Hospital staff shortages create stress and strain for San Francisco nurses

The latest COVID-19 surge and resulting staffing shortages across The City’s hospital system are leaving health care workers stressed and...

The latest COVID-19 surge and resulting staffing shortages across The City’s hospital system are leaving health care workers stressed and strained.

“We are tired, everyone’s tired,” said Jason Negrón-Gonzales, a registered nurse who works part-time in the emergency department at Zuckerberg San Francisco General Hospital.

“There are folks who have left, and staffing is thinner. The hospital is trying to mitigate that, but we’re more short-handed than before,” he added. “Winter is normally the busiest time of year, so it’s been really hard during the holidays while we’re seeing more people with COVID.”

At least 250 staff at S.F. General were out this week due to COVID, San Francisco Health Director Grant Colfax said in a Health Commission meeting Tuesday. About 70 staff members were out at Laguna Honda Hospital.

“This year, we are challenged more (than during previous COVID waves) because we have more staff out on leave,” said Dr. Susan Ehrlich, CEO of S.F. General Hospital. “We have quite a number of staff out because they are sick with COVID or have high-risk exposure to someone who is COVID positive.”

ICUs are particularly impacted by staffing losses, Ehrlich said. “In the emergency department, we don’t open all our beds because we can’t staff them.”

Already some elective surgeries have been put on hold to keep beds open and staff available.

“We are uniquely impacted with volume at this time,” the hospital CEO said. “We are working with the other hospitals to see if we can reintroduce the idea of level-loading. We are converting as many visits as we can to telehealth right now.”

At S.F. General, nurses are picking up extra shifts to make up for colleagues out sick and doing what they can, Negrón-Gonzales said. But the sheer longevity of the COVID-19 pandemic has taken a physical and emotional toll on many.

“It’s been two years of this,” he said. “People are extending themselves and doing extra, and that works less and less as time goes on.”

As COVID-19 cases skyrocket to new highs, increasing hospitalizations are occurring and expected, even though the omicron variant is showing to be much less severe than its predecessors among those who are vaccinated.

COVID-19 hospitalizations statewide increased by nearly 59% over the last week, going to 9,279 from 5,822 on Thursday, according to state data. The California Hospital Association reported 41% of hospitals are saying they will reach critical staffing levels next week.

The surge and staffing challenges are not a surprise to those on the frontlines who have now seen multiple waves of COVID disrupt workflows and confidence in hospital staff. In September, the American Nurses Association advocated that the U.S. Department of Health and Human Services declare the nursing shortage a national crisis.

Outside of California, other COVID hotspots such as Florida and Montana are recruiting nurses from places such as the Philippines to make up for the nurse shortage.

“Understaffing is not the result of the nursing shortage, but the cause of it,” Zenei Triunfo-Cortez, a registered nurse and a president of National Nurses United, told Congressional leaders in December as the omicron wave began to surge.

Paramedic trucks outside of Zuckerberg San Francisco General Hospital. The City’s high vaccination rate is driving lower hospitalization numbers, with many patients being hospitalized for reasons other than COVID. (Craig Lee/The Examiner)

Paramedic trucks outside of Zuckerberg San Francisco General Hospital. The City’s high vaccination rate is driving lower hospitalization numbers, with many patients being hospitalized for reasons other than COVID. (Craig Lee/The Examiner)

Locally, however, hospital bed capacity has remained relatively high compared with other hotspots in California — but that’s rapidly evolving. From Dec. 31 to Thursday, hospitalizations in San Francisco increased by 64%, rising to 133 from 81 over the last week.

San Francisco’s high vaccination rate is driving lower hospitalization numbers. About 81% of residents are fully vaccinated and 56% have received a booster as of Thursday. Unvaccinated people were 10 times more likely to be hospitalized with COVID-19 compared with those who are fully vaccinated, according to data from the California Department of Public Health.

Many of the hospitalizations in San Francisco are for reasons other than severe COVID-19 illness, however. At UCSF, for example, the majority of patients with COVID-19 were admitted for other issues, such as a bone fracture, but then tested positive upon screening at the hospital, according to Dr. Jeanne Noble, director of COVID response at UCSF Parnassus Emergency Department.

As of Thursday, San Francisco and the wider Bay Area had the lowest portion of adults hospitalized with COVID and the second-highest ICU bed capacity (20.6%), compared with six other major regions across the state.

Still, health officials are preparing for scenarios where beds could be in high demand and disrupt other hospital services. And hospital staffers feel the pains of yet another personnel crisis amid a COVID surge.

On Wednesday, state public health officials extended California’s indoor mask mandate a month longer, now ending Feb. 15, in an attempt to slow down skyrocketing cases and rising hospitalizations across the state.

“This surge has hit very quickly and all health care systems need to adapt. It hit during a holiday period where staffing was down for the fact that people are off or plan time off to be with their families,” Colfax said. “I will say at this point we are continuing to see unprecedented demand and it’s clear that more needs to be done.”

sjohnson@sfexaminer.com

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