC President Laurie Whalin said the hospital recently shifted its environmental services (i.e. cleaning and janitorial) to a new company, Sodexo, with which NHRMC had a long-standing food services partnership. In addition to more expertise, Whalin said the company also pushed NHRMC to staff up — from 150 to 185 employees — to service the hundreds of thousands of square feet of hospital campus. Whalin said nurses would have a chance to meet with them to address issues. She also acknowledged that, while significant resources are being put into the issue, “we are still in transition.”
Another concern was the lack of nurses’ aides and what’s known as ‘patient sitters’ — staff members who help monitor patients and assistthem with basic tasks like eating and moving around.
“I think a good generalization is the need for aides to be able to be aides, to help the nurse do things for the patient. Pulling those aids to have them be sitters, because we won't pay for sitters, we're going to have the aides be sitters. So then there's nobody to feed, bathe, or help the patient get out of bed,” a 20-year professional said.
Employees related stories of patients left in dirty beds, or becoming dehydrated because they weren’t getting assistance. Most expressed concern about the impact of understaffing on patients.
“I have witnessed critical patients in the ER with soaked bedding, critical drips not being monitored, ventilators not secured properly. If this was my loved one I would be incredibly upset. The staff is stretched too thin and in turn patients aren't being monitored or cared for like they should be,” a 12-year professional said.
One issue that wasn’t tied directly to staffing was supply logistics. Employees noted that NHRMC previously had more direct local access to everyday supplies like medical padding, IV connectors, and even airing devices. In some cases, this led to postponing certain things until staff could get their hands on the correct items. One employee said they’d seen breathing assistance devices Jerry-rigged because the hospital was out of the proper airing devices.
Whalin acknowledged that Novant had undergone not one but two logistics pipeline shifts, which caused “bumps” — but said it was leveling out after reopening a local warehouse on 23rd Street in Wilmington.
Workplace culture
Beyond staff and supplies, many employees pointed to a crisis of culture at NHRMC. They suggested a host of factors: Novant’s corporate attitude, the lingering stress of the Covid-19, the continuing presence of traveling nurses, and the influx of younger, less experienced employees (some of whom had trained with limited patient interaction during the pandemic). Employees talked about “new nurses training new nurses.”
Employees voiced concerns that this eroded the mentorship that had been part of the hospital’s culture in the past. They said that’s led to situations where nurses, through no fault of their own, were “in over their heads.” The reaction has been less communication and camaraderie, many employees agreed.
“It's like this false sense of confidence, this bravado that you can't not know and I see it when I try and teach people stuff at the bedside, they just get all glazed over, indignant, because maybe they feel that they can't say that they don't know. I think it's the culture. It’s a cultural thing and it goes right on up to the providers [doctors and RNs],” a 25-year professional said.
Employees also said that there was less accountability, and that management didn’t encourage the documentation and discussion of mistakes or ‘near misses.’ Employees said these were previously known as “verges,” and also referred to them as variance reports.
Whalin said she was not aware of any situation where accountability wasn’t encouraged or that employees felt it was being discouraged. She noted that the hospital generally puts significant effort into tracking and analyzing variances, with a team that meets weekly to review incidents. Whalin said she reviews variances daily.
“I literally, that's the first thing I do in the morning,” she said. “I pull up that email and I look at all the things — okay, what are the opportunities that came in last night?” She added that she wants to hear from staff about any issues.
Still, one former and four current employees mentioned different situations where they felt accountability had been discouraged.
“There’s no accountability for — I don’t want to say medical errors, necessarily — but medical misses or near misses. Being told ‘don’t say that in front of the family.’ It’s hush-hush,” a 12-year professional said.
Another employee said, “When you've seen a provider do something ,, so not a nurse, but a provider do something wrong, and you're told by management, no, you can't put that [variance report] in on a doctor.”
Employees also told a story about a radiologist missing a key indicator. While they were careful to avoid any identifying information, they said there was a negative patient outcome.
