By Jason KUROSU
Discourse on patient care, safety and hospital staffing has dominated public discussion regarding USC-Verdugo Hills Hospital during ongoing contract negotiations with the California Nurses Association.
The nurses association recently voted overwhelmingly in approval of a strike, citing unsafe working conditions stemming from an understaffed hospital, which protesting nurses allege has led to the hiring of numerous temporary traveler nurses, some of whom have minimal training, and the resignation of long-time Verdugo Hills nurses.
USC-Verdugo Hills Hospital officials denied that nurses have been leaving in what the nurses association characterized as a “mass exodus” of hospital staff.
In an interview with CVW, USC-Verdugo Hills interim CEO Paul Craig said that current turnover at Verdugo Hills Hospital is around 6.5% over the last six-months, a rate that Craig said was below those seen at similar hospitals.
“Every hospital has turnover. Is it higher than we’d like it to be? Yes,” said Craig. “The ideal is to staff 100% full-time nurses all of the time.”
The nurses association contends that, in order to fill spots vacated by departing staff, an influx of temporary traveler nurses has become a regularity at the hospital and is central to their concerns for patient safety.
USC-Verdugo Hills Chief Nursing Officer Janet Brooks refuted claims that training and orientation for new traveler nurses was as minimal as an hour, saying that temporary nurses receive a full day of orientation and a review of hospital policies. In addition, they meet with the hospital’s director of Education and Clinical Coordinator and receive 7.5 hours of training on the hospital’s computer system. Brooks also said that traveler nurses were also paired with other travelers while receiving training and did not care for patients during this time, contrary to claims from the nurses association.
Hospital officials also denied that traveler nurses were making up a significant portion of current hospital staff. Brooks said that traveler nurses currently comprise about 25% of the overall nursing staff at Verdugo Hills Hospital.
Ovsan Kuyumjian, clinical director, said that the hospital has been “very well staffed” and on Tuesday afternoon reported zero traveler nurses in her unit.
Nurses on the opposing side of the argument describe much different scenarios, in which temporary nurses are thrown into situations they are ill-trained to handle.
“I’ve seen four traveler nurses recently in the operating room,” said Lisa Ryken, a nurse working in Same Day Surgery. “Before USC took over, you never saw travelers in the OR.”
Dinorah Williams, California Nurses Association Labor representative, said that current schedules for multiple units at USC-Verdugo Hills Hospital reflect a hospital staffed by more than 25% traveler nurses. From April 19 to May 16, Williams said that schedules for the hospital’s Intensive Care Unit would be staffed by seven traveler nurses out of 13 total during the day shift and eight traveler nurses out of 15 during the night shift. Similarly, six out of 12 nurses scheduled to work the day shift in the Telemetry Unit during that month are travelers. In addition, Williams said that many of the usually full-time nurses are scheduled for one day a week and, in some cases, a few days in the entire month or not at all.
The nurses association also claims that USC Verdugo Hills Hospital has been operating outside of the legal nurse-to-patient ratios, as dictated by the California Code of Regulations. For example, one nurse in a medical/surgical unit may not oversee more than five patients at any time.
“We staff to comply with state required staffing ratios and have added nurses to our shifts in order to comply with those regulations,” said Brooks, who added “there is a dedication to patient care here,” noting improvements made since the acquisition of Verdugo Hills Hospital by USC in 2013.
These include a drop in the rate of hospital-acquired pressure ulcers from 14% to 2%, compliance with stroke care clinical measures improving from 72% compliance to 100% compliance and compliance with sepsis care clinical measures improving from 77% before July 2013 to 99% compliance today.
The reduction in hospital-acquired pressure ulcers was, in particular, described by Craig as “a remarkable credit to the nursing care” at Verdugo Hills Hospital.
But the nurses association fears that the hospital is becoming so inundated with temporary nurses that soon travelers will be training travelers due to a lack of regular staffed nurses to guide the newcomers, leading to unsafe conditions for patients.
“The patient care reports that we have given to USC officials show that the increase in errors is greater when you have mostly agency personnel,” said Williams. “This is about safe patient care. It’s about building the hospital back to what it was. They need experienced nurses to train, otherwise it’s like the blind leading the blind.”
Craig said that in his experience, contract negotiations and allegations of patient safety issues go hand in hand.
“If contract negotiations were not currently ongoing, I don’t expect they’d be going to the press at all,” said Craig, who related experiences at other hospitals where similar allegations regarding patient safety were made, but were not heard before or after the labor negotiation process.
Ryken said the nurses are invested in improving patient care, though it is often the union who is said to be “stirring the pot.”
“The nurses are the union,” said Ryken. “They’re the ones working in these conditions.”
Both sides have previously stated progress has been made on contract negotiations, but Williams said the areas of “patient care, nurse recruitment and retention” still need to be addressed.
When asked as to how he felt contract negotiations with the nurses were going, Craig said, “I’m optimistic.”
The hospital and nurses association meet again on Friday to continue discussions.
In an earlier version the sentence—”Similarly, six out of 12 units scheduled to work the day shift in the Telemetry Unit during that month are travelers.” Units is incorrect and has been changed to “Nurses.”