Most nurses working in the emergency room at Zuckerberg San Francisco General Hospital are per diem nurses, meaning they do not get standard benefits. <ins>(Kevin N. Hume/S.F. Examiner)</ins>

Most nurses working in the emergency room at Zuckerberg San Francisco General Hospital are per diem nurses, meaning they do not get standard benefits. (Kevin N. Hume/S.F. Examiner)

Hundreds of S.F. nurses left out of city’s emergency sick leave policy

In April, shortly after the COVID-19 pandemic hit, San Francisco Mayor London Breed signed an emergency ordinance drafted by Supervisor Gordon Mar that grants permanent city employees up to 80 hours of additional paid sick leave. It sounds good on paper, and is a smart public health decision; no one should feel pressured to go to work in order to make ends meet if they’re feeling sick, particularly during a global pandemic.

But in implementation, the ordinance has left out one large group of frontline workers. More than 500 per diem nurses, who according to the Department of Emergency Management account for approximately 25% of the nursing staff at the Department of Public Health, are exempt from this time off. (SEIU 1021 estimates that number to be closer to 40% of the nursing staff workforce.) For months, they’ve fought to be included. Now, after appealing to the Department of Human Resources to no avail, they’re taking the issue up with the Board of Supervisors.

There are hundreds of per diem nurses — nicknamed “P103s” in reference to their human resources classifications — employed by the Department of Public Health. They work across all sectors, in hospitals, clinics, and conducting COVID tests. Most of the nurses in the emergency room at Zuckerberg San Francisco General Hospital, which was understaffed even before the pandemic hit, are per diem nurses.

Unlike permanent staff nurses with the Department of Public Health, per diem nurses don’t get standard benefits. Sick leave accrues at a much lower rate, and they don’t get retirement benefits, vacation time or health insurance. But they are paid at a higher rate — as much as 25% more than their coworkers — and they’re awarded more flexibility with their hours. For those reasons, many nurses choose the per diem jobs intentionally, forgoing the benefits for the higher hourly rate.

But when the pandemic hit, the lack of benefits became a major issue. As the stress of the job increased, the lack of paid time off to recover emotionally, take care of kids out of school, or deal with a possible COVID-19 exposure became a huge challenge. And when permanent nurses took their allotted time off, per diem nurses were left to pick up the slack.

“We’re exhausted, we’ve had no time off, and we haven’t stopped since the pandemic started, because we don’t have the reprieve,” a per diem nurse told the Examiner, requesting anonymity lest their statement affect their job. “It makes an already dangerous situation more dangerous. It’s not safe, it’s not fair. You have tired nurses covering staffing holes on the front lines, potentially getting exposed, but not at liberty to take a day off.”

In July, per diem nurses wrote a letter to the Department of Human Resources through their union, SEIU-1021. In it, they stated, “In denying us the 80 hours of COVID-19 sick time, DHR has overlooked our ability to stay home if we become sick with COVID-10 which can assure our patients’ safety in a time of great risk. The 80 hours of COVID-19 sick time are meant to ensure the safety of the workforce, but that workforce overwhelmingly includes workers who have been denied this very protection.”

Two months later, the Department of Human Resources denied their request, stating that per diem nurses could always apply to become permanent employees, though it acknowledged that the department “cannot guarantee that all interested P103s will receive an appointment.”

The Department of Human Resources did not respond to a request for comment by press time.

Having exhausted other options, the nurses have now brought the issue to the Board of Supervisors. A letter is circulating, asking for supervisors’ support in their request to overturn the Department of Human Resources’ decision.

“To be clear, we are not asking to change our job status or obtain union-negotiated benefits,” it reads. “Rather, we are asking to be allocated the same emergency response sick leave allocation that The City pays to all regularly scheduled workers.”

As of Tuesday afternoon, Supervisors Matt Haney, Hilary Ronen, Shamann Walton and Dean Preston had signed on.

“These nurses have been working hard, long hours saving lives,” Haney told the Examiner. “Many have been on the job for years. The protections afforded to other health care workers exist so that they can protect their own health and that of their families, colleagues and their patients. It’s not only unfair, but it’s dangerous to exclude them from these critical worker protections.”

The per diem nurses advocating for their rights hope that with the Board’s support, the Department of Human Resources will reverse its decision.

But in the meantime, COVID-19 continues its latest surge. As of Dec. 27, the California Department of Public Health reports 67,573 health care workers statewide have contracted COVID-19, and 251 have died.

Got a tip or a story idea? Shoot me an email at

Editor’s Note: This story was updated to clarify that SEIU 1021 and city health officials disagree on the percentage of per diem nurses employed by The City.

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