University Of California RNs Authorize Strike As Nurses Protest Eroding Staffing Conditions

Main Category: Nursing / Midwifery
Article Date: 02 Jan 2009 - 3:00 PDT

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UC Med Centers Staffing by Budget, Not Patient Need Say Nurses, Charging UC Violating State Law and Contract

Registered nurses at five University of California medical centers have voted to authorize a strike, which would be the first ever strike by UC RNs, to protest what they say is an alarming decline in safe staffing conditions at the well known hospitals.

Concurrently, the California Nurses Association/National Nurses Organizing Committee has filed a formal complaint with the state agency that oversees public employees charging the UC hospitals with violating their collective bargaining agreement by unilaterally changing staffing practices and determining staffing on the basis of UC profit goals rather than patient need and state law.

UC made those decisions despite ending the 2007-2008 fiscal year with $227 million in profits and $3.6 billion in net assets at the five medical centers according to their own audits. The staffing violations, says CNA/NNOC, are pervasive throughout the UC system, and reflect a policy change from patient need based staffing to economic-based staffing.

"The UC medical centers' focus on maximizing profit has meant shorting patients on the nursing care they require," said CNA/NNOC co-president Geri Jenkins, a UC San Diego RN. UC nurses, she said, are "standing together to insist UC increase nurse staffing levels so we can adequately care for our patients."

In membership meetings held over the past eight days, RNs at the major medical centers at UCLA, UC San Francisco, UC San Diego, UC Davis, and UC Irvine, voted overwhelmingly to give their nurse negotiators approval to call a strike. No strike date is set at this time, and further negotiations are likely. CNA/NNOC represents over 10,000 RNs at the five hospitals along with UC student health centers.

At the heart of the dispute, both the strike vote and the charge filed by CNA/NNOC with the state Public Employees Relations Board (PERB), is the RNs' contention that UC sets staffing on the basis of its budget priorities, rather than the state's landmark law requiring minimum RN-to-patient staffing ratios in concert with a hospital wide patient classification system.

"Patients must have adequate nursing care at all times," said UC Davis RN Carol Majesky.

State law sets a minimum number of nurses per patient that varies by unit that all hospitals in California must meet. The law also obligates hospitals to increase the staffing as required by patient need. CNA/NNOC says UC has violated the law by failing to meet that standard, and using a variety of means to avoid compliance, such as placing inappropriate placement of very sick patients in lesser staffed hospital units.

James Darby, a UCSF RN notes that UC hospitals typically have many of the sickest patients in the state which makes compliance with patient need or acuity in addition to the ratios especially critical. "High acuity patients need more nursing care. We call on UC to staff by acuity, in addition to ratios, as required by law," he said.

"UC patients deserve world class care, which includes adequate numbers of nurses to provide that care," said UCLA RN Manny Punzalan.

The PERB complaint, along with additional documentation to be filed this week, cites numerous examples.

At UCSF's transplant medical-surgical unit where RNs care for liver and kidney transplant patients, RNs saw a significant increase in patient assignments in July, based on budgetary goals not nursing assessments or the hospital's patient classification system. In a UCSF general medical unit, a nurse manager told RNs that staffing reductions were being carried out, and would remain in effect because "UCSF is a business and they are over budget."

At UC Davis, a nurse manager in a general medical unit sent RNs a memo informing them of a change in staffing policies to limit overtime assignments to staffing based solely on the ratio, not on the additional basis of patient need. UCD RNs also cite continual staffing violations in a variety of units including units for open heart, neo-natal intensive care, and orthopedic patients.

UC San Diego RNs have met with managers in their family maternity care unit to report chronic understaffing. A manager told them she would prefer better staffing but that due to budgetary reasons that would not happen.

At UCLA, CNA/NNOC charges the hospital has repeatedly improperly placed patients, such as ventric drains (draining excessive fluid from the brain), in lower staffed units.

UCI RNs report particular problems in psychiatric care staffing.

The current dispute is a contract re-opener of the current collective bargaining contract.

California Nurses Association