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Hundreds of registered nurses marched outside the 478-bed Riverside Community Hospital in California for eight hours Monday during the fourth day of a 10-day strike. They accuse their administrators of ordering staff reductions that have resulted in dangerously high nurse-to-patient ratios that put themselves and their patients at risk.
The nurses say they’re sometimes forced to work their 12-hour shifts without taking a break to eat, get a drink of water, or even use the bathroom.
It’s all the more troubling as COVID-19 case counts and deaths recently spiked in that Southern California county, they said.
“You have to sneak the break in, or you get to the end of the day and it dawns on you that you’re dehydrated and you haven’t been to the bathroom all day,” said Erik Andrews, RN, a rapid response team member at the hospital and vice president of the 1,200-member bargaining unit of Service Employees International Union (SEIU) Local 121RN. He said he’s held on for 10 hours without a bathroom break while wearing an airtight respiratory mask, feeling uncomfortable and dehydrated, yet without a backup if he steps away.
“Each nurse is entitled to three paid 15-minute breaks and a half an hour off the clock every day,” Andrews said. “If I could find a single member who got all those breaks every day, I would keel over from shock because it doesn’t happen. And now it’s expected and accepted; we’re just taking it … when it doesn’t need to be this way.”
“You can’t get away without a safe break,” said Monique Hernandez, RN, a Riverside Community Hospital telemetry nurse and a member of the mediation team for SEIU. “That means someone who says I’m going to watch your patients while you go and put your feet up, take your mask off, go eat something, clock out. You can’t do that legally if there’s no one that can watch for you, because if something happens, that’s on your license.”
Wearing purple shirts, several hundred strikers carried signs around the hospital block for the last four days starting at 7 a.m. Some of the signs said, “Imagine wearing N95 for 12 hours with no breaks,” “Caution, unsafe staffing ahead,” and “You call us heroes yet treat us like zeroes.”
Riverside Community Hospital: “Misguided Tactic“
In a statement, Riverside Community Hospital officials called the nurses’ job action “a misguided tactic” that “create(s) conflict and spreads misinformation” and has “everything to do with contract negotiations.” The statement said that Riverside Community has “not laid off or furloughed a single caregiver due to COVID-19 and has spent $160 million to pay workers, some of whom are receiving 70% of their pay even when there has been no work.”
But labor officials insisted their strike has nothing to do with money and nothing to do with their current contract, which doesn’t expire until September. They are not in negotiations now.
From the labor union’s view, the problem is that when Gov. Gavin Newsom (D) ordered the state to shelter in place in mid-March, and routine hospital operations like elective surgeries came to a halt, Riverside Community Hospital’s administrators took traveler nurses, per-diem and part-time personnel off the schedule and limited hours for other workers. Union representatives estimated that they are between 200 and 400 people below where they need to be.
Hospital officials failed to realize that even though the census has been low, the workload and burden of methodically taking extra precautions — for example cleaning reusable PPE equipment in short supply — turn what were once quick, routine tasks into more complicated, step-by-step procedures, Andrews said.
“When you’re dealing with a disease that presumably is aerosolized, and very contagious, you need people to slow down and think carefully,” he said. But there is no staff available to serve as a spotter, “for when you’re donning and doffing your protective equipment.” Also, COVID-19 patients are not always housed in separate parts of the hospital, complicating safety considerations further, and nursing staff don’t always know a patient’s status.
Nurses as Housekeeping Staff
Kerry Cavazos, RN, the labor union’s chapter president and a labor and delivery unit nurse, said Riverside’s owners, the Hospital Corporation of America, told many members of the housekeeping staff, who are represented by a different labor union, not to come to work. That meant the nurses have to do housekeeping work.
Women about to give birth are brought into rooms that are still dirty from the last delivery, she said. “There was no housekeeper to clean it and there is still blood on the floor, so we have to clean it up. The woman needs to get in the bed because she’s having a baby.”
She and her fellow nurses are told to strip the beds, wipe the poles and the IV, and stock the rooms. “Those were never nurses’ tasks. And it’s not beyond us to do that but we have other things (to take care of patients) that we need to do,” Cavazos said.
Cavazos echoed the concerns expressed by Andrews. “I honestly do not believe this is safe for any patient for a nurse to not have any nutrition or any fluids for 12 hours. But we do it because that’s who we are,” she said.
California’s Staffing Ratio Rules
The issue of hospital nurse staffing is an important one in California, which two decades ago passed the nation’s first set of maximum patient-to-nurse staffing ratios in acute care hospitals. For example, one med-surge unit nurse should take care of no more than five patients at a time. In a telemetry unit, the nurse-to-patient ratio can be no more than one to four.
But according to Hernandez, there has been no financial penalty against the hospital for violating the ratio unless there was documentable harm to a patient that the staffing lapse could be blamed as the direct cause. A new law took effect early this year, imposing fines of $15,000 to $30,000 on hospitals that failed to uphold ratios. Labor officials said that while that is a welcome fix, state health officials have not yet begun to enforce it due to the pandemic.
The history of the issue at Riverside Community Hospital regarding staffing ratios goes back several years, as the SEIU unit tried to get administrators to take the staffing issue more seriously. The bargaining unit got a contract amendment last year that required the hospital to pay a nurse a “monetary penalty” if he or she had been required to absorb more patients than the ratio allowed, regardless of whether the ratio lapse caused harm.
“Everyone was happy and they kept their part,” Hernandez said, until a few months ago when that monetary penalty agreement expired and, sometime in late May, hospital officials declined to renew it. Days after that, which was the weekend of June 13 and 14, Hernandez said, at least one unit at the hospital failed to meet the ratio, “and it’s happened repeatedly” since the agreement ended.
by Cheryl Clark, Contributing Writer, MedPage Today
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