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SF General emergency nurses warn commissioners of unsafe staffing levels
Summary
Four San Francisco General nurses told the Health Commission that emergency department staffing is dangerously low, citing 23 vacant RN positions, examples of patient-care delays and violence, and a recent shift where the unit had 10 nurses instead of an expected 22; commissioners referred concerns to Administration and the Joint Conference Committee.
San Francisco General emergency nurses brought stark warnings to the San Francisco Department of Public Health (DPH) Health Commission during public comment, saying chronic understaffing is compromising patient safety and staff well-being.
Dan Mayer, an emergency-department nurse, said the trauma center has 23 vacant registered-nurse positions and is not budgeted to the number of nurses the unit needs. "We're down 23 registered nurse positions in that department," Mayer said, adding that even filling current vacancies would leave the department short because budgets do not reflect actual staffing needs. Mayer said sitters for patients on constant observation are not budgeted, leaving some high-risk patients unattended, and estimated ambulance diversions cost the hospital "about $1,500,000 a month." He urged commissioners to provide a budget that will support adequate staffing.
Heather Bollinger, a night-shift trauma-area nurse, described a single shift in which ICU and restrained psychiatric patients were mixed across zones while a wave of stab- and gunshot victims arrived. She said nurses were already over Title 22 ratios and that trauma arrivals forced further delays in care; in one instance, a patient asked only to use a bathroom and was handed a urinal in a hallway. "This is our reality," Bollinger said, and asked the commission for help to resolve staffing shortages.
Kim Cigna, an ER nurse, said violence against staff and patients has increased over her five years in the department and argued that adequate clinical staffing—not only security—is required to prevent escalation. She described daily practices of closing beds in less-acute zones to prop up the trauma area, which she said concentrates risk.
Melissa Pitts, a charge nurse, gave concrete numbers on required coverage: when fully staffed the ED should have 22 nurses plus a charge nurse, she said. "Yesterday, we had 10," Pitts said, describing that as not an exception but "quickly becoming the norm" and warning that staffing choices are forcing impossible trade-offs in patient care.
Chair remarks after public comment noted the commissioners' appreciation for San Francisco General staff and announced the concerns would be taken under consideration and referred to Administration and the hospital's Joint Conference Committee for follow-up.
The comments fed into subsequent budget questions from commissioners, who asked DPH budget staff and the CFO about reconciliation of salary-savings assumptions with hiring constraints and whether planned hiring tied to the new hospital would address emergency-department shortages. DPH staff said salary savings in the budget include attrition assumptions and that planned hiring associated with the new San Francisco General hospital would add FTEs in 2015—16; they also said human-resources efforts to accelerate hiring were underway. Commissioners requested more granular FTE breakdowns and asked staff to report back on how budgeted positions and planned hires map to on-the-ground ED needs.
The commission did not take a formal vote on staffing at the meeting; instead, the chair referred the public comments to the Administration and the Joint Conference Committee for San Francisco General for further review and action.
