San Jose nurses say hospital leaders undermine patient care

Santa Clara County nurses who keep oxygen flowing to people with spinal cord and brain injuries already work in a tense environment, but some fear their jobs are about to get harder.

Three nurses in the acute respiratory rehabilitation unit at Valley Medical Center — who spoke to San José Spotlight under condition of anonymity due to fear of retaliation — allege county hospital management is trying to increase patient ratios to unsafe levels, from two patients per nurse to as many as five patients per nurse. That means less nurses out on the floor and fewer hands to save immobilized people from choking in bed.

It captures an ongoing disconnect between county hospital workers and leaders despite appearing to sort out key disagreements with a labor contract in May — a symptom of county efforts to reconcile a $150 million budget deficit this year.

“We’re having to vocalize and justify our reason for the current staffing levels when we’ve never had to do that before,” one respiratory rehabilitation nurse told San Jose Spotlight.

Nurses said hospital management shared the proposed staffing changes in a February letter and initially sought to implement the changes in March. That window has come and gone, but nurses claim management continues to push for the changes in meetings and through interactions with workers on the unit’s floor.

A Santa Clara Valley Healthcare spokesperson said the agency doesn’t make staffing changes that go against the state.

“These claims are not accurate. The safety, care and well-being of our patients is our No. 1 priority. All hospital staffing levels, including at VMC’s respiratory rehabilitation unit, are aligned with the state’s rules and regulations,” a spokesperson told San José Spotlight.

Helping patients 

The respiratory rehabilitation unit has 10 patient beds and runs on a ratio of two patients per nurse, with additional support staff. Each of the unit’s three shifts see anywhere from 10-15 nurses on the floor. The unit relies heavily on teamwork, according to workers who say they’ll often walk by the room of another nurse’s patient and hear gurgling from the hallway — meaning a lung secretion needs to be suctioned — or notice the patient needs to be repositioned in bed for safety. Paralyzed patients also can’t call for help like other patients. This create intense stakes and pressure as nurses wean paralyzed people off ventilators.

“Our patients need a high level of critical nursing care and support as they go through this difficult ventilator weaning process, often alone,” one nurse told San José Spotlight. “They can not do anything for themselves, they are paralyzed, often from the neck down. If they somehow become separated from the ventilators for mere moments they face immediate danger.”

The county initially proposed changing staffing ratios for nurses who wean patients off ventilators, according to the nurses, but walked it back because it wouldn’t align with state law.

“But even the patients that aren’t on the ventilator that come to our unit are just as high risk, if not sometimes higher risk, and have more needs than the ones on ventilators,” another nurse told San José Spotlight. “Our patients can’t cough. So when they’re off the ventilator and are eating, they are at very high risk of aspiration (food entering the airways). They get a diet started when they’re off the ventilator, they get pneumonia, then they’re put back on the ventilator.”

Nurses said hospital management is also ignoring their own expertise on the level of care their patients need. Nurses in the unit use a staffing matrix based on nurse charting to help them decide how many nurses they need on the floor, minimum, based on the level of patients’ sickness and the amount of time for care they need. But the nurses allege management is undermining the tool and challenging whether patients need as much time as nurses believe they do.

“They believe based on their own review of patients’ charts that the acuity of the patient is being calculated wrong and that the patient is not that sick — their needs are not as high as what the nurses believe,” one nurse told San José Spotlight. “We’re the ones who actually know how many minutes and hours care takes, versus management who like to walk around from many many feet away, never entering a patient’s room, and tell us that a patient is more stable and requires less of our time.”

Quadriplegic patients in the unit’s care often can’t move anything except their neck — requiring nurses to bathe them and help them eat. It can take 45 minutes to an hour to safely feed a patient, nurses say.

“Those are all tasks that can be listed quite easily on a chart, but the time it takes to complete those tasks is not captured in the scoring system,” the same nurse told San José Spotlight.

Remaining concerns

Valley Medical Center — one of the only options for poor and uninsured patients to get care in the Bay Area — has endured years of scrutiny over worker shortages, outdated equipment and monthslong waits for crucial scanning and diagnoses at VMC, a problem made worse by the COVID-19 pandemic.

The problems plaguing the nurses come after county leaders and the nurses’ union avoided a second nurse strike in May — reaching a deal on pay and worker safety after a walkout rocked the region’s health system more than a month earlier. Nurses and county leaders were at odds over pay raises, worker safety and a controversial proposal to float nurses between different hospitals. The dispute reached a breaking point in April when thousands of nurses went on strike — forcing the county to spend more than $20 million on traveling nurses to keep hospitals running. The strike ended after three days as contract talks continued behind closed doors.

The deal grants nurses a 15% compounded raise over four years, though county nurses had previously asked for 15% over three years. The proposal to float nurses between hospitals was dropped.

But concerns remain for the respiratory rehabilitation nurses.

“If they changed our ratio to five patients, and if there’s not a nurse intervening with a patient in time, it could lead to respiratory distress and poor patient outcomes,” one nurse told San Jose Spotlight. “A lot of the newer nurses are already looking for other jobs.”

Contact Brandon Pho at [email protected] or @brandonphooo on X, formerly known as Twitter.