Nurses at Kaiser Permanente Medical Center in San Rafael, and 20 other Kaiser hospitals from Santa Rosa to Fresno, picketed Wednesday to protest what they say is "persistently inadequate nurse staffing."

The action mounted by the California Nurses Association/National Nurses United comes as Kaiser is attempting to cut its nurse staffing.

Gay Westfall, senior vice president of human resources for Kaiser's hospitals in Northern California, stated in a press release, "We have reached out to CNA to have a conversation about aligning staffing with the current numbers of patients in our hospitals, which is declining for all the right reasons — quality, service and improved utilization. We have not discussed layoffs."

Westfall went on to say that Kaiser is "seeing an ongoing shift in care delivery from the hospital to other settings such as outpatient clinics, and from those clinics to patients' homes, over the phone and online."

She said Kaiser has a  surplus of hospital nurses every day at certain medical centers and departments throughout Northern California and needs to supplement staffing in others. But union representatives dispute this and say Kaiser has declined to identify which hospitals it believes are overstaffed.

Colleen Gibbons, one of the nurses who picketed in San Rafael Wednesday, said, "We're here to provide excellent care to our patients, and Kaiser keeps understaffing us and making it more difficult to provide that care."

Gibbons said nurses at the Kaiser hospital in San Rafael have filled out 300 Assignment Despite Objection forms so far this year — 69 during the month of November. Nurses file the forms to document formal objections to an unsafe, or potentially unsafe, patient care assignment.

Julie Puccinelli, a medical-surgical nurse who has worked at the San Rafael hospital for five years, said, "It's a way to protect ourselves when we feel an assignment jeopardizes our license." Puccinelli said she had filed "a couple of" ADO's herself.

Puccinelli said the patients she is seeing are sicker than in previous years and need more care than ever. She said that may be because Kaiser is "trying not to admit as easily as they used to" and is sending patients home sooner.

Pat Tomasello, a nurse who works in the intensive care unit of Kaiser's San Rafael hospital, said, "It's harder to get admitted into the hospital. It's harder to stay as a patient, and the mantra now is, 'Your family can take better care of you at home.' That is provided you have a family that knows how and is available."

In her statement, Westfall said, "Our nurse staffing levels comply with, and sometimes exceed, state-mandated staffing requirements at our hospitals, as we increase staffing as necessary for patients based on the complexity of their medical condition."

But Puccinelli said, "Staffing tends to be based on census and numbers rather than the acuity of patients.

Wanda Jones, president of San Francisco's New Century Healthcare Institute, said she believes some Kaiser hospitals may be overstaffed; but she said Kaiser is also preparing for Medicare reimbursement cuts to hospitals, which is mandated under the Patient Protection and Affordable Care Act, commonly known as "Obamacare."

Jones said the law will establish tougher criteria for admitting patients to hospitals and penalize hospitals that readmit patients for the same diagnosis within 30 days.

"If the hospital does, it won't get reimbursed for it," Jones said.

But nurse Gibbons says Kaiser's push to reduce nurse staffing is a "knee-jerk reaction" to Obamacare. She said Kaiser is doing very well financially now and will gain new members due to the health care reform act.

Contact Richard Halstead via e-mail at rhalstead@marinij.com