“There’s no checks and balances. Like, did the radiologists miss it because they're short-staffed and they're reading all these films, and they just miss it because they're human and stressed, like everybody else in the institution seems to be? And then when you do see something outright bad, we are told by management – we have been told not to report doctors for doing things,” a 20-year professional said.
Several employees said they felt like, even when there were variance reports, management wasn’t taking action to drill down on what was going wrong.
“We see so many keep coming up on the same departments. We're constantly getting the same types of [variance reports] with them – it's just something simple, but it's constantly happening. So you can tell, obviously, management is not holding anyone accountable to make any changes…we don't ever feel like the changes, it feels like it still stays the same. We're just hoping for better outcomes,” a 20-year professional said.
Employees said they appreciated some aspects of Novant’s management and noted that all hospitals — including NHRMC prior to the sale — have issues. But they largely agreed that Novant was disconnected from its employees working the floor.
One example that came up a lot was Novant’s corporate team-building exercises, which employees described as “cringeworthy,” “infantilizing,” and “gaslighting 101.”
Many referenced a two-hour “SPARK” training session, featuring an inspirational video and a motivational speaker.
“The gas-lighting undertones, where we watched a video of a drive-through attendant who worked at Wendy's for 20 years, and it didn't matter what kind of day he had. He always smiled and greeted people. Didn't matter what was happening at work. That was the whole video,” a 20-year professional said. “Then [the motivational speaker] went around to each table and asked, ‘what did you learn from the video?”
One employee’s frank assessment of the situation, which others agreed with, put things plainly.
“The patient’s not at the center, and that’s what makes me upset. I’m very unproud — I’m embarrassed,” an 11-year professional said.
Declining grades from CMS and Leapfrog
Over the last four years, NHRMC’s ratings from CMS and Leapfrog have been trending down. CMS releases annual ‘star’ ratings on a one-to-five scale for both hospital quality and patient experience. Leapfrog releases letter grade ratings twice a year, in the spring and fall.
Importantly, as Novant has noted, both CSM and Leapfrog rely on historical data — and their overall ratings are based on a host of component scores, looking back at least a year and in some cases up to four years. (CMS also allowed hospitals some flexibility around the first two years of Covid-19 reporting).
For those reasons, CMS and Leapfrog ratings are less of a snapshot and more of a trend analysis, so it helps to look at the history of scores and see where those ratings are going.
Back in 2022, Novant celebrated that nine of its fifteen facilities had received an “A” rating from Leapfrog; NHRMC didn’t make the cut and received a “B.” The hospital had consistently received “B” scores since 2019, prior to the sale, but some had hoped that the sale to Novant would give NHRMC the resources to level up. At the time, Novant noted an overall decrease in the number of A grades, but also said the new protocols at NHRMC (specifically, a hand-hygiene program) aimed at improving safety.
That year, CMS reduced NHRMC’s rating from three to two stars (previously, the hospital had fairly consistently received three stars). The patient survey remained at three stars.
In 2023, NHRMC again received a “B” and Novant reported it was “pleased” with Leapfrog’s assessment. For the second year, CMS gave NHRMC two stars. At the time, Novant said CMS’ rating painted an incomplete picture, and pointed to significant improvements in infection and mortality rates over the past year that weren’t reflected in the data.
In the summer of 2023, Novant sacked NHRMC president Shelbourn Stevens. Not long after, NHRMC’s interim president and longtime Novant executive Jeff Lindsay left to take a job at UNC Health. In late 2023, Novant hired Ernie Bovio away from his longtime gig at UNC Health to run NHRMC and Novant’s coastal market.
Then in the fall of 2024, Leapfrog downgraded NHRMC to a “C,” and gave the hospital the same grade this spring. CMS still ranks NHRMC as two stars, with a three-star patient survey rating.
Over the last several years, Novant has made some improvements, especially in steadily reducing infections, like MRSA (Methicillin-resistant Staphylococcus aureus) and C. Diff. There have also been recent improvements in surgical site infections for the colon and central line-associated bloodstream infections (related to catheters often placed in the large veins around the heart), although scores for the latter are still below average.
