Nurses Increase Alarm on Unsafe ER Circumstances at a High SF Hospital

Bridget Parr has seen intensive care unit sufferers sitting in her emergency division ready room with out a nurse to look after them. These are the times when the hospital is so full that she will’t even discover a room for the sickest of the sick. 

“One of many issues that we concern as emergency room nurses, as triage nurses, is that any person goes to die,” she stated.

Parr is an emergency room nurse who has labored on the College of California San Francisco Parnassus Hospital for 20 years. In current months, the overcrowding has gotten so extreme that circumstances on the hospital have turn into unsafe, Parr stated. 

“There’s days on a standard foundation the place we now have each room, each hallway, each every thing is full,” Parr stated.

On the busiest days, the hospital’s ER looks like a warfare zone, Cost Nurse Dave Thomson stated.

“Folks wind up within the corridor spilling out, individuals are yelling, psychiatric sufferers are popping off,” stated Thomson, a 19-year veteran of the hospital. “Everybody’s stress stage is thru the roof.”

Thomson and Parr had been among the many 125 cost nurses from the UCSF Parnassus ER who despatched a petition final month to hospital management stating that they’re unable to supply protected affected person care below present circumstances. They demanded a collection of adjustments, starting from extra strong staffing and canceling elective surgical procedures to offering ample provides, together with wheelchairs and cardiac displays.

Nurses instructed The Commonplace of staggering ER wait occasions, sick individuals left sitting on hallway beds for days, untreated psychiatric sufferers endangering workers, overworked suppliers unable to supply high-quality care and clean-ups forward of auditor visits. They stated the circumstances are a results of the administration’s determination to prioritize profitable surgical procedures over sufferers stuffed into the emergency division, a lot of whom are uninsured.

“Like hospitals throughout the nation, UCSF Medical Middle continues to be impacted by the mixture of healthcare staffing shortages and excessive volumes of sufferers–many presenting with complicated care wants and behavioral well being diagnoses,” a hospital spokesperson stated in an announcement. “That scarcity impacts each hospitals and the care amenities the place we’d discharge sufferers who require continued care outdoors a specialty care hospital.”

“All through this problem, affected person security stays our high precedence,” the assertion learn.

Nationwide Disaster Hasn’t Spared Prestigious Hospital

Hospitals throughout California—and the nation—have struggled with overcrowding, inflicting ripple results throughout the emergency response system, together with lengthy ambulance delays. Whereas the circumstances at UCSF are removed from distinctive, nurses there stated they’re particularly annoyed that hospital directors have appeared unwilling to deal with workers’s considerations about degrading circumstances.

It’s been six weeks for the reason that cost nurses submitted their petition, however the administration nonetheless has not responded.

In the meantime, UCSF nonetheless has some of the aggressive medical colleges within the nation, and the hospital ranks nationally for specialties resembling neurology and neurosurgery. It’s a stark juxtaposition from the determined circumstances workers describe within the every day grind of the emergency division.

Hospital management has been working for a lot of months to deal with the challenges introduced on by staffing shortages, excessive affected person masses and treating quite a few individuals on psychological well being holds, UCSF’s assertion stated. The hospital has successfully addressed acute wants by maximizing hospital staffing, enhancing workflows and allocating workers to discharge sufferers extra effectively, it added.

A pedestrian walks previous UCSF Helen Diller Medical Middle on the Parnassus Heights campus in San Francisco on March 23, 2023. | Justin Katigbak for The Commonplace

Thomson remembers being stunned when UCSF first began placing sufferers on beds within the emergency division hallway eight years in the past.

“I used to be like, are we allowed to do that?” he stated. However over time, the apply has turn into normalized. “Now, we simply have, like, 20 beds within the hallway.”

Sufferers are put in hallway beds once they’re sick sufficient to require care, however no rooms can be found within the basic wards upstairs from the emergency division. Coronary heart assault, stroke and Covid sufferers can all find yourself on hallway beds, Thomson stated. The watch for a room can last as long as 4 days.

That’s days spent in a hallway that smells like feces and vomit and sitting on a mattress that isn’t outfitted with the oxygen, suction or monitoring tools that suppliers must look after a affected person, Thomson stated.

“It’s simply one other collection of injustices and horrors,” Thomson stated. “Why do I even do that anymore? It’s unattainable to supply excellent care to anyone below these circumstances.”

A Selection From the High

Parr stated the UCSF administration has made a acutely aware determination to permit ER overcrowding whilst elective surgical procedures have continued on the hospital.

“The surgical procedures herald extra money than emergency room sufferers,” Parr stated. Many ER sufferers are uninsured, which isn’t the case for elective surgical procedures, she stated.

“There was a time period the place [the administration] favored guilty overcrowding on the Covid surges. These days are executed,” she stated. “That is only a practical manner of how they need to run.”

When outdoors regulators come to evaluate circumstances within the ER, the hospital management will get a warning forward of time that auditors are on their manner.

“Every little thing is cleaned up once they get there,” Thomson stated. “There’s no beds within the hallways.”

Lauren Nunez (left), Bridget Parr (center) and Dave Thomson (proper ) are a part of Nationwide Nurses United and work at UCSF Parnassus. | Justin Katigbak for The Commonplace

Lauren Nunez is a nurse in UCSF’s organ transplant unit, the place she cares for sufferers who’ve undergone main surgical procedures. When the emergency division is overflowing, ER sufferers get despatched to her ward in a determined bid to discover a mattress anyplace within the hospital.

However Nunez’s transplant sufferers require a excessive stage of consideration. That’s why laws require that every nurse can solely be liable for a most of 4 sufferers, she defined. When new ER sufferers are positioned below her care, it typically throws that ratio off, Nunez stated.

“You have got this ethical misery the place you’re simply overwhelmed and drained,” Nunez stated. “You need to present the best stage of care that you can, however you bodily can’t do it as a result of you may’t be in 5 locations directly.”

“We’re required to adjust to California Division of Public Well being necessities, together with staffing ratios and the usage of area,” the hospital responded in an announcement.

Thomson has labored at UCSF for practically 20 years, and his emotions in regards to the establishment are sophisticated. He loves that individuals can arrive on the hospital coping with extremely uncommon illnesses, and UCSF has specialists on workers who can resolve their issues. But it surely’s onerous to sq. that with the disrepair of the emergency division.

“I’m unhappy in regards to the scenario,” Thomson stated. “Most of us are in well being care due to service to others, we’re making an attempt to assist individuals. But it surely’s unattainable to do on this atmosphere.”

Noah Baustin might be reached at [email protected]