L.A. Nurses Take Direct Action on the Hospital Floor To Protect Patients, Themselves

In case you hadn’t heard, there’s a health care crisis in the United States. Two symptoms of this crisis are understaffed medical centers and health care workers who are overworked and underpaid.

To treat these symptoms, health care workers’ unions have been pushing for better nurse-to-patient ratios as a way to improve both working conditions and patient care. In California, a union-initiated law implemented January 1, 2004 (AB 394) regulates staffing ratios, but according to registered nurse Joel Solis, Los Angeles County hospitals are not meeting AB 394’s requirements.

“It never happened,” says Solis, a member of SEIU Local 660. “There’s been no enforcement.” According to Solis, even after AB 394 passed, nurses were being assigned as many as 20 patients each.


Local 660 member Lucy Gonzalez says that “nurses have been really frustrated” by the county’s failure to enforce the ratios. Gonzalez, a registered nurse at L.A. County/USC Medical Center, explains that poor staffing ratios jeopardize not only patient safety but also nurses’ livelihoods. “We can lose our licenses if we take unsafe assignments,” she says.

On September 7, nurses on a Harbor/UCLA Medical Center medical surgery ward began refusing to accept more than six patients per shift. They explained to management that to do so would violate AB 394, jeopardize patient safety, and put the nurses at risk of losing their licenses.

Management told the nurses they were being insubordinate and threatened disciplinary action. The nurses told management they couldn’t be ordered to break the law. “Management didn’t know how to react,” Solis said.

Caught off guard, management was forced to hire temporary help to meet staffing requirements for that day. Soon after, nurses on other wards began refusing unsafe assignments, and soon nurses at L.A. County/USC Medical Center followed suit.

Gonzalez was involved in one incident where three nurses were asked to handle 22 patients. When the three refused, management “got really upset and told me I’d be suspended.”

Gonzalez told management she wanted to exercise her Weingarten rights and have a union representative present. When the reps arrived, management called the police to get them off the premises.

Local 660 staffer Paul Krehbiel remembers that when he and fellow staff rep Mario Valenzuela explained to the police that the nurses were being asked to help management violate a state law, the police “didn’t want to hear about that.” According to Krehbiel, one of the policemen told him to “stop throwing all these laws at us.”

After four hours of arguing, management finally got another nurse on the ward to meet the ratio requirements.


Because nurses knew that management would respond aggressively, they prepared extensively for the campaign. “It took a lot of hiding,” says Solis, “and a lot of confrontations with management.

“We began by educating the nurses about the law,” Solis continues, “meeting with them in lunch areas and in the nurses’ lounge. We did a lot of role playing—manager versus nurse—to prepare nurses for confrontations.”

To keep management from catching on, off-duty nurses would bring their county badges and dress in their scrubs when talking with working nurses about the campaign. “Managers leave at five o’clock,” Solis explains, “so we had really good meetings on night shift, around nine p.m., after patients had their dinners and were in bed.”



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Understanding the staffing ratios law was critical. According to the law, nurses—not management—decide how many patients they can accept, “based on our professional judgement.”

Addionally, Solis notes, though the law mandates a 1:6 ratio as the maximum, depending on a patient’s needs and the severity of their condition, a nurse may be able to handle only three or four cases on a given shift, sometimes even less. The key point, he believes, is that “nurses know there is a law which says, ‘You are the one who gets to determine what is safe.’”

Staffing ratios are a huge issue for nurses across California and across the country. Nurses at Mount Clemens General Hospital in Michigan recently went on strike for more than a month over staffing ratios.

Krehbiel believes that the conflict around staffing ratios is related to the onslaught of state budget cuts happening around the country. He says that L.A. County health services have suffered drastic cuts over the past few years.

“It’s an example of how the private sector has been strangling the public sector for decades,” asserts Krehbiel. He explains that private health services companies—like Kaiser Permanente and Tenet Healthcare—are a major political force in California.

It’s no coincidence, he observes, that as private companies gain political power, elected officials push plans to privatize or weaken public health services, paving the way for private control of the health services market.

Budget cuts have been management’s excuse for not hiring the additional nurses necessary to meet the AB 394 requirements. However, Solis notes that since the nurses have begun refusing unsafe assignments, management has been forced to hire many temporary nurses, who come at “double the cost” of county nurses.

Gonzalez calls the temporary nurses “a very expensive band-aid,” noting that, “If they can hire them, [the county] must have some money somewhere.” In fact, Solis says the county recently revealed that it has millions in surplus.


Adding to the nurses’ frustration is the fact that they’ve been working without a contract since September 2003. Pay increases have been the key sticking point. According to Solis, the low pay at county hospitals has led to the nursing shortage.

“A lot of nurses have gone to Kaiser [hospitals],” he explains. “At Kaiser, they have the best ratios, and nurses make $15,000 to $25,000 more.”

Gonzalez says that while nurses are tired of working without a contract, they’re “not going to settle for chump change.”

Since the nurses began refusing unsafe assignments, Solis says, management has come back to the bargaining table. However, he believes that the biggest gain has been that “nurses are able to stand up to management and use the law to empower themselves.”

Gonzalez notes that since the campaign began, many new leaders have emerged in Local 660, and nurses have become more active in the union. “One nurse that got disciplined is becoming a steward,” she adds, “and I’m becoming a steward.”

Both Solis and Gonzalez say that the campaign shows no signs of weakening. At press time, nurses on at least 17 wards at L.A. County/USC Medical Center and five wards at Harbor/UCLA (all represented by Local 660) are refusing unsafe assignments.“It’s kind of scary, standing up to management,” says Gonzalez, “but as long as we stick together, we can win.”