Dozens of registered nurses demonstrated in front of Hollister’s City Hall on April 18, and then spoke during the city council meeting in an attempt to get its support for negotiations between Hazel Hawkins hospital and the nurses’ union, which claims that staffing practices are benefiting executives financially and endangering patients.
Courtney Parinell, an emergency room registered nurse, spoke outside City Hall and said the union had been bargaining with the hospital since July.
“We’re trying to reach a fair contract,” she said. “We’re not asking for anything except for safe patient conditions.”
Another nurse said the hospital is, “…cutting us to the bare bones and if one thing goes wrong, we’re short-staffed.” She said patients are waiting longer primarily because the hospital uses the “acuity system” dating back to the 1980s.
According to Mediware: “Patient acuity is a concept commonly referenced by caregivers and the health science literature but without specificity or consistency of definition or measurement…. Current legislative proposals impose requirements of patient acuity measures be used to adjust nurse staffing specifically to current patient census in an attempt to improve the quality of patient care…. Inconsistent measurement, undefined standards, patient, provider and facility variables have so far frustrated the attempt to demonstrate acuity as a predictor of demand to reliably influence practice decisions.”
“They’re trying to cut that in half and are saying we don’t know how to manage our time,” the nurse said. “In my department (obstetrics) it’s the same staffing as during the 1980s. And you know this community has grown tremendously.”
“We have been in front of the (hospital’s) board (of trustees) and they’re not listening to use,” said Rene Homes. “We’ve gone to administration, we’ve gone to the board and they’re just not listening, and we need to protect our community. It’s a safety issue. We’re going to ask that the city council to meet with us outside of the council so we can educate them more about the safety issues.”
Monica Benton said the nurses want Hazel Hawkins to have staffing levels comparable to other hospitals in the area.
“The numbers are different on different days, but they’re not utilizing in-house resources effectively, and they’re not opening doorways for other applicants to come in,” she said. “So they’re using the goodness of the hearts of our nurses to work 18- to 22-hour.”
Benton said she moved to Hollister from Texas five years ago and said she believes in the community.
“All I ask is that people pay attention and hopefully the city council understands the passion that the nurses have to take care of the community,” she said. “We hope the council will back our nurses.”
Dr. Teresa Mack, labor representative for the California Nurses Association, said the nurses of Hazel Hawkins are trying to do the same thing that nurses in Watsonville, who were facing the same issues, accomplished.
“There was chronic, intentional short staffing,” she said. “Hospitals save a lot of money by working the nurses on skeleton crews at the expense of the safety of patients. When the public knows about this they should be very upset because the hospital belongs to them. As public sector nurses they’re trying to protect and serve the public. But when they’re working short staffed patients are at risk.”
Mack said the nurses in Watsonville could not get the attention of hospital management and the board of trustees, so they focused on educating the public.
“Over several months’ time the city council of Watsonville was courageous,” she said. “They took responsibility for their constituents and the patients, and they partnered with the nurses and passed a resolution that told the corporation that owns the hospital they had to follow state law, which is staffing ratios these nurses fought for.”
The nurses did not say they were prepared to strike yet, but only that they wanted to continue to negotiate until they could come to a reasonable and safe practice for the community and their patients.
Inside council chambers, during public comments, Mack told the council the nurses were there to talk about serious patient safety concerns. She said the nurses had come to the council because their concerns had “fallen on deaf ears” at the hospital.
“The concerns of the nurses here are pretty much as they are all over the country,” she said. “What’s great about California is that you have a caring way of making hospitals, or at least you did in the 1960s when you created public healthcare districts. That’s what’s great about our hospital. It’s a public sector hospital. It belongs to you and you are the guardians to these registered nurses who chose to work for the public sector.”
Mack said public sector nurses do not make as much income as those who work in privately-owned hospitals. She said the nurses standing before them choose to work for Hazel Hawkins because they are part of the community.
“They took time off from work after long shifts of 12 to 14 hours to come here to talk to you tonight about serious patient care concerns,” she said. “I hope you will listen to them and take their concerns seriously and agree to meet with us in a private forum.”
The meeting suddenly turned from cordial and informative to contentious when Councilman Raymond Friend objected to not only Daniel Dodge’s comments but his very presence. Dodge, the former mayor and councilman of Watsonville, said he was there on behalf of Assemblyman Luis Alejo (D-Salinas).
