Day 10: The Confederate Nurses Enterprise - Final Speculation and Summary

As of today, March 27, 2026 two hundred and nineteen days have passed since the verdict in Joppy v. HCA HealthOne, the landmark case at the intersection of racism in nursing, workplace mobbing and Civil Rights. 

The enterprise hasn’t commented on the verdict in Joppy v. HCA HealthOne. They’ve never acknowledged the facts underlying the case, or even responded to direct outreach by several people over several years, which leads to the obvious question: What’s their strategy? 

We can only speculate, so I developed a list of ten potential reasons. We’re exploring each of these ten possible reasons over ten business days, and after nine days evidence shows: 

1. The enterprise has been aware of Joppy v. HCA HealthOne since early to mid 2022, when Joppy’s claims of race discrimination and retaliation were filed in US District Court;

2. The enterprise is at least aware of the issues in Joppy v. HCA HealthOne, i.e. race discrimination and retaliation in the nursing workplace;

3. The enterprise may not understand or appreciate the legal and historical significance of Joppy v. HCA HealthOne, which if true is a dereliction of duty.

4. The enterprise does more than just comment about ongoing cases. According to their CNO, “(W)e often have outreach with the individual or their representative or their attorney and we let them tell us what would be most helpful, particularly when it’s a legal issue.”

5. The enterprise and AACN policies regarding what issues they choose to speak on and who they choose to advocate for are confusing and contradictory. 

6. If the enterprise is silent because it finds the racism and workplace mobbing evident in Joppy v. HCA HealthOne disturbing, disquieting and/or uncomfortable, that’s evidence of moral failure from an org that says it serves the interests of over five million registered nurses. It’s cowardice.

7. Testimony and other evidence in Joppy v. HCA HealthOne undermines the myth of “most trusted profession” and makes the latest slogan “the power of nurses” sound like a creepy threat - “the power of nurses to do what?!?” Testimony in Joppy v. HCA HealthOne also raises questions about the purpose and value of two enterprise "must haves” - Daisy and magnet(tm).

8. The enterprise may not want to call attention to Joppy v. HCA HealthOne because the perpetrators were all white women. That could cause angst. Members could quit. There’s precedent for this fear, most recently since 2016.

9. The enterprise is aligned with the Defendant in Joppy v. HCA HealthOne; 

Here’s our last speculation:

10. The enterprise has a conflict regarding Joppy v. HCA HealthOne.

Today is Day 10, so let’s see if the enterprise has a financial conflict regarding Joppy v. HCA HealthOne.

The enterprise hasn’t commented on the verdict in Joppy v. HCA HealthOne. They’ve never acknowledged the facts underlying the case, or even responded to direct outreach by several people over several years, which leads to the obvious question: What’s their strategy? 

We can only speculate, so I developed a list of ten potential reasons to explore over ten business days. Today is Day Ten

10. The enterprise has a financial and/or other conflict(s) in Joppy v. HCA HealthOne

Note: The following financial calculations are estimates based on available data and may be wildly inaccurate - either too high or too low. If you have access to more detailed information please let me know so I can include any corrections or revisions.

The Defendant is a customer that has paid the enterprise at least one million dollars for a series of magnet(tm) certifications, based on a minimum estimated cost per certification event of two hundred and fifty thousand dollars in 2008, 2014, 2019 and 2024. 

The 2019 recertification was conducted in the same timeframe as events testified to in Joppy v. HCA HealthOne. Several of the witnesses and perpetrators were involved in that recertification process. 

From Day 3 Transcript, Page 728, lines 12-25: Page 729, lines 1-6 regarding magnet(tm)

Questions by Attorney for the Plaintiff 
Answers by Witness Paul Page, RN

Q Okay. Now, you stepped down from being (TMCA ICU) manager at some point. Do you remember when that was?

A I'm trying to address -- see, I know it was late April (2019) sometime. They wanted me to stay on until late April because we had a hospital-wide survey that needed to have some leadership there to help with the survey. And so I decided to stay on until they left, and then I stepped down, yes.

Q Was that the survey that concerned Just Culture?

A No. It's something called magnet. It's a designation that nurses -- the nurse's governing board gives hospitals for excellent nursing care or something like that.

Q Why did you want to step down?

 A As I explained earlier what about was happening in the ICU, I was spending 60, 70 hours a week trying to fix things, mainly fix staffing. I was -- I was -- that was what my main focus was, and I was trying to help the nightshift and dayshift. I was working a lot, and I was -- I was done. I needed a better life, so I stepped down.

 Q Thank you. No further questions at this time.

The 2024 recertification was granted before Joppy v. HCA HealthOne went to trial but after the enterprise became aware of the claim in 2022, and also following substantial discovery, depositions and pretrial hearings.

Also note that Defendant is part of an international corporation and other hospitals owned by the corporation are also enterprise customers. (scroll to Awards and Recognition) “HCA Healthcare’s network included 15 Magnet® Designations covering 19 facilities, and 19 Pathways® designations covering 20 facilities.”

Based on an estimated payment of two hundred and fifty thousand dollars for each designation, the estimated total payments for thirty-four designations is eight million and five hundred thousand dollars.

Finally, there is significant actual and potential overlap and interaction among nurses including senior management and executive positions at corporate hospitals or headquarters with the enterprise at multiple levels. The career trajectory for these nurses often includes assuming roles and positions in each environment, such as with the late Dr. Loressa Mae Cole. “Loressa retired in 2023 as Chief Executive of the American Nurses Association and also held other career positions including Chief Nursing Officer and Chief Operating Officer within the HCA capital division.”

