‘We’re drowning’: Dominican nurses raise alarms over staffing, patient care

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‘We’re drowning’: Dominican nurses raise alarms over staffing, patient care

Quick Take

Nurses at Dominican Hospital in Santa Cruz say staffing levels aren’t meeting the needs of patients who are arriving with more severe conditions than in prior years. They told Lookout that hospital administrators aren’t doing enough to address their concerns. 

Nurses at Santa Cruz’s Dominican Hospital say they are stretched beyond their limits, struggling to provide basic care as patients arrive sicker and stay longer than in the past.

The mounting crisis, they say, stems from a gradual reduction in support staff positions, leaving nurses to handle an increasingly complex array of duties that pulls them away from critical patient care.

Registered nurse Jennifer Powers has worked at Dominican Hospital for 20 years. She said over the years she’s seen the hospital gradually reduce the number of support staff, like patient care technicians and resource nurses. 

Patient care technicians groom, bathe and feed patients, while resource nurses fill in to allow nurses to eat meals and take breaks. With fewer of those support staff, nurses say they are left to fill those gaps, leaving them struggling to address patient needs and often forgoing meal breaks.

Powers said nurses are helping patients with very basic needs, such as cleaning patients after they have soiled themselves, which takes away from the time they could be spending on core nursing tasks, such as teaching patients about medications they are taking or tests they’re about to have.

The ongoing staff shortage is having a direct impact on patients, Power said. “[Patients] get very weak because we can’t get them out of bed to walk. They get very dirty because they don’t shower for weeks on end,” she said. “So patient care has just continually degraded, and management has not seemed to care.” 

The lack of staffing also means the emergency department’s three bathrooms aren’t regularly cleaned throughout the day, nurses said, raising the risk of spreading infectious diseases among patients visiting the emergency room.

Mary Kelly, a nurse at Dominican Hospital Infusion Center, said that nurses have been bringing up their concerns for years with hospital administrators. Kelly has been a nurse for 30 years, including a decade at Dominican. Powers said the administrators often say they don’t have the money to hire more staff. 

“We meet every month with management or the chief nursing officer and we lay out all these issues, staffing issues, nurse safety issues,” Kelly said. “And every month we get the same answer.”

Lookout reached out to Dominican Hospital through communications staff of the hospital owner, Chicago-based CommonSpirit Health. The company was created in 2019 through a merger between the hospital’s previous owner, Dignity Health, and Colorado-based Catholic Health Initiatives. CommonSpirit Health provided an emailed statement but didn’t respond to questions sent via email and didn’t provide a staff member for an interview. 

The company’s statement mentioned the company’s new Morehouse School of Medicine Graduate Medical Education program, which it hopes will reduce emergency room visits. The undertaking brings eight doctors-in-training each year into a three-year program at the hospital to earn their physicians licenses. 

Dominican Hospital nurse Jennifer Powers stands outside the Santa Cruz hospital Tuesday. Credit: Kevin Painchaud / Lookout Santa Cruz

“At Dominican Hospital, the health and safety of our patients and staff is our highest priority,” the statement reads. “We are committed to strengthening our workforce, exemplified by the launch of our new Nurse Residency Program to complement our existing new grad program, which is designed to train and empower the next generation of healthcare professionals.”

Dominican is one of just two hospitals with an emergency department in Santa Cruz County. The general acute care hospital has a total of 222 beds and 24 emergency department beds. Watsonville Community Hospital has 12 beds in its emergency department, 106 total in the hospital. The Dominican facility at 1555 Soquel Dr. employs about 700 nurses, a level that nurses say hasn’t changed much over the years.

The nurses previously raised their concerns in an open letter to Dominican Hospital in October that warned of “patients left without baths for days,” and a “lack of safety measures to mitigate and protect staff and patients from highly contagious illnesses.” The letter, signed by 300 nurses, also said nurses were struggling to get a single meal break during an eight- or 12-hour shift.

“These conditions are not just affecting our ability to care for our patients but are jeopardizing the safety of our patients,” they wrote. “As you should be aware by now, there are numerous problems we have been pleading with your leadership to address without success.” 

