By Mike Rosenberg

About 50 sign-toting nurses rallied outside San Mateo Medical Center in the hope of attracting taxpayer funds to pay for more staffers and equipment. It's part of ongoing contract negotiations between the California Nurses Association union and the San Mateo County Health System, which operates the hospital.

The nurses claim the 509-bed hospital on 39th Avenue in San Mateo has become a "provider of last resort." They point to staffing levels that have dropped and often don't meet state mandates, wait times that are too long in the emergency room, and a recent spate of attacks and rapes in the psychiatric unit.

They also cited a lack of proper lift equipment that has resulted in nurse injuries, a shortage of hours at the pharmacy, a need for regular employee breaks and a lack of food options for patients who require specialty diets.

"We're trying to do the best we can with what we got," said Anna Wilson, a nurse in the psychiatric unit for the past six years and a leader of the bargaining team. "But it gets frustrating."

Health System Chief Jean Fraser said the organization was put in a hole last year when the county cut the department's funding by 10 percent on top of state reductions.

"Making these cuts in a time of increased need for our services due to the recession is very difficult, and requires sacrifices from everyone," Fraser said in a statement. "We value the commitment our nurses have to provide great care to our patients and clients."

She said the hospital maintains a "good working relationship" with the nurses and is confident the two sides will hammer out an agreement that benefits both parties. The current contract expires Jan. 22.

The nurses said the budget cuts have come at a time when 22,000 county residents lost their health insurance benefits since 2007 and the number of emergency room trips has increased from 29,000 three years ago to 39,000 last year.

They also predict that 65,000 additional county residents will need to obtain insurance in 2014 under federal health care reform, which will put even more of a strain on their services. The nurses said those new patients create an opportunity for a larger investment, since the federal government could match any county spending made in advance of the transition.

But they argue that nearby private hospitals, such as Sequoia Hospital or Mills-Peninsula Health Services, stand to attract most of the patients, since they've been able to avoid more drastic reductions and generally are rated higher in patient and independent surveys.

Mike Rosenberg covers San Mateo, Burlingame, Belmont and transportation. Contact him at 650-348-4324.