OCEANSIDE — Nurses at Tri-City Medical Center are ramping up pressure on hospital leadership, warning that chronic understaffing, workplace safety issues and stalled pay negotiations are putting both caregivers and patients at risk.
Dozens of nurses, represented by the California Nurses Association, held an informational picket on April 24 outside the Oceanside hospital, criticizing leadership for what they described as years of inaction on key safety and workplace concerns. The demonstration was not a strike, according to the union.
Following the picket, nurses presented hospital leadership with a petition alleging management’s failure to comply with Title 22 safe staffing regulations, provide protections against workplace violence, and adopt fair compensation policies to recruit and retain experienced staff across all units. The nurses also delivered a vote of no confidence to the Tri-City Board of Directors.
“(Tri-City) executives need to be held accountable to nurses and the community it serves when they do not comply with agreed-upon staffing standards,” said Astrid Warner, a registered nurse in the progressive care unit.
According to Warner, patients in her unit are sometimes left with only one registered nurse.
“Not only is this in violation of our union contract, it also means our unit’s patients are taken care of by nurses with different specializations,” Warner said. “This is not safe or appropriate for our patients.”
Tri-City nurses have filed formal complaints with the California Department of Public Health, Cal/OSHA and other agencies over rising incidents of violence, understaffing and workplace hazards. Following a March inspection, the Department of Public Health found the hospital lacked adequate personnel to ensure a nurse was immediately available for each patient.
“Based on interview and record review, the facility failed to ensure nurse-to-patient ratio… was maintained in the intensive care unit according to standards of practice,” the CDPH report stated. “This failure had the potential to affect the safe delivery and quality of patient care and treatment. In addition, this failure had the potential to affect staff workload and morale.”
The report also cited failures in nurse supervision and patient care planning.
In response, Tri-City CEO Dr. Gene Ma acknowledged staffing challenges but said conditions have improved since a difficult winter surge.
“Like every hospital, we occasionally have situations that result in a mismatch of patient volumes and staff,” Ma said. “Every hospital continues to have these challenges, and Tri-City is no exception.”
Ma said that operational changes implemented more than a year ago have shifted job duties and restructured staffing to increase frontline care roles while reducing executive and administrative positions, including those in external affairs and media relations.
The April 24 demonstration echoed a similar picket last spring, when nurses protested working conditions and staffing shortages.
“We have tried to work with management to address the issues that impact nurses and our ability to provide quality care,” said Cathy Cronce, a registered nurse in the post-anesthesia recovery area. “Our priority is our patients and we know they deserve better standards from (Tri-City).”
Ingrid Corona, a registered nurse in the telemetry unit and chief union representative for the California Nurses Association, said nurses have suffered physical attacks from patients, including being thrown into walls.
“Nurses have been hurt here,” she told The Coast News. “Even something as simple as a meal choice can set patients off – they can get very aggressive.”
Corona said untreated mental health and addiction issues often escalate tensions, particularly in the emergency room, where wait times are exacerbated by short staffing.
“It’s hard for the nurses to deliver the quality care in a timely manner,” Corona said. “If I’ve got another emergency and can’t make it back to help another patient to the bathroom, they might not wait for me and try to get out of bed themselves, which isn’t safe.”
Ma said a key disagreement between hospital administrators and the union has been over the rollout of pay raises. The hospital proposed a “nursing clinical ladder” that would offer targeted raises in high-demand departments such as the operating room, interventional care, and ICU. The union opposed the plan, calling for across-the-board increases for all nursing units.
“Despite multiple discussions to try and share that their proposed approach was untenable, and that this was our commitment and method of systematically increasing compensation in a financially responsible manner, we were unable to convince the labor unit of that,” Ma said. “Hence, we have yielded to their demands and ceased any progression on the clinical ladder, which I am very much disappointed about.”
Ma said the abandoned plan would have strengthened recruitment and addressed staffing gaps.
Corona, despite her concerns, said patients can still expect quality care from Tri-City nurses.
“We give excellent care at Tri-City,” she said. “We have very compassionate nurses and we are breaking our backs to give patients the care they need.”
Editor’s Note: A previous version of this article had a typo that stated 500 nurses were present at the picket. There were about 50 nurses present at the picket. The California Nurses Association is the union that represents 500 nurses at Tri-City Medical Center. We sincerely regret this error.
