Nurse Rachel Cohen Cepeda knows staff members at the University of California San Francisco Medical Center who got their heads slammed to the floor, were stabbed with pencils and smashed into glass so hard that it broke. Cohen Cepeda, a 30-year nursing veteran, works at UCSF Mount Zion in the behavioral unit.
She says that patients in the psychiatric ward there experience extreme distress, including screaming, urinating on the floor and hearing voices. And she says that when there aren’t enough nurses working, that distress can turn to violence against staff and other patients, as she’s witnessed in the past.
“It’s horrible,” Cohen Cepeda told The Standard.
Cohen Cepeda spoke at a rally of dozens of nurses Tuesday outside the UCSF Mission Bay facility. Short staffing is degrading patient care and leading to a spike in violence against health care workers, nurses from across UCSF proclaimed at the rally. The worker shortage stems from a hiring freeze the hospital put into effect in May 2023, according to a statement from the California Nurses Association, the nurses’ union.
UCSF has violated legally required nurse-to-patient ratios, Cohen Cepeda said, and nurses have filed hundreds of reports documenting unsafe conditions stemming from that deficit at all three UCSF campuses, Mission Bay, Mount Zion and Parnassus, according to the union.
The hospital froze hiring from May through Aug. 31, 2023, though the freeze “intentionally excluded roles critical to delivering safe, high-quality care in compliance with staff-to-patient ratios,” a UCSF spokesperson said in a statement. “Nursing ratios are mandated by the State of California, and UCSF prides itself on meeting or exceeding those state-mandated ratios.”
Tuesday's rally came seven months after 125 charge nurses from the UCSF Parnassus ER petitioned hospital leadership, stating that they were unable to provide safe patient care due to short staffing and other issues. At that time, nurses shared stories of chaotic conditions in the UCSF ER, including sick people left in hallway beds for days and untreated psychiatric patients endangering staff.
Meanwhile, UCSF has been in the process of expanding in recent months and is poised to purchase two other San Francisco hospitals. Amid that expansion, some patients have seen their medical bills balloon, including one who took the medical center to court over mysterious fees and won.
While the hiring freeze ended on Sept. 1, Cohen Cepeda said the hospital has failed to kick off the type of robust hiring she thinks it needs. While the freeze is over, “now I call it a hiring drip,” she said.
Problems Have Plagued ERs Across the City and the Country
San Francisco’s emergency rooms have struggled to handle the demands of incoming patients in recent years. In 2022, every hospital in the city failed to meet targets for offloading patients from ambulances fast enough to avoid jamming the city’s emergency response. That left many waiting too long for an ambulance to pick them up.
Nurses across the country are at far higher risk of workplace violence compared with most other professions, according to the Centers for Disease Control and Prevention (CDC). The agency found that nurses are more than four times more likely than the average American worker to be assaulted at work.
At UCSF, some of that workplace violence stems from hospital security failing to keep nurses safe, advocates said at the rally.
Matthew Jones, a nurse at the Parnassus Intensive Care Unit, described an interaction with a patient who was so agitated that nurses called for hospital security, who told Jones to call for UCSF police officers. But once two security guards and two officers were on hand, the officers refused to help nurses restrain the patient so staff could administer antipsychotic medication, Jones said. The officers said they could not physically bring a patient to a bed unless that patient first harmed someone, Jones said.
“The nurses and I found this extremely distressing,” Jones said. “Who has our back?”
“Providing a safe and supportive workplace for every employee is one of our core values at UCSF Health, which we strive to achieve through both our staffing models and dedicated workplace safety and wellness programs,” the hospital's statement said. Its violence prevention program meets state regulations, and in 2022, the hospital launched a committee on workplace violence, the statement said.
UCSF nurse Rosa Villarroel said hospital leadership has prioritized bonuses for management over investing in nursing and security staff, with shortages persisting for two years.
“All they seem to care about is saving money,” Villarroel said.