SF Nurses Fight VA Scheduling Change Caused by Outsourcing & Cost-Cutting

The national wave of worker unrest over hospital conditions that create job stress, burnout, and short-staffing reached the corner of Clement and 42nd Streets in San Francisco’s outer Richmond district last month.

On October 18, nearly one hundred RNs and other staffers from the San Francisco Veterans Administration Medical Center (SFVAMC) spent their breaks or lunch hour on an informational picket-line. It was organized by Local 1 of the National Federation of Federal Employees (NFFE), which represents 1,100 employees at the facility.  Dressed in blue scrubs, and accompanied by a boom box blasting golden oldies like “We Are Family,” the RNs waved signs, chanted slogans, urged passing drivers to honk their horns in solidarity, which many did, and perfected their picket-line call-and-response skills (“When nurses are under attack, what do we do? Stand up, fight back!”) 

A key organizer of the protest was SF DSA member Mark Smith, an occupational therapist at the VA. NFFE members are getting picket line and public support from other SF DSA labor committee activists and SF Supervisor Dean Preston, who is also a DSA member.

The protest was triggered by a cost-cutting measure, announced by one of 170 medical centers run by Department of Veterans Affairs (VA), which serves nine million patients nationwide.  SFVAMC executives want to cancel flexible work schedules for bedside nurses at a time when the VA is struggling to fill RN vacancies around the country. A recent report by the agency’s own Inspector General found “severe shortages” of nurses in more than 90% of VA hospitals.

NFFE members—who picketed in T-shirts with the slogan “Serving Those Who Served” on the back—say this management move will impede RN recruitment and retention locally and adversely affect the quality of patient care.  According to one report, 87% of healthcare recruiters surveyed are having more difficulty hiring nurses, with two-thirds reporting major difficulties.  This has created an intense post-pandemic competition for nursing staff.  The flexible work schedule known as “72/80,” which allows nurses to work for 72 hours while being paid for 80, has become a key tool for keeping experienced RNs on the job and attracting younger ones.

Why Change What’s Working?

To conform to this new industry standard, VA management initiated “72/80” about a year ago.  As part of a national effort to reduce RN burnout and relieve staffing shortages, more than 5,100 nurses at 57 VA medical centers around the country are currently on this schedule, a 70% increase from earlier this year. At the San Francisco VA, inpatient and emergency department nurses currently work six 12-hour shifts in two weeks, totaling 72 hours instead of the traditional 80 hours. 

This arrangement is popular because it permits workload relief and more time off between shifts.  As one NFFE member explained, it allows nurses to have more time to care for themselves and their families, and also work part-time elsewhere if necessary.  In a high cost of living city like San Francisco, this is often a necessity. Another nurse, who has been with the VA for over a decade, recalled that management initially rolled out flexible scheduling “very intentionally, unit by unit to see how it would work and it was working.  People were happier and morale went up.” 

But then management decreed that nurses at Fort Miley, as the facility is popularly known, would have to return to a traditional 80-hour schedule in early November.

“We have been told by our leadership that there is a $76 million deficit and that part of the way they want to deal with that is by taking away our flexible work schedules,” said one picketing nurse, who did not want her name used for fear of employer retaliation. “To now take that away and have us work more for no difference in pay, no increase in pay, is a huge problem for us.” She and other nurses interviewed for this story worry the schedule change, if implemented, will lead valued co-workers to quit.  “That would absolutely happen,” one RN predicted. “There are so many nurses that are hanging on because they care about our veterans.”  

Listening to Nurses?

Union supporters were also irate about management’s stance during a recent virtual town hall meeting with nursing staff. Instead of listening to rank-and-file concerns, one reported, “They ended up speaking over the nurses for nearly the entire time and, when we tried to have the union meet with our medical center director, she wouldn’t even entertain the idea.”  (Not surprisingly, a VA Inspector General report issued in August found deficiencies in the local leadership, including the facility’s nurse executive. Even more alarming was its finding that 40% of San Francisco VA hospital staff were afraid to disclose a “violation of any law, rule, or regulation” for fear of reprisal.) 

According to NFFE chief steward Mark Smith, management “has been unwilling to negotiate over its proposed change in nurses’ working conditions and has not responded to our bargaining related data requests.” NFFE has a filed an unfair labor practice charge over this, triggering a pending investigation by the Federal Labor Relations Authority (FLRA).

VA management did respond to a CR request for comment on the dispute. In an email message, local public affairs representative Shirley Jih told us that “the re-evaluation of the 72/80 alternate work schedule was carefully made and we are confident, that as a health care organization, our ability to provide high-quality care for veterans will remain unchanged. We will monitor outcomes and continue to evaluate the decision as we move forward.” Jih said that the SF VA Medical Center has “an active talent management program and will continue to utilize available recruitment and retention authorities to hire and maintain highly qualified nursing staff.” 

Community Support

Mark Smith points out that the VA’s top three local competitors for nursing staff—UC San Francisco, Zuckerberg San Francisco General, and California Pacific Medical Center—all offer flexible schedules along with equivalent or better salaries and benefits for their nursing staff. Two San Francisco Supervisors, who have weighed into the dispute, are questioning management’s claim that the impending schedule change will have no adverse impact on what Jih called the “valued, dedicated, and hardworking members of our staff.” 

On October 18, District 1 Supervisor Connie Chan offered personal picket-line encouragement to VA nurses, who work in her district. She told us that “taking away flexible schedules is creating a hazard in the work environment not just for nurses but for their patients.” In a letter sent the same day to SF VA hospital executives, District 5 Supervisor Dean Preston chided management for not “consulting with frontline nurses or their union.”

Preston put the ill-advised scheduling decision in the broader context of “privatization of public goods.” This has led, under the Obama, Trump and Biden Administrations, to massive out-sourcing of veterans’ care to the private healthcare industry. Currently, more than one quarter of the VA’s $120 billion clinical care budget is being spent outside the VA for treatment that could be provided, at lower cost and with greater effectiveness, inside the nation’s best working model for socialized medicine.

Impact of Privatization

As a result, the VA Medical Center in San Francisco is only one of many around the country with operating deficits, due to unnecessary but Congressionally-mandated patient referrals to the private sector. The hospital’s $830 million budget for 2020 was increased by $87 million for the following year; yet $50 million of that increase was spent on reimbursement of private doctors and hospitals. When a group of VA patients and union activists held an anti-privatization protest four years ago at the same location as the NFFE protest this month,  Vietnam combat veteran Paul Cox warned that “outsourcing is going to do serious damage to the VA’s ability to provide healthcare.”

That prediction has, unfortunately, come true. And those paying the price today, locally and nationally, are VA patients like Cox and front-line care-givers forced to wage defensive fights over the fall-out from privatization of VA services. Like trade unionists under attack anywhere, NFFE Local 1 is necessarily focused on local damage control.

“Nurses understand the necessity of effective budget management,” says chief steward Mark Smith. “They are prepared to discuss alternative solutions to address financial concerns while preserving the 72/80 schedule. They firmly believe that cost savings can be achieved in ways that don’t reduce bedside nurses’ quality of work-life. We want an agreement that benefits the VA, its bedside nurses, and the veterans they care for.”

Any such “win-wins” on a larger scale will not occur until more caregivers stand up and fight back politically against the privatization push that threatens more 300,000 union-represented workers at the VA and nine million patients.