When Dodge began to list Alejo’s involvement with various hospitals and his promise of support to the nurses, Friend interrupted angrily: “I’ve got to say something here. We’re here to listen to these nurses and their problems. I don’t want to hear from a political…”
Dodge talked over Friend, asking Mayor Ignacio Velazquez if he had three minutes to make a public comment as Friend told Dodge he had not filled out a speaker card and to sit down. The mayor indicated that Friend should calm down, then told Dodge to continue, but to keep his comments away from politics and about the nurses.
Dodge, however, decided to declare his ire at what he called the “immature actions of Councilman Friend. I would expect a little higher behavior than that, but I will finish my comments. We’re trying to make a point that these are members of your community and they’re having difficulties in having their voices heard. They’re coming to you, as elected officials, to respect their voices, to hear their concerns and act in their best interest. I find it insulting as a community member to have to listen to that kind of rhetoric.”
Ariahanna Sanchez, a registered nurse who was born and raised in Hollister, said as a public-sector nurse she is proud and honored to give back to her patients, her friends, neighbors and family. She said hospital management should be proud of the dedication of the nurses, but said that she wanted to speak about short staffing and retention issues.
“On any given night our registered nurses are giving basic, intermediary and critical care, as well as acting as teachers, comforters and protectors,” she said. “We may be dealing with a heart attack, teaching a new mother how to breast feed, or keeping a confused patient from climbing out of bed and injuring herself.”
Nurses run toward danger, not away from it, Sanchez said, but when it is danger that could have been averted and has been created by intentional short staffing, they cannot remain silent.
“Registered nurses are legally bound to advocate for our patients and required by the Board of Registered Nurses and the State of California to speak out about dangerous patient care conditions,” she said. “Nurses know about critical staffing levels because we are on the front lines every day. We know that when we work chronically short and long hours without any rest patients are the ones who suffer.”
Sanchez said she wanted to ask the council and community if they thought working up to 18 hours a day is safe for patients.
“As nurses we don’t see numbers,” she said, “we see patients, we see mothers, fathers, children, we see our loved ones. Today, we are calling our city council to help us to protect and serve the people of Hollister, who this public hospital belongs to.”
Monica Benton, a leading nurse at the hospital, started to read a letter from a Watsonville councilmember when Velazquez asked her to refrain from reading political comments, which could be construed as campaigning for elected offices, and for her to speak her own feelings.
Benton said that she is responsible for selecting nurses from a roster of names to work certain shifts, but said there are so few names that the nurses she is asking to come in have already worked long hours and are exhausted, but they continue to come in anyway.
“As one of the leaders there, I can tell you this group of people have the community interest at heart,” she said.
Jennifer Home, who is a nurse from Watsonville, said chronic short staffing is a never-ending problem. She said the nurses work in Hollister because it is their community and they want to take care of the people who live there.
“Conserve your nurses the way you would conserve water,” she said, referring to an earlier presentation about the local water situation. “One of the Watsonville city councilmembers asked the nurses, ‘If it’s that frustrating, why don’t you just work somewhere else?’ There is a difference when you work in your community. When I go into Safeway in Watsonville, I know I might run into my patients or their family members. It makes a difference to know you’re accountable at the place you work in. Please listen to your nurses and if there’s a chance to talk to them please do so.”
Rene Holmes, who has been a registered nurse at Hazel Hawkins for 21 years, said the nurses cannot remain silent when patient safety is the issue. She said as an obstetrics (OB) nurse she is used to taking life-saving measures at a moment’s notice.
“Intentional short-staffing at an acute-care hospital is never OK,” she said. “Senior administration has chosen to maximize profits by operating our OB department with skeleton crew mentality. The CEO and director of nursing want us to do more with less. The problem is when OB nurses work short it is ultimately our mothers and new born babies that pay the price.”
Holmes claimed that the director of nursing has insisted on organizing the way nurses and vital support staff are scheduled in a fashion vastly different from staffing standards at other similarly-sized hospitals. She said that administration has determined to staff the maternity department with three registered nurses.