But the trends for other key factors — including nurse communications, staff responsiveness, and catheter-associated UTIs (CAUTI) – have all been negative. Much of this data comes from the 2023 calendar year, with CAUTI pulling data from mid-2023 to mid-2024. Communication and responsiveness, in particular, are issues that reflect concerns shared by many employees — and shared on social media by patients and their families.
Two of the most serious outcome measures — the death rate for surgical inpatients with serious but treatable conditions, and a composite safety and adverse event score – have both trended down, placing NHRMC in the lower third or worse among Leapfrog-rated hospitals.
Based on CMS data from mid-2021 to mid-2023, the Spring 2025 Leapfrog death rate measure for NHRMC is well below average, and has declined steadily since the spring of 2023. The most recent score does include data from the NHRMC’s most difficult months during the pandemic — but also for almost a year after the hospital’s nadir in the summer of 2022, when Novant was pouring tens of millions of dollars into NHRMC. The score is worse than the Spring 2024 rating, which would have been looking almost entirely at the pandemic era. Likewise, the composite safety score has also decreased from last year, based on the same time frames.
In other words, while there’s no question Novant was tapping its resources to address the issues that led to NHRMC’s crisis in the summer of 2022, the data doesn’t show improvements in the following year. In fact, it suggests that some safety measures were still getting worse.
Related: A retired doctor says he nearly died at NHRMC. Now he's pushing for reform
Last year, WHQR interviewed retired doctor and hospital administrator Jon Martell, who said he nearly died when his surgical recovery was mishandled at NHRMC. After the incident, he took a personal interest in improving the quality of NHRMC, founding a non-profit to advocate for reform. During the interview, Martell discussed the real-world lives that are represented by the scores, grades, and ratings from Leapfrog and CMS.
“If you are at a two-star hospital, the death rates and the complication rates are higher than a four or a three-star hospital, definitely higher than a five. So lives are at stake. When you say it's a two-star hospital, their lives are on the line,” Martell said. “This is important. This is our community. These are our parents, these are our loved ones that are going in and carrying this as excess risk. I think the numbers pretty much speak for themselves. I don't really know what else to say about this. Except we deserve better than this. We need better than this.”
NHRMC’s new president says hospital is on a new footing
Laurie Whalin has worked at NHRMC for about 15 years — long before the sale — and served in a variety of Novant roles including running Brunswick Medical Center and three years as chief operating officer for the coastal market prior to being named NHRMC president in February. Her promotion is part of a new leadership structure rolled out by Novant; former president Ernie Bovio (whose office is across from Whalin’s) now oversees the coastal market and is still actively working with her.
She said that when she took the job, she didn’t foresee any unexpected challenges.
“I've been here, so I would say nothing different than what we were already working on,” Whalin said. “I've been the chief operating officer of the coastal region since February of 2022 so been working closely with the leadership team here. Over the past year, we've worked on what we're calling our five year strategic plan, which we're calling our Vision 2030, that was endorsed by our board in September, and it really focuses on all of the areas that we need to focus on. So safety and quality is at the forefront. Team member engagement, obviously, access, making sure we can keep up with the growing population, being an employer of choice, all of those things. So that was kind of our roadmap going into me stepping into this role, we kind of already had it laid out.”
Whalin said she and Bovio were working to increase engagement with staff, including listening tours. She also said that NHRMC’s “lean management system” — which gave more agency and a “seat at the table” to frontline staff — was being reinstituted. Whalin said the management system was in place at NHRMC but inadvertently “went away” during the integration with Novant.
“We did that at NHRMC for 12-plus years, and I saw the direct benefits, because what it does is it puts the frontline staff, the frontline positions, at the table, helping to solve problems and make decisions,” Whalin said. “They know what's happening on the units the best, and they know what things we need to put in place to fix it. So all of our leaders are going back through lean boot camp right now, and they'll be done by July, and then each of them is going to be doing a project on their units with their staff and starting to cascade that down.”
Whalin was candid about her reaction to the low ratings, especially the “C” from Leapfrog. But, as Novant has noted in the past, she said the latest scores don’t encapsulate what the hospital has done more recently.
