Kaiser executives stuck in their offices claim to be appropriately staffed but the frontline nurses tell the truth and share the evidence of dangerous understaffing
FOR IMMEDIATE RELEASE: September 19, 2023
Jeff Rogers | email@example.com | 909-263-7230
Anjetta Thackeray | firstname.lastname@example.org | 909-455-5146
SAN DIEGO—Nearly every day, Nikki Avey, RN, in the Labor & Delivery unit at Kaiser San Diego Medical Center gets panicky texts from Kaiser Permanente with messages like: SHORT RNS IN ICU, DOU, TELE, & MS 5E/2E. PLEASE REACH OUT IF INTERESTED. THANK YOU!
Ask any of the hundreds of nurses who picketed this morning at Kaiser Permanente’s San Diego Medical Center and they could all whip out their cell phones and scroll through dozens and dozens of similar texts. [See examples of the texts here.]
“We get them almost every day,” said Nikki, “sometimes several times a day.”
Avey is also the local hospital president for UNAC/UHCP, which represents more than 3,200 Kaiser San Diego nurses. More than 650 of them came out today before or after work or on their breaks for an informational picket to alert the public to the chronic short staffing issues which have been plagued KP San Diego for years.
The Kaiser RNs alerted the public when KP opened their new medical center in San Marcos on August 9.
“They’re opening a third hospital and they can’t even staff the two they have,” Avey said then. “Where is the logic in that?”
Kaiser ignored their pleas for help, instead issuing the usual rote public denials.
So, on September 7, the RNs delivered a legally-required 10-day notice to Kaiser’s administration about today’s informational picket.
Each time the nurses have taken public action, Kaiser has released essentially the same statement—claiming they meet state-mandated ratios or they’re appropriately staffed.
Yet, Kaiser paid out in excess of $1.5 million last year in penalties for nurses’ missed meals and breaks—an amount that could have funded full pay and benefits for 10 full-time RNs. Kaiser maintained nearly 180 open RN positions throughout 2022 in their two San Diego hospitals. Kaiser sends weekly texts listing upcoming shifts in need of help and near-daily texts saying they’re short RNs on certain units.
“We’re almost always understaffed and have even been over the state ratios far too many times,” said Alexa Torres, RN, who works night shift in the emergency room at San Diego Medical Center (SDMC).
Where is the disconnect between what Kaiser executives claim in public and what the nurses and the evidence reveal about short staffing—including Kaiser’s own text pleas for help sent to the nurses?
“I’ve seen regional leadership in our unit maybe once in four years,” said Lauren Metropoulos, RN, who works on the Medical-Surgical/Telemetry unit at SDMC.
“Executives write these statements from their offices, but we’re the ones who know,” said Nate Poliakoff, an ER nurse at SDMC. “How would you feel if you were watching your mom unable to get turned, or changed, or bandages changed appropriately? Or having to lie in her own feces or urine—just due to short staffing? It’s not right.”
Another reason for the disconnect is that Kaiser claims to follow state-mandated nurse-to-patient ratios but actually agreed in the collective bargaining agreement negotiated with the RNs to follow better-than-state, Kaiser-specific ratios. A signed contract is a legal document. But Kaiser doesn’t even claim to follow the better ratios that they’ve agreed to abide by in the contract—a promise they made to Kaiser RNs and Kaiser members—to deliver the best care and be the best place to work.
“On my unit we’re supposed to have 20 nurses a day to meet KP ratios, but we can go down to 14 without breaking state ratios,” said Metropolous. “It’s not safe for patients and it’s affecting the mental health of the employees. Nurses are overworked. The danger to my patients is that I can’t check on them as often as I need to.
“We’re supposed to turn patients every two hours so they don’t get bedsores, pressure ulcers. We’re supposed to document on their chart that we turned them. But I’m not going to lie on my chart, so I document that we didn’t have enough staff. This puts our patients at risk. Bedsores can be a huge problem and we’ve had patients get them while hospitalized. Enough staff would decrease those injuries.”
“We are not looking for nursing to be easy,” said Tierra McCottrell, who also works in Med-Surg/Tele at SDMC. “We got into nursing to care for patients. We’re not looking for easy nursing. We want safe nursing. We want safety for the nurses, safety for our patients. Kaiser keeps adding demands and goals and subtracting resources.”
“I pray every day that I’ll get through my shift without a sentinel event,” said Meagan Davison, RN, in the Definitive Observation Unit (DOU) at SDMC. A sentinel event is medical terminology for a patient fatality. “My floor has two hallways that are each the length of a football field, with four nurses on each side. Patient call lights will go unanswered for 20 minutes. If a patient is confused and tries to get out of bed and falls, we might have to race the length of a football field to try and catch them. If they fall and hit their head on the tile, that could be a sentinel event. Kaiser had sixteen patient falls in just one unit so far this year.”
In their attempts to meet state ratios—while disregarding agreed-upon contractual ratios—Kaiser overworks the RNs to a point that endangers patient and nurse safety. They use band-aids to cover festering wounds.
“The nurses are working overtime. Nursing assistants are working overtime. We’re often times running short to where we’re going without breaks to make sure that our patients are safe, and we’re exhausted,” said Sandy Early, RN, ICU at SDMC.
“We don’t have the support,” said Jill Salem, RN, Post-Partum, SDMC. “We’re tired. We’re overworked. We’re working sixteen hours over our twelve-hour shift. We’re being called in constantly to help our unit. And you feel bad because you can’t be there all the time. But we know that the need is there. I get calls every single day that our unit needs help, needs staff.”
“I came here from New York,” said Davison. “Sure, at times we had more patients per nurse there, but it was easier and safer, because we had the support staff to help.”
