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As an RN that has worked for Kaiser San Francisco in the Labor and Delivery unit for 6 years, I have to add to the voices trying to make the public aware of what the management is trying to get away with at the North Calif hospitals.
The aggressive and confrontational attitudes of management are to be expected as we head into contract negotiations. It is always to the financial benefit to the administration to piss off the senior nurses that can afford to walk away into retirement or part time work elsewhere.
With 17800 RN's in the NorCal district, if management persuaded 10% of the RN's at the top of the pay scale to quit or retire the payroll savings would run into the billions.
Of course, being bean counters they are willing to risk the loss of years of experienced nursing skills in the chase for profits and bonuses.
At San Francisco Kaiser L&D over the past year we have been so short staffed that I have been in constant fear that I could be faced with a sentinel event that would cost me my license.
On night shift there has rarely been an assistant manager on duty over the last 12 months and during the worst of the staffing shortage in June, July and August of 2013 the posted on call managers did not even answer their phones.
Previous to my career as a nurse I worked in restaurant management for 20 years. In that business, if you were the on call manager and failed to respond to a page or phone call from work, most likely you would be quickly unemployed.
At one point last spring management posted a calendar spread sheet with the shortages listed for an entire month. These were shortages that they were aware of well in advance,due to vacation time that had been approved in March of that year and several Rn's out for maternity leave.
The spreadsheet posted by management show the following
for the period from
May 19 to June 15
Night shift short 31 shifts: Day shift 2 short; Evening shift short 98 shifts
July 14 to August 10, 2013
Night shift short 102 shifts,Day shift 16 short; Evening shift short 97 shifts.
August 10 to Sept 7th
Night shift short 112 shifts, Day shift 9 short; Evening Shift short 104 shifts
The Contract language for CNA members states that it is management responsibility to hire contract RN's and schedule part time and on call RN's to cover vacation requests.
Someone quite obviously made the decision to not hire any additional coverage for these vacation times in the interest of saving on labor costs.
You can do the math on this if you credit each shift at 8 hours length and an average RN salary somewhere in the vicinity of $60/hr. and over 500 shifts unfilled. It also is curious that there so few shortage staffing situations on day shift when the department managers where present
Staffing in Labor and Delivery is predicated on California State Patient/Nurse ratio law and the number of labor rooms available on the unit. Labor cost budgets are based on these rules for the Hospital to remain in compliance with the State laws and minimum standards of practice
.This begs the question of who received a financial bonus for bringing labor cost in under budget, and made the decisions that placed Kaiser patients safety in jeopardy.
Labor and Delivery units are under the influence of Federal laws regarding the emergency treatment of patients in active labor. Regardless of Kaiser membership, if a patient shows up at a Kaiser Hospital showing the signs and symptoms of active labor or any medical situation effecting the life and safety of the mother or child we are bound by law to evaluate and treat that patient.
There were many times over the course of this last 12 months when the nurses have been in the dangerous position of being responsible for more patients than is considered safe. We have had patients laboring on stretchers in the hallways on more than one occasion with insufficient staff to safely manage and guide mother and baby through the labor process. Only the fine work of the nursing staff, the OB/GYN residents and attending MDs on the staff at Kaiser SF prevented dangerous situations from becoming tragic events.
When I graduated from Nursing school I took an oath to be the advocate for the patient. Kaiser management policies have repeatedly placed me in the uncomfortable position of risking the safety of patients, the legal status of my license to practice as a nurse and left me physically and emotionally exhausted at the end of a night's work, but I cannot allow their pursuit of profits to dull my dedication and love of this job, and will not allow their course of business to go unchallenged.
Kaiser stands to profit greatly from the changes in healthcare coming in the future as the ACA goes into full effect and they are positioning themselves to expand profits and management compensation at the cost of patient safety and the careers of thousands of dedicated healthcare professionals. We are the ones that watch over your safety and help you come into this world and hold your hand and offer comfort and solace as you go out of this life.
I have copies of all the posted schedule requests referred to in this letter.
Feel free to contact me via this email address if you wish to discuss the situation further.
Joseph M Adams RN
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