Nurses weren’t able to provide Lookout with the exact number of staffing for patient care technicians and how the number changed over the past several years. CommonSpirit also didn’t respond to requests for information. 

However, in response to an Oct. 15 opinion piece by former nurse Elizabeth Gordon, hospital spokesperson Sandy Doucette said Dominican has “hired 297 new nurses in the past two years and launched a nurse residency program to train future health care professionals.” 

Government data shows that the number of emergency room visits at the hospital has increased by only about 10% over the past decade, to 51,223 in 2023. But nurses say that the number of patients coming into the hospital with complex and demanding conditions has risen, even as support staffing levels have dwindled.

High-complexity cases – such as life-threatening conditions or a patient who fell and is unable to walk – made up 32.3% of emergency visits in 2023, up from 25.1% in 2014, according to the California Department of Health Care Access and Information. The number of days that patients stay in hospital has gone up by 19% over the same time period. 

Olivia Sta Rosa, a night-shift nurse in the emergency department, said her shifts in late December were short three nurses. The hospital doesn’t pay enough of a premium to keep nurses on night shift, she said, so some of the more experienced night nurses have switched to earlier shifts.

“Staffing for the ER, the night shift has basically been robbed of experienced nurses,” said Sta Rosa, who has been at Dominican Hospital for five years and a nurse for 20.

As the charge nurse, Sta Rosa is responsible for supporting and leading the nurses during her shift by assigning patients to nurses and to rooms based on their condition. Charge nurses are more experienced but generally don’t take on their own patients. Sta Rosa said she regularly has to take care of her own patients and has to leave available rooms unused by patients because there isn’t enough staff. 

The entrance to Dignity Health Dominican Hospital in Santa Cruz. Credit: Kevin Painchaud / Lookout Santa Cruz

“As a charge nurse, you have to do some creative staffing,” she said. “So I might have to shut down beds, and I have done it. You shut down beds early, and people wait in the lobby.” 

Nurses also point to what they say are a lack of proper safety protocols to prevent the spread of infectious disease in the facility. 

They say patients who are potentially infected with viruses like COVID and norovirus or other highly contagious diseases are not being isolated, and lacked personal protective equipment even if they were suspected to have a virus.

In addition, the nurses said there is a lack of contact tracing to prevent spread among units. Patients suspected of having a contagious infection are supposed to be treated by just one nurse to avoid spreading the disease, but that is not consistently happening.

The acute rehabilitation unit was locked down recently after a COVID outbreak caused most patients and staff to become sick. The unit helps patients recovering from disabling illness or surgery regain their full functioning. Nurses also pointed to same-day surgery patients being placed next door to patients suspected of having infectious diseases. 

The nurses’ concerns are at odds with the hospital’s publicly available patient safety data. Dominican Hospital’s ratings for patient safety, patient reviews and other metrics show the hospital generally scores positively, and often better than statewide averages.

The hospital scored 4 out of 5 stars overall when looking at mortality, safety of care, readmission, patient experience and timely and effective care, according to Medicare.gov. For the patient survey, which measures patients’ experiences, it scored 3 out of 5 stars. 

In November, the hospital earned an “A” for patient safety from an independent nonprofit, The Leapfrog Group. Additionally, the percentage of patients who left the emergency department at Dominican before being seen was 1%, compared to the state and national average of 3%. 

Dominican Hospital nurses didn’t respond to questions about why they think the hospital scored highly in these ratings. 

Next Thursday, Jan. 16, Dominican nurses represented by the California Nurses Association will be participating in a nationwide informational picket from 2:30 to 5 p.m. in front of the hospital. The union represents about 680 nurses at the hospital who work in areas including the medical surgical unit, emergency department, intensive care unit and infusion center.

They say they’re protesting unsafe staffing and “constant attempts to undermine our contracts.” Nurses at Dominican Hospital are not in contract negotiations but they’re participating in the rally they call a “National Day of Solidarity Action.” 

Credit: Kevin Painchaud / Lookout Santa Cruz

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