In Midst of COVID-19, San Francisco Moves To Solve Nursing Shortage

Mayor suspends civil service hiring procedures during pandemic.


Mayor London Breed said Tuesday she would temporarily waive the civil service procedures normally required to hire nurses at San Francisco General Hospital – procedures that usually take as long as six months to bring a new employee onboard.

“We’ve been chronically understaffed,” Aaron Cramer, a nurse and union shop steward at SFGH, tells SF Weekly. “I’m for that action. Now is the time for dramatic measures, and we need nurses today. The city needs to do what it takes.”

The hospital has long operated with fewer permanent full-time staff than called for in its budgeted staffing level. In February, it was down 8 percent, with 73 permanent full-time equivalent nursing positions vacant.

“I want to make it really clear we have been maintaining care by using our nurses that are per-diem,” says Terry Dentoni, chief nursing officer for SFGH. “We’ve never been below the staffing levels required to care for patients.”

“Per-diem” nurses are hired on a temporary basis, for a fixed period of time – think of the equivalent of a temp agency – and used as a stop-gap measure. They’re also a point of contention with SEIU 1021, the union which represents nurses at SFGH.

“The primary purpose of per-diem are to hire for backfill, or for staff on medical leave or vacation. But they employee per-diem on a full-time basis because they can’t meet the budgeted [staffing levels],” Cramer says. “Per-diems are not something we can count on. They’re not tied to work commitments here. In a crisis, we need permanent, dedicated staff to handle this situation.”

Per-diem workers also aren’t given medical benefits, retirement, or vacation pay, Dentoni says. She says she would rather fill those 73 vacancies with permanent staff, and the suspension of the civil service rules pave the way for that to happen much more quickly now.

“Twenty-six (people) have already accepted conditional offers, and HR is processing them,” Dentoni says, which leaves about 50 positions left to fill to reach the budgeted staffing level.

The Department of Public Health is hosting an invite-only hiring fair at SFGH on Saturday, and HR is reaching out to people who have previously applied to see if they’re still interested.

“If it’s a match, we’ll hire them on the spot,” Dentoni says. Those nurses could then be able to start working in as little as one to two weeks.

And it can’t come soon enough, nurses tell me.

“I feel management and leadership is doing the best they can in the midst of a pandemic,” says Norissa Cooper, a medical-surgical nurse at SFGH. “However, as a level 1 trauma center and as a disaster hospital, I feel we don’t have the capacity to surge as we need to right now.”

Cooper has worked at SFGH for 12 years and is currently assigned to a floor dedicated to COVID-19 patients. But pandemic or not, the hospital still needs to serve patients who are receiving end of life care, giving birth, or suffering unforeseen accidents.

“I feel like the hospital is not meeting the staffing needs in order to make that happen,” Cooper says. “Years of understaffing, mandated budget cuts, stagnant and cumbersome hiring practices are now coming to bear. The pandemic has exposed us, and now we are forced to acknowledge our shortcomings.”

“The staff on the front lines are waiting, and hoping,” says Cramer. “We have faith, and we will get the job done one way or the other. We have no choice.”

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