“While that may look good on paper,” Holmes said, “the reality is that only two nurses may actually be on the unit. The third nurse is not at the hospital, but placed on stand-by. And while our hospital boasts of a new women’s health center, intentional short staffing causes a major problem. We do not have a designated nurse on duty to treat the numerous walk-ins. Instead, nurses on the unit are forced to stop their patient care assignment and race to assist them. There’s a time and a place for doing more with less, but risking a patient’s safety in a hospital setting is not it.”
Surgical nurse Michelle Yanez, who has worked at Hazel Hawkins for 19 years, said the recent population increase has put a strain on the hospital. She said the senior administrator has done nothing to stop the chronic staffing problem.
“The only thing that has gone up at Hazel Hawkins seems to be administrative salaries and bonuses,” she said. “About 10 years ago, the nursing staff in our department dropped drastically. We lost two coordinators and three surgery nurses, leaving five nurses to cover surgery. Today, we five nurses continue to cover all surgeries. We do this 24/7, 365 days a year.”
Meanwhile, she said the number of surgeries has climbed by more than 200 cases each year since 2013. As of December 2015, she said the hospital performed approximately 2,900 surgeries with only the five nurses.
“I want to make it clear that we did not decide to speak to the public right away,” she said. “Our nurses have tried to keep these serious concerns inside the hospital. Our numerous attempts have failed. We do not blame the elected board members. We know that the CEO and his top administrators have closed-door access to the board. We know that the high-powered attorneys and the extravagantly paid outsider law firm hired by the administration has instant access to the board.”
She said the nurses are not asking for pay raises or bonuses, but are speaking because of a serious staffing and patient safety concern.
Marcelle Norman, a nurse of 30 years, accused the hospital’s CEO, CFO and director of nurses of seeming to be concerned only with raising their own salaries, while cutting those of staff.
“Every single day and shift I’m forced to ask myself how can I safely do the work I’m legally bound to perform to keep my patients healthy and alive,” she said. “I’m forced to ask myself how can I care for patients who are becoming sicker when chronic short staffing makes me do the work of two and sometimes three team members on a given shift.”
She quoted the saying, “some cuts never heal,” and said, “For front-line registered nurses this phrase means more than profits can quantify. When California nurses won the landmark legislation for nurse-to-patient ratios for a historic standard of safety in acute care hospitals, we did not do this by allowing three administrators to work nurses on a skeleton crew model. We do it by actively and self-sacrificially advocating for our patients.”
After repeated pleas from each speaker for the city council to meet with the nurses, Velazquez reminded them that the city council cannot change conditions at Hazel Hawkins.
“It’s very important that all of you work with the board of trustees at the hospital to see the change,” he said.
In response to the nurses’ accusations, Gordon Machado, president of the Board of Trustees, responded to BenitoLink by email, saying: “We meet and exceed all State of California staffing guidelines. We adjust our staffing levels based on acuity, and shift by shift, as assessed with information the nursing units provide. We do not have mandated overtime. Like all hospitals, we are reviewed annually and have never been cited in any nursing unit or department of the hospital for staffing issues. Records of our State surveys and citations are available through the California State Department of Public Health.”
In a later phone interview with Benitolink, Machado said the long hours a nurse may work is determined by seniority and how many hours of overtime the nurse wants to work, and not that the hospital is shorthanded.
“They’re the ones who have the choice to do it or not do it,” he told BenitoLink. “They’re not telling the whole story. The staffing level, there’s no problem. Our staffing level at the hospital is scrutinized by the State of California continuously. It is interesting to note that we do not receive complaints from any of our physicians regarding hospital patient safety and quality of care. Our management and administrative teams have numerous processes in place for any staff member to voice their concerns.”
Machado challenged the nurses’ claims that because of a shortage the patients were at risk.
“Patient safety is always a No. 1 priority for our organization,” he wrote in the email. “We have active patient safety and performance improvement committees that are comprised of front-line nursing staff, management staff and administrative representatives that meet monthly, as well as physician committees that review and oversee patient safety. The District Board receives monthly quality/patient safety reports at its Board meeting.
When asked why 30 nurses would make such claims at a public forum, he claimed it is simply a negotiation tactic.
“The last meeting we had, 50 percent or 60 percent of them were from out of town,” he said. “They’re aggressive people. They’re excited. It’s the union reps, not necessarily our nurses. They did the same thing in Watsonville. They went to the Watsonville city council and the Salinas city council. Watsonville has been negotiating for two years now and Salinas it’s been over a year.”