Dissonant realities in an underresourced setting
OPINION On Nov. 29, Department of Public Health nurses once again found ourselves in the San Francisco Chronicle. Forecasting a budget deficit that prompted the mayor to implement a hiring freeze, the article alleged the shortfall "stems in part from a jump in the number of police officers and nurses on the city payroll and hefty pay raises doled out to those professions." "It's our fault again," a nurse colleague uttered with a sigh.
Her remark needs to be placed in the context of the dissonant realities in which health department nurses work. On the one hand, market forces and a national nursing shortage have forced the city to make some improvements in nurse compensation. On the other hand, we work in an underresourced setting where we find it challenging to care for our patients adequately and keep ourselves intact in the process.
Truthfully, most nurses feel we earn our wages. We work on our feet for 80 percent of our shifts, in ergonomically difficult settings. We sometimes serve as nurse, clerk, and engineer simultaneously due to understaffing. We often forgo our full meal breaks. We increasingly suffer injuries, some permanent. Some of us acquire occupational infections.
But far worse is the soul-corroding distress we experience when we cannot meet our patients' needs or our professional or ethical standards due to short staffing, a broken system, and decisions made by people remote from the realities of direct patient care. We believe that our patients, many of whom are marginalized in our society, deserve the care, compassion, and opportunities for healing that we try to afford them.
Enter the budget process. Every year vital services are slated to be cut. For three years our hospital interpreters, the lifeblood of the hospital, were on the chopping block. Every spring, health care workers, unions, and the community spend hours at City Hall, testifying to the harm that would be done to San Franciscans, particularly the poor and the ill, should hospital services be cut. Regrettably, neither the mayor nor the city controller is required to join the supervisors in hearing this heartbreaking testimony. Through the work of the supervisors, their staff, community coalitions, and an annual outpouring of public concern, some services are saved. But the yearly threats and fights are exhausting and create a cynical illusion that the process is only a political game.
Additionally, not reflected in the budget process is the accumulated erosion of DPH services and infrastructure: the equipment that is not replaced, the vacant positions that remain unfilled or "frozen," etc.
All of these conditions existed when Mayor Gavin Newsom announced the inauguration of Healthy San Francisco, a program created to provide health care to tens of thousands of uninsured San Franciscans through the Health Department. The program's ability to succeed is based on the department's plan to hire more clerks, pharmacists, nurses, and providers. The fact that the mayor was one of the program's architects, along with Sup. Tom Ammiano, unions, and community participants, suggests that access to health care is a policy and budget priority for his administration.
But is it? After the mayor's advocacy for HSF, it is confusing to read about a hiring freeze and the budget deficit being blamed on nursing hires and salaries. Health care workers and the public need to know where this administration stands. 2
Mary Magee is a registered nurse who has worked for San Francisco General Hospital for 20 years.