Support staff includes Certified Nursing Assistants (CNA’s), who help with feeding, turning, and cleaning, getting water for patients, helping them go to the bathroom or get out of bed and take a walk; also unit secretaries who help with admissions and discharges. Support staff free registered nurses to run IV’s, ensure their patients get the proper medications at the correct time, intercede with the physicians, and meet with patients’ family members.
“It’s morally distressing to us when we’re short staffed because we want to be able to meet basic human needs like sitting in the room with a patient for five minutes and have a conversation with their family,” said Davison. “We can’t do it when we’re inundated by urgent nursing tasks and that’s unfair to patients and their families.”
More than 700 nurses, their families, and supporters, picketed over the course of the day at all three Kaiser Permanente medical centers: San Diego Medical Center, Zion Medical Center, and their newest facility, San Marcos Medical Center.
The union world can be confusing, with multiple unions at KP representing different classifications of health care workers. Every union has its own acronym and its own color, and there are two broad groups representing numerous local and international unions in the Kaiser universe.
Today’s informational picket is not a strike or a work stoppage. Nurses joined the picket lines before and after work or on their breaks. UNAC/UHCP and the Kaiser San Diego RNs are currently under contract and won’t negotiate a new one until 2025.
“This is not about money,” said Nate Poliakoff. “This is about patient care.”
UNAC/UHCP belongs to the Alliance of Health Care Unions, which represents 52,000 KP employees in hundreds of classifications and 21 local unions.
The Coalition of Kaiser Permanente Unions, which includes the ancillary staff represented by SEIU-UHW, are in negotiations for a new contract right now and recently voted to authorize a strike if their leadership decides to call one.
Still, the Kaiser RNs have used every contractual method they can for years, including their Labor Management Partnership (LMP), Unit-Based Teams (UBT), and various nursing, staffing, and patient care committees, to attempt to address the chronic understaffing. The nurses have offered both short- and long-term solutions, only to meet with stonewalling, more meetings scheduled, promises made and not kept.
“We had staffing issues way before COVID made it worse and really exposed them,” said Avey. “Since October, 2021, there’s been an average of 180 open RN positions between the two medical centers. A lot of nurses have left the bedside with severe PTSD. At some point we’ll break. It’s sad we don’t get the support we need from KP leaders.”
Nikki Avey, RN, as hospital president, has been in on many of these negotiations over staffing: “Local leadership sends us to regional leadership, regional sends us back to local. We’ve met with Jane Finley, the Senior VP of the San Diego Region, and Ernesto Perez-Mir, the Chief Nursing Executive. We’ve escalated. They’ve spent years band-aiding all these problems.
“We suggested an on-call program, they said no. We asked for breakers—nurses to cover breaks and meal periods—no. We’ve asked for more CNA’s to help provide the patient’s basic needs. They say it’s not in the budget. Now it’s difficult to recruit new nurses for labor and delivery because the nursing community in San Diego. Nurses would rather get paid a little less if they have a clerk to answer the phone, a nursing assistant to help with feeding and basic patient needs.
“We’ve offered other things, short and long-term solutions. We meet only roadblocks. We’re the ones on the frontlines, in the trenches, and they’re safe in their offices, saying no to every idea, then writing their statements denying the problems that nurses and patients see every day.”
Nora Vargas, Chair, San Diego County Board of Supervisors, addressed the crowd at Zion Medical Center at 1 p.m.:
“People know that I’m the Chair of the Board of Supervisors. But I’m also the oldest sister to a nurse practitioner. So when you don’t treat nurses right, I take it personal.
“My dad, he just passed away last year, and it was nurses who were there with him all the way to the end. And it happened right during COVID. All of you are out there early morning, late shifts, doing the right thing, taking care of patients. You did it when people didn’t have family members that could go take care of them. And you were there by their bedside. I saw it. Some of you Zoomed in so that I can say hi to my daddy when nobody else was able to and sometimes you did it when you weren’t supposed to. Right?
“But you gave me and my family peace. And so I stand proudly here with you not just as the Chair of the Board of Supervisors. Enough is enough. Everybody needs to be taken care of. The County has 20,000 employees. Kaiser is our provider. They’re going to hear from me.”
Charmaine Morales, RN, UNAC/UHCP President, also riled up the picketing nurses and their allies:
“There’s a problem when we need to be outside of these hospitals, just to get someone to listen. We are averaging 200 RN vacancies consistently. That’s a clear picture.
“I feel like I’m in Groundhog Day. You show up every day reliving a crappy day. You’re overwhelmed, you’re stressed out, burned out. It’s a huge problem. So why can’t we have a Groundhog Day when you walk through the door and say yes! We have staffing. Yes, we have support. Yes, we have the equipment. Yes, we have the supplies. And a Groundhog Day where you’re not getting that text message: We need you, can you come in for an extra shift? And you can walk out that door not feeling crappy and needing to go cry in your car.
“We have solutions. We have ideas. Why can’t we implement? We don’t want to meet to just to meet. We want to walk out the door with progress, progress toward solutions. No more band-aids. Maybe it’s a short term solution, and that’s okay—if it’s gonna get us to the long term solution. We need solutions that focus on recruitment, retention. And respect for what we do to take care of patients.
“You need to talk to the people that are hurting. You need to talk to the frontline. Nurses are trusted by the public more than any other profession. We need to be listened to because we are part of the solution.”
United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP) represents more than 35,000 registered nurses and health care professionals in California and Hawaii, including optometrists; pharmacists; physical, occupational and speech therapists; case managers; nurse midwives; social workers; clinical lab scientists; physician assistants and nurse practitioners; hospital support and technical staff. UNAC/UHCP is affiliated with the National Union of Hospital and Health Care Employees and the American Federation of State, County and Municipal Employees, AFL-CIO.
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