Nurses to protest nurse to patient waiver
Proper staffing, not ‘stretching resources,’ is what will save lives, medical staff says
WATSONVILLE >> Within 24 hours of the facility receiving its first coronavirus vaccine doses, Watsonville Community Hospital will become the site of another historic moment: a gathering of nurses against changing the years-long nurse-topatient care ratio.
Nurses from Watsonville Community Hospital and even nearby hospitals such as Salinas Valley Memorial Hospital and Natividad Medical Center, will stand outside and demonstrate while being socially distanced from one another from 2- 4 p.m. Wednesday. They are asking supportive community members not to join them but to drive by and honk to show support.
“Let the owners of the facility and the management team know how we feel, where we stand on this,” longtime ICU nurse Roseann Farris said.
As Gov. Gavin Newsom was live on social media giving the most recent numbers and announcements around the state’s COVID-19 response, he thanked the California Nurses Association and other community stakeholders for making it possible to “stretch resources” to get more patients to each nurse. He said that leaders were looking at patient care differently in the short-term to appease bogged down hospital systems.
But those who have been caring for coronavirus patients first hand have major concerns about his decision to issue an executive order at the beginning of the pandemic, ASL-2026, that allows hospitals to apply for a waiver to waive nurseto-patient ratios. Just a few days ago, the nurses association found out that there was an extension to the order — now, nurse and CNA organizer Quiché Rubalcava says, not much is required to request the waiver.
Farris said that the California Department of Public Health issued an all-facility letter to in-patient establishments giving them the option to waive Title 22, the nurse-to-patient ratio regulation passed in 1999 and enacted in 2004. The extension, made possible through a statewide Proclamation of Emergency, is valid through March 2021.
“It’s our professional judgment that this would be extremely unsafe in a pandemic with COVID patients
who are extremely sick with high acuity,” Rubalcava said. “Thinking that a nurse can adequately care for these patients, adding patients to their load, is going to be catastrophic.”
Watsonville Community Hospital has not yet taken the California Department of Public Health up on its offer, which is why CNA is hosting a protest now. Neither Watsonville Community Hospital nor the California Department of Public Health could not be reached for comment.
“We need to put (the community’s) safety in the center of all of this,” Farris said.
Nurses such as Rubalcava and Farris are hoping to make their voices heard so that the ratio remains 1:1 or 1:2 (depending on the severity of a patient’s illness) in the ICU, 1:3 or 1:4 in the cardiac monitor unit and 1:5 in medical-surgical units. If the hospital operators elect to increase ratios, the ratios would change to 1:3 in ICUs, 1:6 in cardiac monitoring units and 1:7 in medicalsurgical units.
“We are by and large seeing COVID patients now and having to watch their oxygen and respiratory (capabilities),” Rubalcava said. “If you have a patient that takes a lot of your attention, if you have two of them then you have a really hard job at that point… What do you do if both of their oxygen levels are dropping at the same time?”
In addition, CNA feels that increased ratios will lead to more healthcare worker cases and deaths, according to a press release the association issued Monday.
“Nurses have been working under enormous strain, putting their lives and safety in jeopardy, without enough personal protective equipment and without sufficient hospital engineering controls to reduce the spread of infection that have turned hospitals into COVID-19 hot zones,” CNA Executive Director Bonnie Castillo, a nurse, wrote.
A deeper bond
The nurse-to-patient ratio means more in Watsonville, one of the cities with the highest COVID-19 case rates in the county, because the Watsonville City Council made a historic resolution in 2015 to support the statemandated ratios in the law as they were written.
“That’s our bond with the city of Watsonville,” Rubalcava said. “Those ratios really give patients the best care… data from the last 15 years has shown these ratios stabilize. It is insurmountable, indisputable. It saves lives.”
According to Sentinel coverage from five years ago, this decision was a result of Watsonville Community Hospital nurses showing up to the council’s chamber and urging them to adopt a resolution around safe staffing protocols.
“I witness nurses working back-to-back and 16-hour shifts,” Farris said at the time. “In the Critical Care Unit where I work, the hospital’s core staffing requires that we have four nurses available for every shift; but there are times we have had only one or two.”
Then, hospital officials denied the allegations.