Nurses raise alarm on unsafe ER conditions at a top SF hospital

Bridget Parr has seen intensive care unit patients sitting in her emergency department waiting room without a nurse to care for them. Those are the days when the hospital is so full that she can’t even find a room for the sickest of the sick. 

“One of the things that we fear as emergency room nurses, as triage nurses, is that somebody is going to die,” she said.

Parr is an emergency room nurse who has worked at the University of California San Francisco Parnassus Hospital for 20 years. In recent months, the overcrowding has gotten so severe that conditions at the hospital have become unsafe, Parr said. 

“There’s days on a normal basis where we have every room, every hallway, every everything is full,” Parr said.

On the busiest days, the hospital’s ER feels like a war zone, Charge Nurse Dave Thomson said.

“People wind up in the hall spilling out, people are yelling, psychiatric patients are popping off,” said Thomson, a 19-year veteran of the hospital. “Everyone’s stress level is through the roof.”

Thomson and Parr were among the 125 charge nurses from the UCSF Parnassus ER who sent a petition last month to hospital leadership stating that they are unable to provide safe patient care under current conditions. They demanded a series of changes, ranging from more robust staffing and canceling elective surgeries to providing sufficient supplies, including wheelchairs and cardiac monitors.

Nurses told The Standard of staggering ER wait times, sick people left sitting on hallway beds for days, untreated psychiatric patients endangering staff, overworked providers unable to provide high-quality care and clean-ups ahead of auditor visits. They said the conditions are a result of the administration’s decision to prioritize lucrative surgeries over patients stuffed into the emergency department, many of whom are uninsured.

“Like hospitals across the country, UCSF Medical Center continues to be impacted by the combination of healthcare staffing shortages and high volumes of patients–many presenting with complex care needs and behavioral health diagnoses,” a hospital spokesperson said in a statement. “That shortage impacts both hospitals and the care facilities where we would discharge patients who require continued care outside a specialty care hospital.

“Throughout this challenge, patient safety remains our top priority,” the statement read.

Hospitals across California—and the country—have struggled with overcrowding, causing ripple effects across the emergency response system, including long ambulance delays. While the conditions at UCSF are far from unique, nurses there said they are especially frustrated that hospital administrators have appeared unwilling to address staff’s concerns about degrading conditions.

It’s been six weeks since the charge nurses submitted their petition, but the administration still has not responded.

Meanwhile, UCSF still has one of the most competitive medical schools in the country, and the hospital ranks nationally for specialties such as neurology and neurosurgery. It’s a stark juxtaposition from the desperate conditions staff describe in the daily grind of the emergency department.

Hospital leadership has been working for many months to address the challenges brought on by staffing shortages, high patient loads and treating numerous people on mental health holds, UCSF’s statement said. The hospital has effectively addressed acute needs by maximizing hospital staffing, improving workflows and allocating staff to discharge patients more efficiently, it added.

Thomson remembers being surprised when UCSF first started putting patients on beds in the emergency department hallway eight years ago.

“I was like, are we allowed to do this?” he said. But over the years, the practice has become normalized. “Now, we just have, like, 20 beds in the hallway.”

Patients are put in hallway beds when they’re sick enough to require care, but no rooms are available in the general wards upstairs from the emergency department. Heart attack, stroke and Covid patients can all end up on hallway beds, Thomson said. The wait for a room can last up to four days.

That’s days spent in a hallway that smells like feces and vomit and sitting on a bed that isn’t outfitted with the oxygen, suction or monitoring equipment that providers need to care for a patient, Thomson said.

“It’s just another series of injustices and horrors,” Thomson said. “Why do I even do this anymore? It’s impossible to provide good care to anybody under these circumstances.”

Parr said the UCSF administration has made a conscious decision to allow ER overcrowding even as elective surgeries have continued at the hospital.

“The surgeries bring in more money than emergency room patients,” Parr said. Many ER patients are uninsured, which is not the case for elective surgeries, she said.

“There was a period of time where [the administration] liked to blame overcrowding on the Covid surges. Those days are done,” she said. “This is just a functional way of how they want to run.”

When outside regulators come to review conditions in the ER, the hospital leadership gets a warning ahead of time that auditors are on their way.

“Everything is cleaned up when they get there,” Thomson said. “There’s no beds in the hallways.”

Lauren Nunez is a nurse in UCSF’s organ transplant unit, where she cares for patients who have undergone major surgeries. When the emergency department is overflowing, ER patients get sent to her ward in a desperate bid to find a bed anywhere in the hospital.

But Nunez’s transplant patients require a high level of attention. That’s why regulations require that each nurse can only be responsible for a maximum of four patients, she explained. When new ER patients are placed under her care, it often throws that ratio off, Nunez said.

“You have this moral distress where you’re just overwhelmed and tired,” Nunez said. “You want to provide the highest level of care that you know that you can, but you physically can’t do it because you can’t be in five places at once.”

“We are required to comply with California Department of Public Health requirements, including staffing ratios and the use of space,” the hospital responded in a statement.

Thomson has worked at UCSF for nearly two decades, and his feelings about the institution are complicated. He loves that people can arrive at the hospital dealing with incredibly rare diseases, and UCSF has specialists on staff who can solve their problems. But it’s hard to square that with the disrepair of the emergency department.

“I’m sad about the situation,” Thomson said. “Most of us are in health care because of service to others, we’re trying to help people. But it’s impossible to do in this environment.”