TURLOCK, Calif. — California, like a lot of the nation, will not be producing sufficient nurses working at bedsides to meet the wants of an getting old and various inhabitants, fueling a workforce crunch that dangers endangering high quality affected person care. Practically 60% of California counties, stretching between the borders with Mexico and Oregon, face a nursing scarcity, in line with state information.
Democratic Gov. Gavin Newsom and state lawmakers have tried to bolster the state’s well being care workforce, partially by implementing suggestions from the California Future Well being Workforce Fee, a 24-member panel of state, labor, educational, and trade representatives. The state lately has expanded the scope of follow for nurse practitioners, permitting them to follow drugs — ordering exams and prescribing remedy, as an illustration — with out conventional physician supervision, and has labored to broaden educational nursing slots and coaching applications.
Nonetheless, California’s scarcity of registered nurses is predicted to develop from 3.7% in 2024 to 16.7% by 2033, or greater than 61,000 nurses, because of insufficient recruitment, coaching, and retention, in line with Kathryn Phillips, affiliate director of the Enhancing Entry group on the California Well being Care Basis, a nonprofit philanthropic group specializing in well being care analysis and schooling.
Regional shortages, significantly within the Central Valley and rural North, are anticipated to swell. “There are major deficits and those could get even worse,” Phillips mentioned.
Researchers say the hole between nursing provide and demand is exacerbated by insufficient profession pathways and excessive turnover in a labor-intensive trade, however nurses and their unions argue the issue is pushed primarily by a management-induced staffing disaster and poor working circumstances. Nurses say nursing stays a noble calling, however many report feeling pressured to show over beds and tackle extra sufferers, stress that may dissuade younger folks from coming into the sphere and drive skilled nurses to depart or retire early.
Trade representatives forged these considerations as union speaking factors to drive up labor prices, however nurses say they’re shedding advantages whereas being overworked, hobbling morale and hampering their potential to offer even primary well being care in hospitals, clinics, and nursing houses across the state.
Lorena Burkett, a registered nurse at Emanuel Medical Heart in Turlock, an agricultural metropolis within the coronary heart of the Central Valley, recounted being so overloaded final 12 months that she didn’t promptly log a medical chart after administering a psychiatric affected person’s remedy, a crucial step for guaranteeing correct drug doses.
“I was being told get him out, and I forgot to scan his opioid medication; I missed it,” mentioned Burkett, a 12-year veteran, who later up to date the affected person’s file. “After that I said no more. We have to prioritize patient care, but we are under a lot of pressure to get patients out and turn profits.”
Tenet Healthcare, the Dallas-based for-profit hospital system that owns Emanuel, declined to reply to Burkett’s declare, in addition to questions on staffing ranges. In an announcement, Tenet spokesperson Rob Dyer mentioned that the hospital gives “quality and compassionate care” and broadly disputed nurses’ considerations.
“We are currently in contract negotiations with the union which represents our nurses,” he mentioned, “and suspect that this is what is behind these false claims.”
Enhancing Circumstances for Nurses
Two years in the past, state lawmakers permitted $300 million to assist financially struggling hospitals preserve operations, which might embody retaining nurses. Lawmakers are additionally attempting to enhance nurses’ work circumstances in hospitals and to guard affected person care by strengthening minimal nurse staffing at well being care services. Some additionally name for investing in a extra strong nursing workforce.
“Nurses are working in hospitals and other places that are severely understaffed,” mentioned Michelle Mahon, director of nursing follow for Nationwide Nurses United, a union that represents 225,000 nurses.
Phillips mentioned the explanations fluctuate. Within the San Francisco Bay Space, nurses should take care of a excessive price of dwelling, a scarcity of reasonably priced housing, and costly youngster care. Within the Central Valley, there’s inadequate schooling, coaching, and mentoring. And the agricultural North has a tough time attracting sufficient nurses to exchange those that are retiring and to satisfy the wants of an getting old inhabitants.
College of California-San Francisco researchers who’ve studied the nursing workforce say though individuals are nonetheless in search of jobs in nursing, scholar enrollments and graduations have declined.
The California Board of Registered Nursing exhibits practically 552,000 energetic licensed registered nurses in California as of Oct. 1. But the California Nurses Affiliation says considerably fewer had been working towards, pointing to 2024 information indicating solely 350,850 had been working within the discipline. The identical drawback persists nationally, in line with Nationwide Nurses United, which reported that, as of Could 2024, greater than 1.1 million licensed nurses weren’t working within the discipline.
California Hospital Affiliation spokesperson Jan Emerson-Shea mentioned hospitals across the state are going through “skyrocketing costs” for labor, prescription drugs, medical gear, and compliance with authorities mandates. Affected person care prices have soared 30% previously 5 years and proceed to rise, she mentioned. In the meantime, 53% of hospitals within the state “lose money every day caring for patients,” she mentioned.
And it may worsen.
Underneath the GOP tax-and-spending invoice that President Donald Trump known as the “One Big Beautiful Bill,” the state estimates roughly 3.4 million Californians may lose well being protection due partially to main Medicaid cuts and new guidelines like work necessities that slim eligibility for low-income and disabled residents. California is vulnerable to shedding $30 billion in annual funding, and hospitals will probably be hit significantly laborious as a result of they depend on federal reimbursements and want sufficient insured sufferers to stay solvent.
Emerson-Shea mentioned California hospitals stand to lose as much as $128 billion over 10 years as a result of legislation.
“This projection does not include the likely increases in uncompensated care due to Medicaid work requirements, coverage losses due to the elimination of the Affordable Care Act subsidies, more frequent Medi-Cal redeterminations, and coverage losses for those with unsatisfactory immigration status,” Emerson-Shea mentioned.
