We are registered nurses. Many nurses grew up in San Bernardino County, attended local nursing schools, and raised families here. We are your neighbors. We made the decision to dedicate our professional lives to providing quality care to our community in a public health setting. We wanted to work where they took in everyone who needed care — the county.

Eroding conditions jeopardize the county’s mission statement of “providing quality health care — to the residents of San Bernardino County” at its safety net hospital and outpatient clinics. The essential element in the ability to provide quality health care is the expertise of the registered nurses. Sadly, the county is not investing in its loyal, experienced registered nurses — from its hospital, Arrowhead Regional Medical Center, to its many outpatient clinics, the county detention centers, juvenile halls, and public-health programs.

Several hundred San Bernardino County registered nurses voted to strike after 14 months of negotiations and working without a contract since June. That decision did not come easily. Strikes are a last resort for nurses. When we’re out on a strike line, we’re worried about our patients inside. To ensure the well-being of our patients we have a Patient Protection Task Force to make a professional nursing assessment if emergency assistance is requested after the strike begins and will assign a nurse to stabilize the patient if necessary.

Ironically, that’s why we have to go outside. RNs have a legal and ethical obligation to advocate for their patients and ensure they receive the care they need and deserve 365 days a year. That’s just not happening.

Recent years have been difficult for county nurses and patients. We are providing care for increasingly sicker patients while losing more of our most experienced RNs to area hospitals every year. Especially troubling is that the majority of these RNs worked in specialized units where safe care depends on having highly experienced staff.

With an operating surplus of $166 million for the fiscal year ending in June and an expectation of increased revenue, the county does not need to shortchange its dedicated, experienced RNs, and the public’s health.

Rather than invest in retention of experienced nurses, the county is being financially irresponsible. The county spends $50,000 to train a new hire and budgeted $15 million dollars for temporary registered nursing staff between 2013 and 2015.

Nurses have endured a six-year salary freeze. To recruit and retain seasoned nurses we must close the massive 30 percent gap — up to 52 percent for the most experienced nurses — in compensation between nearby hospitals and the county.

This huge disparity is prompting unacceptable turnover and patient safety concerns. According to the county’s own data there were 144 new nurses hired in the last year, an 11.5 percent turnover, higher than the average of other Southern California hospitals. Ninety percent of the RNs in the surgical intensive care unit are new; 75 percent of the nurses are new on the night shift in the medical intensive care unit are new.

Recently graduated nurses, who find a first job with the county, and now make up 20 percent of the workforce, repeatedly move on to better standards at other hospitals. As a result, the county has essentially become a training center for the area’s private hospitals. Taxpayers are subsidizing the private sector hospitals by training the RNs for them.

The loss of experienced nurses leads to a number of patient safety problems.

For example, the county wants to require nurses to work in units far outside their area of clinical expertise, such as having maternity care RNs care for very different extremely ill cancer or intensive care patients. The county restricted this unsafe practice in our prior contract, but is now demanding this protection be eliminated to make up for inadequate staffing and high turnover.

We need to stop the hemorrhaging loss of experienced nurses. The county needs to reverse the wasteful spending on temporary labor and invest instead in seasoned, competent nursing staff who will provide our patients the quality care they deserve.

Original posting: http://www.sbsun.com/opinion/20141207/nurses-strike-is-about-preserving-san-bernardino-county-patient-care-guest-commentary