LANCASTER — A group of Antelope Valley Hospital registered nurses denounced a state-approved waiver that allowed the hospital to increase nurse-to-patient ratios amid a nationwide surge of COVID-19 cases and called for it be rescinded.
The state-mandated nurse-to-patient staffing ratios provide assurance for nurses and patients that safe care will be delivered, the nurses said.
The California Department of Public Health recently announced that hospitals may apply for a waiver of these ratios in cases of short staffing. Nurses say the hospital’s decision is premature, and that the hospital did not take sufficient preventative measures to protect patients from short staffing.
“We’re here as nurses to advocate for our patients and for ourselves, and our safety and the safety of the community,” Ruth Godde, an Intensive Care Unit registered nurse, said during a protest with about 12 nurses conducted Wednesday morning on the sidewalk along 15th Street West in front of the hospital.
“We’re very concerned about being out of ratio, that means that the nurse has more patients than she would normally have.”
Telemetry nurses, who care for patients in critical condition who need constant cardiac monitoring, typically care for patients on a 4-to-1 ratio. The waiver will allow that to increase to five patients each. The progressive care unit, or PCU, which is a step down from the ICU, normally has a 3-to-1 ratio. The waiver will allow a 4-to-1 ratio, Godde said.
“We just want the community to know that we’re going in to care for you and your family members in our community,” Godde said. “As you go out to celebrate the holidays this December, be careful; wash your hands. Be aware that we are at capacity at the hospital. We’re here to care for you but we also want to care for ourselves. A lot of us are getting sick; our family members are getting sick, But we’re going in; we’re going to care for you.”
Godde called on the AV Hospital administration to do everything possible to keep nurses within the state-mandated ratios for the safety of patients and staff.
“Our nurses have been hard at work amidst the COVID pandemic for the past nine months, warning the hospital that the surge would happen. The surge is here,” Courtney Hayes, a labor rep at the California Nurses Association said at the protest. “Nurses and the community are getting sick and they’re suffering. A waiver is not going to help anybody.”
The California Nurses Association represents nearly 1,000 nurses at AV Hospital.
AV Hospital released the following statement in response to the nurses’ concerns:
“Currently the entire state is experiencing a surge of patients. Antelope Valley Hospital, in particular, are seeing an increase mainly related to the pandemic, but also due to the addition of trauma patients, considering we’re the area’s only trauma center. As a hospital, we need to take necessary measures to continue caring for our patients. Due to the state of emergency, AVH received temporary permission from the CA Dept of Public Health for program flexibility. This is a temporary measure.”
The state approved a temporary staffing ratio waiver for telemetry patients going from a 1-to-4 to a 1-to-5 ratio on an as-needed basis, a spokesperson confirmed. PCU or ICU ratios have not changed. In addition, a hospital spokesperson said it is not a blanket change.
“We’re assessing shift to shift,” the spokesperson said.
The hospital has more than 100 traveling nurses on staff. They have added additional nurses this year, compared to last year
Nurse Cindy Gillison said for the past nine months the nurses have asked administration for guidelines or a plan for the when the COVID-19 surge hit.
“Again and again we were told there was no need for a plan,” Gillison said. “There was no need because COVID was going to go away, they said. It’s not. The surge is here and the hospital is unprepared to deal with it. The way they went around to do it is to go ahead and apply for this waiver taking nurses out of ratio.”
Gillison added taking nurses out of ratio is not the answer.
‘There are plenty of nurses in this hospital that are out of patient care,” Gillison said. “They can be brought in to the bedside to help us care for these patients. The safety of these patients is at risk. These patients are sick; the nurses are sick. We have 100 nurses currently out on medical illnesses, most of them with COVID. We have family members that are sick. We need safe patient care. The hospital has not exhausted all measures to provide that.”
For example, Gillison said the hospital could cancel non-essential services. The hospital could also bring in nurses who work in departments out of patient care to help deliver medication, turn patients, feed patients, or other tasks.
“We’re asking the community to please stand behind as we try to care for your loved ones,” she said. “Stay home. Stay safe. Support us as we try to help you.”
Gillison called for the waiver the hospital received from the California Department of Health to be revoked immediately.
Maria Altamirano, California Nurses Association chief nurse representative, said AV Hospital is the only Level II trauma center in the Antelope Valley.
“We serve a square mileage as big as the state of Delaware, serving approximately over three counties,” Altamirano said.
Altamirano added they knew there would be a nursing shortage. She said the hospital implemented the 5-to-1 ratio Thanksgiving night but did not apply for the wavier until Sunday. The state granted the waiver on Monday.
“We ask administration — hands off our ratios so that we can continue to provide safe and adequate care to our patients,” Altamirano said. “To our community, we ask you to please, please stay at home. Wash your hands; wear your masks so that way we can continue to provide for your family. So that we can continue to stay safe as well as we go home to our families.”
Nurse Erick Fernandez, who works in the Emergency Room, compared the department to a New York City Emergency Room.
“There’s places that are blocked off because it’s full of COVID patients,” Fernandez said. “If it’s unsafe, if these people are out of ratio, they shouldn’t have three ICU patients, four ICU patients. That takes care away from other people. You wouldn’t want it to be your family member getting subpar care — not because we want to deliver that, but because we don’t have enough time to take care of your patients.”