Santa Clara County nurses decry staffing shortages amid hiring freeze, fiscal challenges

As they brace for more system-wide financial cuts to come, nurses at Santa Clara County’s four public hospitals are sounding the alarm about chronic staffing shortages they say are already impacting patient care.

“When you push the call light and somebody doesn’t respond in time, there’s a chance (a patient) might take a risk,” Allan Kamara, the vice president of the Registered Nurses Professional Association, said, explaining that patients who aren’t supposed to get out of bed without assistance could fall and hurt themselves.

The union, which represents 4,500 nurses in the county-owned Santa Clara Valley Healthcare system, is holding a “Day of Action” on Tuesday, calling on the county to end its several years-long hiring freeze.

The request comes as the county is preparing for deep fiscal hardship due to President Donald Trump’s signature budget bill, which slashes $1 trillion from the federal Medicaid program over the next decade. More than 50% of the Santa Clara Valley Healthcare system’s annual revenues come from Medi-Cal — California’s Medicaid program for low-income and disabled individuals. The county is expected to lose $223 million due to Trump’s bill this fiscal year, leading local officials to come up with $200 million in cost savings for the health care system.

Susie York, the union’s president who has worked as a medical-surgical nurse at Valley Med for the last nine years, fears what a combination of understaffing and changes to Medicaid will bring to the hospital.

New work requirements that determine eligibility for Medicaid will go into effect next December — potentially costing several million California residents their health care coverage. Without insurance, York said that patients will likely end up treating the emergency room as their primary care doctor, leading to an influx of demand on health care workers.

“We’re already being pushed to the limit and I think it’s going to be catastrophic when we get into the new year,” she said. “I’m honestly scared.”

But problems are already persisting — and have been for many years, York said. The county is staffing its hospitals at the “bare minimum,” according to the union president. Both York and Kamara also allege that the county sometimes attempts to disregard or “manipulate” patient classifications that dictate how sick a patient is and how many nurses should be tending to them. When nurses have more patients, they said that ultimately impacts patient outcomes.

“Certain patients, you have to be in the room longer, you’re hanging multiple antibiotics, you’re doing wound care or assessing them, they could go downhill,” York said. “They could get really sick and you’re not picking up on those cues because you haven’t been in the room long enough.”

County Executive James Williams said in an interview that California has “some of the nation’s strictest regulations and rules” when it comes to staffing ratios and has additional processes outlined in its labor agreement with the nurses union.

“The county is of course going to continue to comply with both state regulations and our contracts, but most importantly consistent with our foremost obligation to patient care and patient quality,” he said.

Kamara, who has been a trauma nurse at Valley Med for over a decade, said that nurse staffing shortages have become “normalized” in their field.

Following the COVID-19 pandemic, more nurses are feeling burnt out and leaving the industry, putting even more pressure on the system. Working in Valley Med’s Level 1 trauma center — which treated the most trauma patients in the entire state last year — the images of gun shots, motor vehicle crashes and severe burns often stay with them long after they’ve clocked out, Kamara said.

Nurse staffing shortages, though, don’t just impact patients, they impact the safety of health care workers too.

“If you’ve waited two, three hours in the waiting room and nobody is helping you and you’re in pain, there’s more of a chance you can become agitated,” Kamara said. “And when you’re agitated, that’s a recipe for you to assault the health care worker.”

Kamara is among the many health care workers across the nation who have experienced an uptick in violence in recent years while trying to treat patients. Last October, Kamara, who is 6′ 2″, was attacked by a combative patient who started throwing punches and eventually hurled a chair at the nurse. As he sought to restrain the patient and ensure no one else got hurt, Kamara tore his left rotator cuff. A year later, he says he’s only about 60% back to normal.

Williams, the county executive, acknowledges that the cuts and consolidations the county is currently examining is difficult, but the reality is that they’re “not going to be able to operate the way as we were before.”

“We are undoubtedly facing an extraordinary fiscal challenge, and that is going to call upon our staff to make additional sacrifice and that’s a hard thing, we recognize that,” he said. “This is going to be part of ongoing conversations with our county organization over the next several years as we continue to face these fiscal challenges that have been foisted upon us by the really callous and damaging decision coming from Washington, D.C.”