Whereas some California hospitals lose cash on affected person care, monetary information exhibits the trade is earning profits, incomes about $11.5 billion in web revenue, or revenue, in 2024, mentioned Kristof Stremikis, director of Market Evaluation and Perception on the California Well being Care Basis, pointing to preliminary state information evaluating 365 hospitals. “The industry as a whole has returned to pre-covid profitability levels,” Stremikis mentioned.
He acknowledged, although, that Medicaid cuts will scale back income for all services.
Hospitals will probably be burdened as uninsured sufferers, who typically arrive with extended sickness or accidents that may make remedy dearer, improve in quantity. That may exacerbate well being care challenges in high-poverty communities with giant Medi-Cal populations, because the security web program usually pays hospitals and suppliers lower than non-public insurance coverage or Medicare.
Already, some hospitals are closing because of monetary struggles, earlier than the impacts of the federal well being care cuts are felt, and others are limiting entry to care, together with by shuttering maternity wards and emergency rooms. Officers at Glenn Medical Heart, about 85 miles north of Sacramento, reported that it could be shutting down its ER on the finish of September because of staffing shortages.
Pandemic-Period Burnout Persists
Entrance-line nurses mentioned the well-documented burnout of well being staff from the covid-19 pandemic, blended with rising hospital calls for, remains to be being felt in the present day as many half methods with the trade. That’s prompting some hospitals to rent extra touring nurses from out of state.
At Hazel Hawkins Memorial Hospital, a financially strained public facility in San Benito County close to the Central Coast, the California Nurses Affiliation mentioned the hospital is using 22 touring nurses, though the hospital put the quantity at 16. Native nurses mentioned momentary staff can ease workloads, however they fear hospitals are utilizing touring nurses to keep away from labor contracts that require larger pay and advantages. They are saying hospitals ought to spend money on well-trained, native workers acquainted with the group.
ER nurse Ariahnna Sanchez mentioned staff at Hazel Hawkins, a 25-bed crucial entry facility, are pressured to discharge sufferers rapidly so extra sufferers could be seen. As union contracts come up for renegotiation, union officers say, hospitals have slashed advantages and haven’t provided ample raises to maintain up with the price of dwelling. Salaries fluctuate by area however the common annual wage for California registered nurses was $148,330 in 2024, in line with the U.S. Bureau of Labor Statistics.
“The morale is so bad right now,” Sanchez mentioned. “We’re trying to fight the good fight but we’re constantly holding people in the emergency room who should be admitted due to the hospital being at max capacity.”
State information exhibits San Benito County has an excessive scarcity of nurses and wishes about 180 extra to accommodate the native inhabitants. However Hazel Hawkins disputes it has a scarcity. The California Nurses Affiliation mentioned 40 nurses have left since final 12 months, whereas the hospital mentioned it has changed 15 of 21 departing nurses.
Hazel Hawkins spokesperson Marcus Younger mentioned nurses are conflating staffing ranges with protocols for dealing with ER sufferers when there aren’t sufficient beds. “There is no material shortage of nurses and hospital operations are not being impacted today,” Younger mentioned. “We are in full compliance with state-mandated nurse-to-patient ratios at all times.”
California legislation dictates staffing minimums at hospitals, starting from one nurse for each three sufferers to at least one nurse for each 5 sufferers, relying on the extent of care the sufferers require. Analysis has proven that medical errors can improve in hospitals and different well being care workplaces when nurses are careworn and overwhelmed. Research point out that burnout associated to work overload, profession satisfaction, and affected person satisfaction is a significant concern and may result in errors.
The state has issued 32 citations to California hospitals since 2020 for violating these minimal nurse staffing ranges, monetary penalties totaling $840,000, in line with the state Division of Public Well being. Neither Hazel Hawkins nor the Turlock hospital Emanuel had any citations. Spokesperson Mark Smith mentioned the company couldn’t present info on any “potential, pending or ongoing investigations” into well being care services alleged to be in violation of state nursing ratios.
Burkett, the nurse in Turlock, mentioned although she will be able to see as much as 5 sufferers at a time, she exceeded her ratio twice previously 12 months. In its newest quarterly monetary submitting, Tenet reported $288 million in web revenue, up from $259 million over the identical interval final 12 months.
“I’ve taken that assignment against my will,” Burkett mentioned, noting that the union distributes types defending nurses from repercussions if errors occur on their watch once they tackle extra sufferers than the state permits. “It says I’m taking these patients against my better judgment and I’m protected because I am not agreeing to this, but the hospital is making me do it,” she added. “It’s tough. I mean, you just have to juggle and do what you can and hope you’re not going to miss something important. It’s not safe.”
State Sen. Caroline Menjivar, a Democrat representing a part of the Los Angeles area, has laws on Newsom’s desk to strengthen the state’s nurse-to-patient ratio legislation by requiring hospitals to work tougher to establish obtainable nurses to satisfy staffing mandates.
“Hospitals for years have been getting a pass on minimum nurse staffing,” mentioned Menjivar, a former emergency medical technician. “If we do not provide more support to our nurses, then we do not get the quality care that is needed.”
Menjivar’s niece Megan Noguera-DeLeon is happy about turning into a nurse, regardless of office challenges. A nursing scholar who expects to graduate subsequent 12 months from West Coast College in Southern California, she mentioned family members who work as nurses have warned her how robust the job could be. She’s fearful about burning out however stays dedicated to the mission.
“I think taking care of people is a beautiful thing,” Noguera-DeLeon mentioned. “I know this job can be really hard and a lot of nurses are experiencing burnout, but honestly I’ve seen firsthand how much nurses can help people even on the darkest of days, and I want to help people.”
This text was produced by KFF Well being Information, which publishes California Healthline, an editorially impartial service of the California Well being Care Basis.
