The San Francisco County Board of Supervisors convened on July 4, 2025, to discuss critical updates regarding the Department of Public Health (DPH) and its nursing staff management. The meeting featured a presentation by Troy Williams, the newly appointed Chief Nursing Officer for the DPH, who outlined proposed amendments to the trifecta nursing registry contract.

Williams, who has been with DPH for 29 years, emphasized the importance of stabilizing nursing staff to ensure high-quality patient care. He reported that the department serves nearly 100,000 patients annually through various facilities, including Zuckerberg San Francisco General Hospital and Laguna Honda. Williams highlighted the commitment of the department's 1,400 nurses and the necessity of supplementing staff with registry nurses to meet state-mandated patient-to-staff ratios.

The proposed amendment seeks to increase the trifecta contract by $1.5 million, bringing the total to $11.4 million. This increase is intended to cover invoices incurred during the COVID-19 pandemic and subsequent patient surges, particularly at Laguna Honda, which faced challenges during its recertification process. Williams noted that the use of registry nurses has decreased to 4%, significantly lower than the national average of 10-20%, indicating effective management of staffing needs.

The discussion also addressed the ongoing efforts to hire permanent nursing staff, with Williams reporting the addition of 135 new registered nurse positions since 2019. The department aims to maintain a vacancy rate of no more than 5% by the end of the fiscal year. Williams underscored the importance of supporting nursing staff well-being, especially in light of pandemic-related burnout.

Supervisors expressed their support for the proposed amendments while also raising concerns about the high costs associated with the contract and the need for better performance metrics. Supervisor Melgar highlighted the importance of personal relationships between staff and patients, advocating for permanent staffing solutions over temporary hires.

In conclusion, the board is set to vote on the proposed contract amendment, which aims to enhance staffing stability and improve patient care in San Francisco's public health system. The DPH remains committed to addressing staffing challenges while ensuring the well-being of both patients and healthcare workers.