San Mateo Medical Center nurses demand staffing hike

Staffing at San Mateo Medical Center is so lean it risks violating nursing ratios, endangering patients and keeping at bay federal matching funds for improving facilities and the public health system, according to dozens of nurses who yesterday protested outside the public hospital’s front door.

The nurses say there are too many patients and too few of them, leading to times when patients are unattended and little relief for staff during a shift.

"We don’t believe nurses should feel guilty for taking a break or using the bathroom,” said Anna Wilson, a nurse in the inpatient psychiatric unit.

Others shared stories of juggling patients in separate wings, choosing to care for a patient rather than eat lunch and empathizing with the ill and injured waiting more than an hour in the emergency room just to be acknowledged. Peter Zych, a medical-surgical nurse, recalled taking more than 10 minutes to hoist a fallen patient who weighed more than 400 pounds because there is no lift team and no one else around to help.

The situation is only worsening as 22,000 newly uninsured patients flood the hospital and its clinics, said labor representative Tim Jenkins of the California Nurses Association.

On top of that, health care reform will be implemented by 2014, transitioning the hospital to a provider of choice instead of just a resource for the indigent and low-income.

In the last fiscal year, the Health System had to absorb a 10 percent reduction in county funding on top of the state hits.

"Making these cuts in a time of increased need for our services due to the recession is very difficult and requires sacrifices from everyone,” said Health System Director Jean Fraser.

Wilson said the bargaining team met Wednesday with the county but there is no end yet in sight. The nurses are asking for the restoration of positions cut since 2008, more jobs to mirror more demand, dedicated break relief, a lift team, float nurses for high need areas and no further cuts.

But while county officials have pointed to increased pension costs and a hefty structural deficit, Jenkins and the protesting nurses say there is no fiscal crisis behind the facility’s cutbacks and deterioration. The nurses argued the county is actually acting as if there is no financial crunch, increasing its rainy day fund, meeting pension obligations and throwing more money at other pet projects.

"The ‘rainy-day fund’ jumped more than 13 percent last year to almost one-third of a billion dollars,” said Zych.

County Manager David Boesch, however, said the rising need and cost for services, the poor economy and the need to cut $36 million required the county to use $90 million in reserves to balance the current year’s budget.

"Without additional, painful cuts we project the deficit for the 2011-12 fiscal year at more than $100 million; and, that’s without accounting for anticipated further cuts in state funding, which seem imminent. Like the budgets of all public agencies, we are facing real operating deficits that we simply cannot ignore,” Boesch said.

However, the county also increased money for departments like probation, the sheriff and the District Attorney’s Office while cutting the Health System, Jenkins said.

"These are political choice about values. They are choosing not to fund the newly uninsured,” Jenkins said.

The CNA members demanded county officials and managers put the brakes on the situation and reverse the slump in the new year. The protesters ticked off several examples they say show diminished care in recent months and years, including a strong spike in emergency room patients to the point of violating legal nursing ratios and making it an unsafe environment. The intensive care, medical-surgical and other units are also frequently non-compliant with staffing laws, they said.

MediCare gave the long-term care unit only one star of a possible five, its lowest rating. The nurses also pointed to numerous violent assaults of patients and staff over the last year in its psychiatric unit. Several of those already made the news, including two alleged sexual attacks by patients on other patients.

Although the county is at the mercy of some state and federal reimbursement for programs like Medi-Cal, Jenkins said it is also at fault.

He claims the county’s billing error rate is 30 percent compared to the industry standard of 5 percent — a gap that means $7 million.

The county is eligible for 2-to-1 matching federal funds but won’t be a great draw if it doesn’t beef up staffing and improve its deteriorating health care and safety ratings, Jenkins said.

Fraser said the first step, though, is finding matching county dollars and officials are currently looking at current and future funding to see if it will be available.

Michelle Durand can be reached by e-mail: michelle@smdailyjournal.com or by phone: (650) 344-5200 ext. 102.