Registered nurses, hospital administrators disagree about patient safety, charge nurse value |

Registered nurses, hospital administrators disagree about patient safety, charge nurse value

Hospital staff mingle in front of the entrance of Sierra Nevada Memorial Hospital in Grass Valley following a ceremony last year.
Elias Funez/

Nurse Positions

Registered Nurse: A graduate trained nurse who has been licensed by a state authority after qualifying for registration.

Charge Nurse: A nurse who is in charge of one section of a hospital.

Nurse’s Aide: A person who assists nurses at a hospital or other medical facility with basic tasks, such as bathing and dressing patients.

On Dec. 13, Sierra Nevada Memorial Hospital registered nurses are calling for public support in an informational picket on hospital grounds.

Their grievance is with cut hours to nurses’ aides and staff reductions, and the effects on patient care.

“Give us back the aide hours and don’t eliminate the charge nurse position,” said Sierra Nevada Memorial Hospital Registered Nurse Chrissie Marshall.

Marshall said nurses’ aide hours have been reduced by 50%.

“(Nurses’ aides) are vital in the event of a sudden critical patient emergency,” said Marshall. “They can bring medications, perform bedside testing or care for other patients while (registered nurses) tend to the one crashing.”

Hospital administrators said they are still working with registered nurses, and CEO & President of Sierra Nevada Memorial Hospital Brian Evans noted that nurses’ aides staffing may increase.

A Dignity Health statement said layoffs to charge nurses are not happening, that the hospital will be open and its services will remain available during the picket.

When asked for comment, the California Nurses Association directed The Union to Marshall.


While charge nurses haven’t been laid off, nurses’ aide hours have nonetheless been cut, said Marshall, and charge nurses who quit or go on leave for more than 12 weeks are being let go and not having their positions refilled. That’s happened to three positions.

Instead of replacing them, “nurse shift managers” — who are not allowed to provide the same care — are filling the positions, said Marshall.

Evans didn’t know of charge nurses not being replaced, but acknowledged that charge nurses have often become nurse shift managers.

“I don’t think the experience with nurse shift managers has been consistent with (the nurses’) claim,” said Evans, believing that nurse shift managers improve patient care, not reduce it.

The decreased hours and unfilled charge nurse positions creates “an unsafe patient environment with risks of increased patient falls, (increased) pressure or other skin wounds for immobile and incontinent patients, (and) less opportunity to physically mobilize our patients to help speed their recovery,” said Marshall.

Evans disagreed about patient safety being placed in jeopardy.

“Our primary objective in what we provide is absolutely safe, high quality patient care every single day,” said Evans. “Our quality scores reflect that.”

Evans added that the hospital adheres to nursing ratio mandates.


Generally, charge nurses are “waiting for the ax to drop,” said Marshall, as the only charge nurse positions hospital officials said they are not eliminating include those in the Emergency Room and Intensive Care Unit.

Originally, Marshall said hospital administrators told registered nurses that charge nurse positions would be eliminated through attrition.

“Now, (the hospital is) coming to us and saying ‘We’re eliminating the charge nurse position altogether’ and not even through attrition,” Marshall said hospital administrators told her.


Evans said he is working to balance clinical needs with financial pressures.

He acknowledged the challenges: Medicare and Medi-Cal reimbursements declining, increasing costs and added regulatory requirements.

“We ended up making the decision that we needed to adjust our labor costs and spend less money on labor,” said Evans, which includes about 60% of hospital costs, or $100 million.

“Our hospital last year had an operating margin of zero,” he continued. “We have to generate an operating margin in order to upgrade the facility, meeting regulatory requirements (and) purchase equipment to replace things that are outdated and failing.”

Due to the tight margins, Evans said the hospital must analyze everything to see what can be cut.

“I think we have to look at every dollar we spend with extreme scrutiny,” he said, adding “I’m very open to having discussions with all of our employees and the community about what the high priority items are.”


Marshall, a registered nurse, hopes the community becomes more aware of the hospital’s issues.

“Our board of directors at this particular hospital (are) community members,” she said. “That’s different than any other Dignity Health hospital, and I don’t know if our community is aware (of what) Dignity Health as a corporation is trying to do to our community hospital.”

Evans said that Sierra Nevada Memorial Hospital is an affiliate of CommonSpirit Health, and Dignity Health is a sub-brand.

“This hospital is essentially an asset that belongs to the people of western Nevada County,” he said. “The biggest employer, it has a huge economic impact on western Nevada County. And we need it. We need it for the financial contribution. We need it for the healthcare that is provided in an acute care facility.”

Correction: An original version of this story misstated how Chrissie Marshall described the functions of nurses aides. The Union regrets the error.

Clarification: On Dec. 6 edits were made to clarify the story for the reader.

To contact Staff Writer Sam Corey email or call 530-477-4219.

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