For San Francisco’s public-sector registered nurses, this year’s Nurse’s Week was a paradox. On May 10, nurses from throughout the city gathered in the cafeteria of San Francisco General Hospital to celebrate Florence Nightingale’s birthday by bestowing gratitude and appreciation on nurses selected by their colleagues. Martha Hawthorne, long-time Castro-Mission Health Center public health nurse, was one of those honored.
Upon acceptance of the award, Martha said that city nurses would be most appropriately honored by getting a fair contract. The next day a smaller gathering of nurses, including Martha, was back across the bargaining table from city negotiators who have proposed significant financial and working condition concessions. Decreased compensation threatens the future of nursing in the public sector by impairing recruitment and retention of highly-skilled registered nurses. Working conditions concessions are even more broadly harmful and unacceptable; it is both risky for the nurses and increases the likelihood of adverse outcomes for those we care for.
San Francisco DPH nurses care for the city, quite literally, and with great pride. We are also proud of San Francisco’s historically progressive record on public health. Immigrant pregnant mothers are not interrogated by immigration authorities before giving birth. Public health nurses don’t require insurance company pre-authorized visits before teaching self-care to elderly residents of downtown SROs. The quality of care given by Jail Health nurses is no less than that given to someone living in a nice house by the city’s home health nurses of Health-at-Home. Laguna Honda, one of the last municipal long-term care centers, has a beautiful new campus and San Francisco General Hospital is being noisily rebuilt thanks to voter-approved bond measures. But nice buildings and well-conceived health programs don’t care for the ill and injured, nurses do.
Nurses are professionally pragmatic; we don’t offer false hope. Patient advocacy requires great patience. This is especially true in the public sector, where the population we serve is likely to suffer from intractable extreme poverty and social marginalization. The poor don’t require less health care than wealthy individuals, in fact they require more. It’s not always pretty, but we know that if we are given the human resources to do so we will continue to deliver excellent patient care.
The complexity and intensity of patient care seems to be rising far faster than inflation. Aside from the issues of fairness and quality care, nurses simply don’t have enough hours in the day to do the repair our over-burdened fractured health system requires. Activist nurses are needed to save lives by preserving and expanding health care access. While universal single-payer health-care is elusive nationally, California nurses are optimistic we can do better here. Women’s health is under attack nationally by fanatics who would deny cancer screening and care for rape survivors.
Nurse’s Week is over and we have a lot to do, let’s start with a fair deal for DPH nurses. It's not to much to ask for and we will all benefit.
Sasha Cuttler, RN, is a San Francisco public health nurse.