The enterprise has financial and/or other conflict(s).

The Defendant in Joppy v. HCA HealthOne is an enterprise customer that has paid at least one million dollars since 2008 for a series of four magnet(tm) certifications, based on a minimum estimated total payment of two hundred and fifty thousand dollars per certification. 

The Defendant’s corporate parent is an enterprise customer with thirty-four other enterprise certifications at thirty-nine other facilities for an estimated total payments to the enterprise of eight million and five hundred thousand dollars.

There is actual and potential overlap and interaction among nurses, executives and managers at the Defendant and/or other corporate sites and/or corporate headquarters with nurses, executives and managers affiliated with the enterprise.

Summary - 

Let’s review each of the ten potential reasons the enterprise has remained silent abut Joppy v. HCA HealthONE that we started speculating, along with our findings after reviewing the evidence to support or disprove each one. 

1. The enterprise is not aware of Joppy v. HCA HealthOne 

False. The enterprise has been aware of Joppy v. HCA HealthOne since around April 2022, when Joppy’s claims of race discrimination and retaliation were filed in US District Court.

2. The enterprise doesn’t understand the issues in Joppy v. HCA HealthOne

False. The enterprise is at least aware of the issues in Joppy v. HCA HealthOne, i.e. race discrimination and retaliation in the nursing workplace.

3. The enterprise doesn’t understand the legal and historical significance of Joppy v. HCA HealthOne

Possible, which if true is a dereliction of duty.

4. The enterprise doesn’t comment about ongoing cases 

False. The enterprise does more than just comment about ongoing cases. According to their CNO, “(W)e often have outreach with the individual or their representative or their attorney and we let them tell us what would be most helpful, particularly when it’s a legal issue.”

5. The enterprise doesn’t comment about individual cases or cases involving discipline, they only focus on issues of concern to the nursing profession

Contradictory and confusing. The enterprise and AACN openly voiced support for an individual nurse found guilty of negligent manslaughter and abuse of an impaired adult, who was also disciplined with termination and loss of license.

Why don’t the enterprise and AACN consider the racism and mobbing evidenced in Joppy v. HCA HealthOne as issues of concern to the nursing profession? Do the enterprise and AACN consider racism and mobbing in the nursing workplace as issues of concern for patient safety and community health?

6. The enterprise finds the facts of Joppy v. HCA HealthOne disquieting

Possible. If so, that’s evidence of moral failure from an org that says it serves the interests of over five million registered nurses. It’s cowardice.

7. The enterprise fears Joppy v. HCA HealthOne undermines its branding

Possible. Testimony and other evidence in the case undermines the myth of “most trusted profession” and makes the latest slogan “the power of nurses” sound like a creepy threat - “the power of nurses to do what?!?” 

Testimony and other evidence also raises questions about the purpose and value of two enterprise "must haves” - magnet(tm), their single largest source of revenue; and the positive recognition program from corporate partner The Daisy Foundation.

8. The enterprise fears it might upset its most dominant demographic if it mentions Joppy v. HCA HealthOne

Possible. The perpetrators were all white women and the enterprise may be afraid to cause angst and lose members. There’s precedent, most recently since 2016.

9. The enterprise is aligned with the Defendant in Joppy v. HCA HealthOne

More likely true than not. Why would they call attention to being on the losing side?

10. The enterprise has financial and/or other conflict(s) regarding Joppy v. HCA HealthOne

True. The Defendant is an enterprise customer that has paid at least one million dollars since 2008 for a series of four magnet(tm) certifications, based on a minimum estimated total payment per certification of two hundred and fifty thousand dollars. 

The Defendant’s corporate parent is also an enterprise customer with thirty-four other enterprise certifications at thirty-nine other facilities with an estimated total payment of eight million and five hundred thousand dollars.

There is actual and potential overlap and interaction among nurses, executives and managers at the Defendant and/or other corporate sites and/or corporate headquarters with nurses, executives and managers affiliated with the enterprise.

Conclusion/tl,dr

The enterprise has consistently refused to amplify or even openly acknowledge Joppy v. HCA HealthOne, even though it has known about the case since early 2022, and even though Ms Joppy, her attorney and others have persistently reached out to the enterprise for the last four years.

The enterprise understands the underlying issues in Joppy v. HCA HealthOne - racism in nursing and workplace mobbing - though it’s unclear if they also understand the legal and historical significance of the case. They don’t appear to consider those underlying issues as matters of concern for the nursing profession. The enterprise’s lack of acknowledgement and advocacy for the Plaintiff in Joppy v. HCA HealthOne contrasts with their active and open participation supporting the Defendant in State of Tennessee v. RaDonda Vaught.

The enterprise may find the underlying facts of Joppy v. HCA HealthOne uncomfortable and could be afraid that any focus on the case undermines the enterprise’s branding and tarnishes the public image of nursing they promote. The enterprise may also be afraid to bring up the case because the guilty perpetrators are all white women nurse leaders.

The enterprise is aligned with the Defendant, and there is at least the appearance of actual/potential conflict(s). The Defendant and its corporate parent are enterprise customers with combined purchases approaching ten million dollars. There is significant interaction and overlap between the enterprise and nurses affiliated with the Defendant and/or its corporate colleagues and/or headquarters.

These potential reasons, alone, in part or in some combination likely explain why the enterprise has consistently refused to amplify or even openly acknowledge Joppy v. HCA HealthOne.

This exercise in speculation is informed by evidence. I invite other evidence-based speculation, additional information, comments or corrections.