“I won't make excuses or defend that score. I think it's not what we expect, and it's not what our community deserves, and I don't believe it's representative of our of our team we've got here, I can tell you that, and it's not the hospital that we are today, but I can't go back and change the scores,” Whalin said.
Whalin pointed to the work of Dr. Heather Davis, who was named the newest chief clinical officer last year.
“She's put the right structure and processes in place to make sure that we can be a highly reliable organization, that we've got reliable processes in place so that we can have sustainable results,” Whalin said.
She said under the current management team, the hospital had improved significantly over the last year — but acknowledged the public would need to see results.
“But I also know the proof is in the pudding. So I know, until you see, and the community sees, there were the results, until that scoreboard changes — right? — we're still gonna be having these conversations until that happens,” she said.
Asked about Leapfrog and CMS scores that continued to slide down even after major investments were announced in 2022, Whalin said she “wasn’t there for that conversation.”
But she noted that “none of those things are going to change overnight, when we're talking about getting trained and qualified staff in the doors to be able to take care of patients. So I’m not surprised that it's taking some time.”
As indicators of recent success, Whalin said nursing staffing was at an all-time high, and turnover at an all-time low. She noted NHRMC is hiring 200 new nurse graduates this summer, “the most we’ve ever brought in from a cohort.” There’s also the longer-term nursing pipeline program, funded by the New Hanover Community Endowment, to graduate nurses’ aides from CFCC and nurses from UNCW.
Still, asked to comment on the concerns of employees, Whalin acknowledged there are still challenges.
“I won't discredit anything our frontline staff feels or says. Their perspective might be part of a bigger context, but it's their perspective that they're seeing day in and day out. So absolutely, I won't discredit anything they have to say,” Whalin said.
She added that NHRMC continues to struggle with nursing aide recruitment, and that the senior leadership team had actually just recently met about the issue.
“What could we do differently? I will hire every qualified nurse aide that the team thinks is a good fit that is put in front of me, but it is certainly a challenge,” she said.
As Novant, and even the most concerned employee, has noted in the past, there are systemic problems facing all healthcare providers. But many critics have pointed to the comparative high quality and safety scores of healthcare systems like WakeMed (which earned “A”s for all three of its hospitals), Duke University, or UNC Health (which earned “A”s for three hospitals).
Asked what other North Carolina hospitals are doing to earn “A” grades and four or five-star ratings that NHRMC isn’t doing or can’t do, Whalin said, “I think we always look at, and that's part of what I talked about before with Dr. Davis, is what is the best practice, what is the highest standard of care, getting the experts at the table to say it's. Somebody is doing something phenomenal and awesome, great. Let's do that here too. And so that's part of what Dr. Davis and that team are looking at, is, what are the best practices and has been implementing over this past year? And how do we do that and sustain it so that it's not just a blip in the bucket?”
WHQR asked Whalin why, given the issues NHRMC has faced for the last five years, some of the key initiatives she cited had only been implemented in the last year. Whalin declined to discuss past management teams.
“I said I can't, and really don't want to, focus, or need to focus on the past,” Whalin said. “I'm all about, what are we doing today and moving forward?”
Whalin agreed that Novant’s acquisition of NHRMC had been challenging — even beyond the pandemic.
“It's not an excuse, it's the reality of taking two large organizations – a $2 billion [sale] – and merging them and integrating them, and there's bumps along the way in that process,” Whalin said. “We're finally getting into that settled zone over this past year in relation to, ‘Okay, who are we as a coastal region? What is the culture that we want, what are the expectations that we want, and how are we going to get there?’”
Though Whalin couldn’t offer a timeline, in part because of the reporting lag for CMS and, to a lesser extent, Leapfrog, she said in no uncertain terms that the public could count on seeing improvement.
“That is part of our vision, we will be Leapfrog “A” and a CMS five star,” she said. “And I feel confident that we are going to do that, and I expect our team here, I expect our board, and I expect our community to hold us to that.”
