S.F. General nurses say understaffing a crisis
“Unstaffed shifts are not just inconvenient or really busy. They’re scary, unsafe, lonely and mentally exhausting.” San Francisco General nurse Hannah Lucero
Hannah Lucero shows up for her nursing shifts at Zuckerberg San Francisco General Hospital and Trauma Center and says she’s often told there will be no breaks.
Due to a lack of adequate staffing in the hospital’s inpatient psych unit, Lucero said, she and her co-workers are forced to take on extra patients, frequently work mandated overtime and suffer repeated assaults from patients. Lucero said she’s been punched in the face and watched her co-workers get shoved, hit and even knocked unconscious.
“Unstaffed shifts are not just inconvenient or really busy,” she said. “They’re scary, unsafe, lonely and mentally exhausting.”
In the midst of contentious contract negotiations, nurses employed by the city are once again raising the alarm over what they say are unsafe working conditions, reduced quality of care and rising wait times due to chronic understaffing.
A Department of Public Health survey, presented publicly at a Tuesday meeting of the city’s Health Commission, found that 73% of the hospital’s workforce would not recommend S.F. General as a place to receive care. And the percent of hospital employees that would recommend working at S.F. General plunged from 63% of respondents in 2019 to 32% in 2023, according to the survey.
At the meeting, the hospital’s chief experience officer, Aiyana Johnson, acknowledged that staff sentiment was a challenge coming out of the pandemic.
“There’s a lot of work that needs to be done, but there’s a lot of work that we are doing,” Johnson said, citing well-being pop-up days, pet therapy and in-person wellness classes offered to hospital staff.
The labor union representing San Francisco’s public nurses is one of the last holdouts after the city earlier this month reached tentative labor contracts with several of its largest unions. Those contracts are expected to establish a $25 per hour minimum wage for city workers, among other provisions, according to SEIU Local 1021, San Francisco’s largest public-sector union.
San Francisco unions threatened to strike this year after a state employment board recently struck provisions in the City Charter that forbade them from doing so. A strike would deliver a blow to Mayor London Breed, who is trying to close a projected $789.3 million twoyear budget gap just months before a competitive reelection race.
Heather Bollinger, an emergency room nurse at S.F. General, said the nurses are “nowhere near close” to reaching a contract with the city. The nurses are seeking higher wages, increased full-time nursing staff and a reduced reliance on contract workers.
According to Bollinger, nearly 100 emergency department nurses have resigned in the past three years — the majority of which were due to safety concerns.
“It’s partly about the actual fear of being assaulted, but it’s also the fear of having a bad patient outcome, because you are spread so thin,” she said. “Nurses don’t feel confident. They don’t feel able to give the care that people deserve.”
At a Civil Service Commission last month, the Department of Public Health requested an additional $100 million to hire “intermittent, supplemental and travel nursing personnel” through 2027.
Troy Williams, director of quality at S.F. General, said at that meeting that the department’s priority was to fill permanent nursing positions. However, because of employee leaves of absences, turnover and patient surges, the department also needed to supplement with contracted nurses to provide “consistent and high quality patient care.”
According to Williams, approximately 95% of nursing hours are still met with permanent employees.
Jennifer Esteen, SEIU 1021 Community RN chapter president, said the increased investment on temporary contract workers over permanent staff “defies logic.”
“I don’t understand what the goal is for the Department of Public Health right now,” Esteen said. “It feels like they are trying really hard to create hardship in the hospital, instead of creating a positive, safe place for people to get well.”
Kim Walden, the department’s chief human resources officer, said at the March Civil Service Commission meeting that the department had “worked hard to improve retention” and hire more full-time staff.
The number of full-time nurses across the Department of Public Health reached 1,340 last month, the highest level in the city’s history. The vacancy rate for full-time nurses dropped from 15.44% in April 2023 to 11.24% in March 2024, according to Walden.
Despite those gains, Lucero said she “doesn’t see it.”
After working as a nurse technician at S.F. General for six years and earning her nursing degree in 2022, it took her nine months to get hired by the department as a registered nurse. Even then, she could get only a per-diem position without benefits. The process has made her contemplate whether staying at S.F. General is the best choice.
“I’m not upset or burnt out because of the population we work with,” she said. “I’m upset and exhausted to be part of the system that is not doing the bare minimum to support us by providing enough staff.”