Nurses at Modesto hospital say coronavirus staffing waivers are unsafe for patients
Nurses affirm that patients who are critically ill with COVID-19 need highly skilled care to give them the best chance to live.
But it won’t be good for those patients if one intensive care nurse is assigned to care for three COVID-19 patients, who may have underlying health conditions in addition to the aggressive viral infection, they say.
Members of the California Nurses Association held a shift-change action Wednesday morning outside Doctors Medical Center to challenge state-approved waivers allowing hospitals to bypass California’s safe staffing regulations during the coronavirus pandemic.
The state standards for nurse staffing limit an ICU nurse to two patients, or one in certain circumstances. At the informational picket Wednesday, nurses said they are responsible for up to seven COVID-19 patients in regular hospital units, which is two more than the state’s normal standard.
If the state Department of Public Health approves the temporary waivers, a nurse may be assigned to four patients in a “step down” or intermediate unit for patients who no longer need intensive care. The normal ratio for step down units is 1 to 3.
“Right now, implementing the ratio waivers would significantly impact nurses’ ability to give safe care,” said Shiloh Garcia, an ICU nurse and the union’s chief nurse representative at Doctors. “The more patients a nurse has is less time she has to spend individually with each patient.”
Garcia said it increases the mortality risk for patients and may compromise safety for nurses. “Errors could be made. We don’t want to compromise our patient care. So we are asking the hospital to do everything in their power to staff us,” Garcia said.
Industry groups like the California Hospital Association insist more flexible staffing is essential as hospitals deal with a tsunami of coronavirus patients during the surge this winter.
Doctors Medical Center released a statement after Wednesday’s informational picket saying the Modesto hospital has joined many other facilities in using the temporary waivers under Gov. Gavin Newsom’s emergency proclamation. The hospital cited a recent surge in COVID-19 cases, which put up to 363 infected patients in local hospitals this week.
“The waiver allows hospitals to move nursing staff where they’re most needed at any given moment,” Doctors said. “The safety of our patients and staff remains a top priority.”
The hospital, at West Orangeburg and Florida avenues, said it is working on other staffing solutions, such as using a staffing agency to bring additional traveler nurses on board soon. “While the demands of COVID-19 have strained California’s health care workforce, we remain committed to caring for our community during the pandemic,” the statement said.
Newsom said Wednesday that the state recorded 39,069 new cases of coronavirus in a 24-hour period and that total ICU capacity statewide has shrunk to 1.1%, down from 2.5% Monday.
Hospitals in California were caring for 18,828 COVID patients, including 3,877 in ICUs, almost double the number three weeks ago. Newsom also pointed to a grim total of 361 deaths in the last 24 hours and noted the seven-day testing positivity rate was 12.6%.
About the only encouraging sign was the test positivity number — it has dropped slightly from 13.3% a few days ago. The state has also charted a modest decline in the growth rate of cases.
The Modesto nurses said they could not provide a count on the number of COVID-positive patients at Doctors Medical Center.
“I know our staff is definitely overwhelmed,” Garcia said. “Our nurses are overwhelmed and we are scared.”
Garcia and another nurse who spoke with The Modesto Bee said they had contracted the coronavirus while caring for patients during the pandemic and knew other staff that have tested positive. Hospital nurses and other health care workers have begun to receive vaccinations against the coronavirus.
Beginning Dec. 11, the state gave hospitals an expedited waiver process that the union claims dramatically increases workload for nurses, who risk their health while caring for COVID-19 patients. The waivers providing more staffing flexibility can remain in effect for 60 days.
Wednesday, the nurses union demanded the hospital not seek another waiver on nurse-to-patient ratios but follow the safe staffing practices. The union also recommended the hospital postpone elective procedures and stop floating nurses outside of their normal work assignments.
The Nurses Association points to studies concluding that California’s staffing law results in up to 14% fewer deaths when compared with hospitals that don’t have the standards for staffing.
“We know the safe ratios protect nurses and patients,” said Elvira Angulo, a registered nurse at Doctors. “We know the waivers will create more fatigue and stress on nurses who have worked during the pandemic for eight months.”
This story was originally published December 23, 2020 at 2:38 PM.
