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Politics & Policy

Nurses say they’re assaulted constantly at San Francisco public hospitals

A group of people protest on steps, some holding signs and expressing vocal enthusiasm.
City nurses grilled health department officials on Tuesday about safety at the city’s public hospitals. | Source: Estefany Gonzalez/The Standard

City nurses excoriated Department of Public Health officials on Tuesday and warned that public hospital systems across San Francisco were struggling under the weight of severe understaffing that has led to a spate of troubling incidents, which include physical and verbal assaults from patients.

Nurses from both Zuckerberg San Francisco General and Laguna Honda hospitals, along with community clinics, reported a chaotic working environment that they said has jeopardized their ability to provide quality patient care. 

“Our system is impacted with folks who need care,” said Jennifer Esteen, a nurse who has worked with the city for 14 years and specializes in helping those with severe mental health issues, in an interview. “The working conditions are tough.”

The complaints come as the nurse’s union, Service Employees International Union Local 1021, is in active contract negotiations with the city and is pleading with officials to beef up staffing. 

A nurse in blue scrubs stands by a wooden bench, her name badge visible.
Brittany Hewett speaks during a Health Commission meeting at San Francisco Department of Public Health (SFDPH) on Grove Street in San Francisco on Tuesday. | Source: Estefany Gonzalez/The Standard

Last week, over 20,000 workers struck tentative deals with the city, winning pay bumps over three years despite a looming $800 million deficit. The clock is ticking to resolve the remaining unions that haven’t reached an agreement with the city; current contracts end on June 30.

The incidents cited during the city’s Health Commission meeting on Tuesday spanned from patients lashing out at workers after not receiving food, water or pain medication to one nurse being spat on by a patient.

Before speaking at the commission meeting, Esteen presented “four phone books worth” of paper that comprised thousands of pages of workers documenting unsafe working conditions.

The records, which were provided to The Standard, include incidents of assault.

“We are short staffed at 6, with 3 1:1 assault 3 patients, high acuity, no clerk,” one report from March 2022 at General Hospital said. “Entire staff was called to de-escalate 2 situations despite having deputies and sfpd present. There were not enough staff to ensure the rest of unit was safe, potentially leaving patients vulnerable.”

A person crosses a glass-walled bridge above a bustling outdoor terminal with passengers and a vendor cart.
People enter and exit Zuckerberg San Francisco General Hospital and Trauma Center on Jan. 13, 2022. | Source: Camille Cohen/The Standard

Members of the nursing union also presented their survey results, which found that many members have experienced assault while on the job. The questionnaire found nearly two-thirds had been assaulted more than 10 times. Over one-third have been injured in assaults.

SEIU Local 1021 represents about 2,300 nurses, according to union spokesperson Ella Sogomonian. 

“They’re continuously missing meal breaks,” said Sogomonian in an interview. “They’re overworked. They’re exhausted.”

The union’s complaints coincide with similarly concerning incidents at the city’s jails. 

Earlier this month, two of San Francisco’s jails were placed on lockdown after an increase in physical assaults on sheriff’s deputies and jail staff, a situation that has been blamed in part on inadequate staffing. 

On Tuesday, an inmate was caught after escaping a cell at General Hospital.

A sheriff's car parked outside the Zuckerberg San Francisco General Hospital.
San Francisco Sheriff's Office vehicles are stationed in front of Zuckerberg San Francisco General Hospital and Trauma Center on Tuesday. | Source: Morgan Ellis/The Standard

When asked about the nurse staffing conditions, Department of Public Health Director Dr. Grant Colfax walked away from this reporter and deferred questions to an agency spokesperson.

The city’s hospitals have also dealt with concerns around its policy surrounding illicit drug use. Last year, nurses told The Standard that they were compelled, in certain circumstances, to return fentanyl and methamphetamine to patients. On Monday, The Standard reported that a man had overdosed on fentanyl and died at General Hospital.

A statement provided by a health department spokesperson said the agency has made “significant progress” in hiring and retaining nurses. The department has added 135 new nursing positions since 2019 and has helped streamline hiring procedures, they said.

A man in a blue blazer and white shirt, with a serious expression, sits with hands clasped in front of him.
Grant Colfax, Director of Health for the City and County of San Francisco, listens during a Health Commission meeting at San Francisco Department of Public Health (SFDPH) on Grove Street in San Francisco on Tuesday. | Source: Estefany Gonzalez/The Standard

The department also addressed concerns from the union about outsourcing labor from contractors, a complaint that other city workers have expressed during contract negotiations, stating that it was an “industry standard” to hire third-party employees to ensure it reaches proper staffing levels. Four percent of the nursing staff is made up of contractors, according to the department.

“Nurses are the backbone of care for SFDPH, and the department is extremely grateful for their commitment, resilience, and compassion they bring to providing high-quality health care to our community,” the statement read. 

A statement from Zuckerberg San Francisco General provided on Tuesday pushed back on assertions that violent incidents impacting its staff were persistent or getting worse.

“While no incidents of violence are acceptable, we are pleased to report a downward trend in incidents at ZSFG due to our comprehensive approach to safety,” the statement read. “Because incidents of workplace violence in hospital and healthcare settings nationally is on the rise, we are always focused on ensuring a secure environment for all.”