A sickout to protest understaffing in the newborn intensive care unit at County-USC Medical Center's Women's Hospital continued Monday, expanding from night-shift nurses to include 14 of 18 day shift nurses, hospital and union officials said.
The night-shift sickout entered its third consecutive night Monday as four of six nurses scheduled to work called in sick, hospital Administrator Connie Diaz said Monday evening. But 14 nurses are on duty to care for the 22 babies in the unit, she said.
Nurses say they walked out on their patients because they are fed up with working under conditions that they believe endanger the babies. They also say that they have tried unsuccessfully for months to get administrators at Women's Hospital to correct staffing problems.
Diaz did not dispute that the unit is understaffed, but said that the hospital has been trying to correct the situation. She and the protesting nurses met for about two hours Monday afternoon.
One of the things they discussed, according to Diaz, was finding ways to relieve the nurses of duties that others can perform. She said other changes suggested at the meeting would require the approval of the Board of Supervisors.
"We wanted something to change," said a nurse, who spoke on condition that her name not be used. "But no decisions were made."
Over the weekend, 16 babies were transferred to private hospitals. Monday, 22 were being cared for by a combination of management nurses, unit nurses filling in from other shifts and temporary nurses hired from nurse registries.
The unit is licensed for 48 babies, but because of the chronic shortage of qualified nurses, Diaz said, the hospital has been trying to keep the total between 30 and 35.
These babies may be premature, drug addicted or critically ill from complications of their birth. They are often on ventilators to assist breathing and multiple medications that have to be frequently monitored by nurses.
The nurses union, Service Employees International Union, filed a grievance several weeks ago on the staffing issue, which is scheduled for a hearing next Tuesday, according to Katarina Davis, union business agent. She emphasized that the sickout is not sanctioned by the union.
As evidence for the grievance hearing, Davis said she has copies of more than 25 complaints about understaffing and dangerous conditions in the neonatal intensive care unit, as well as petitions signed by virtually all nurses in the unit.
"It is not a pay issue at all," said a day shift nurse who participated in the sickout Monday. "We simply don't have enough nurses to give the babies the care they deserve. We have filed numerous complaints, we have signed petitions since July, but no one does anything about it."
The nurse said the current ratio of one nurse to four critically ill babies is so stressful that the unit loses about 75% of new nurses within six months of their hirings. As a result, the load on senior nurses is compounded by the constant need to train new people.
"What this high ratio of patients to nurses means is that (the nurse) is completely unable to provide quality care--even sub-adequate care--to the patients, and the patients suffer," Davis said. The sickout, Davis said, is a reflection of the nurses' frustration with the administration's inaction.
The state staffing standard for neonatal intensive care is one nurse to two critically ill babies. Higher ratios may be permissible for less-sick babies, but most of those at County-USC are in the sicker category, hospital officials said.
Diaz said that the neonatal intensive care unit has been plagued by management problems. Just over a year ago, a longtime nurse manager who had run the unit resigned. The replacement lasted seven months before resigning.
Diaz attributed the resignations to "something of a downward spiral" of understaffing that had affected the managers no less than staff nurses.