For the second year in a row, nurses at Tri-City Medical Center in Oceanside demonstrated over what they say is a critical inability to retain nurses, a multi-year trend they say has eroded the public hospital district’s ability to effectively care for its patients.
Clad in red scrubs and carrying signs, of the California Nurses Association demonstrated just before Tri-City Healthcare District’s monthly board of directors meeting was to start, delivering a poster-sized “petition for safe staffing” and a “vote of no confidence” that accused management of “unfair pay practices” and of violating state nursing ratios that specify the minimum number of ed nurses per patient, depending on the severity of injury.
Emergency department charge nurse Doris Turner held back tears in describing Tri-City’s recent struggles retaining new nursing graduates when other providers in the community are paying at least $10 more, and often $20 more, per hour.
“I think the past three years, I’ll guess we’ve hired probably 25 or 30 new nursing grads that have come through the ER and we’ve trained and have fallen in love with,” Turner said. “We’ve considered them part of our family, but I’d say there are maybe six that have stayed because they can’t afford to pay off $100,000 worth of student loans and rent.”
Tri-City has struggled to operate in the black since the COVID-19 pandemic severely stressed the health care labor market, causing many nurses to pursue “traveler” assignments in other facilities, sometimes in other states, on short-term contracts that could pay double what they might have made at a previous staff job. And, post pandemic, large systems such as Kaiser Permanente, UC San Diego Health, Scripps Health and Sharp HealthCare have all increased pay significantly, competing for a smaller pool of nurses and other medical personnel after many left the profession due to burnout.
These are not new issues. They are much the same as those cited on May 1, 2024, when the same union’s gathered in the same spot at Tri-City. But there have been a few critical new developments since then.
Today, union say they are particularly unhappy with a new incentive plan that pays some workers, specifically those in the hospital’s operating rooms, about $20 more per hour than those who work elsewhere in the hospital. Ingrid Corona, a long-serving telemetry nurse at Tri-City and the union’s chief nursing representative, said that the increases, which were presented to staff as necessary bonuses to help retain critical workers, came outside the collective bargaining process.
“Everyone deserves more money, but you can’t just selectively choose, within a bargaining unit, to pay some nurses more money but not all,” Corona said.
Dr. Gene Ma, Tri-City’s chief executive officer, acknowledged in an email Thursday that the hospital has created a “clinical ladder” that pays more than the salaries negotiated in the collective bargaining process. Rolling out pay increases for all departments simultaneously, Ma said, is “not feasible.”
“(Operating room) nurses received significant wage increases, bringing them to top of market, and that has completely eliminated any open positions or shifts,” Ma said. “Our hope was to do this progressively across all units.”
The executive said that firm union opposition to that plan, and an insistence that increases “be immediately across all units or nothing,” have halted those plans.
“We will succumb to their demands, and will withdraw further efforts to implement a clinical ladder, but they must immediately cease with any activity viewed by our employees as harassment, threats, intimidation or retaliation,” Ma said.
He said the assertion that most nurses are opposed to the istration’s recent wage actions is inaccurate. The hospital, he said, chose to reopen negotiations on the hospital’s collective bargaining agreement two years before expiration “for the purposes of increasing wages,” a change that he said was ratified in December 2024.
As they did last year, nurses said that Tri-City’s staffing crisis has often resulted in fewer nurses being on hand than state law requires. This year, there is fresh evidence to back up those statements. A recently posted complaint investigation document from the California Department of Public Health states that the regulator’s investigators, who visited the hospital from March 11 through March 14, found several instances where intensive care unit nurses were assigned three patients when the limit per state regulation is two.
Standards, the report states, were “not met” because Tri-City “failed to ensure nurse-to-patient ratio was maintained in the intensive care unit according to standards of practice.”
“This failure has the potential to affect the safe delivery and quality of patient care and treatment,” the state’s report said. “In addition, this failure had the potential to affect staff workload and morale.”
Ma said Thursday that while Tri-City regularly meets nursing ratios, staff “callouts” — when workers don’t show up due to illness or for personal reasons — during the winter months have caused “some challenges.”
“When we have had significant callouts, we now occasionally do have to go out of ratio, and we report that to CDPH after all attempts to rectify that have been made,” Ma said.
The state report also mentions a patient who returned to the hospital after a robot-assisted operation on their left knee in late January with pain caused by a “tracker pin” that was not removed from the surgical site before it was closed. Such pins, the state report says, are “used to guide the robotic arm and ensure accurate implant placement.” And investigators also highlighted instances where “staff failed to ensure a physician’s orders were followed.”
“These failures have the potential to result in the preventable demise of (one patient) and compromised pain relief and comfort for (three other patients),” the report states.
Faced with such severe staffing challenges, and without its own large d network of community physicians, Tri-City has sought partnership with other medical providers. In late 2023, Tri-City directors chose to form a t operating agreement UC San Diego Health. While a proposal would have increased Tri-City salaries 20% and would have extended $100 million to the district hospital in order to shore up its finances, the university would not assume full responsibility for the hospital’s operations immediately.
Those were not deemed strong enough by Tri-City leadership to guarantee that Tri-City would avoid insolvency, and the university stopped negotiations in July 2024.
Ma said last July that Tri-City intends to “find the right deal that makes the most sense for this community.” The hospital has hired a private firm to help approach potential collaborators under non-disclosure agreement and Ma said Thursday that a list of candidates and their qualifications will soon be presented to Tri-City’s governing board.
