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The advocates

August 29, 2007 -- Today San Antonio NBC affiliate WOAI reported that nurses at two major local hospitals have gone public with allegations of dangerous short-staffing. The focus of David Cruz's report is a group led by veteran nurse Imelda Balderas (right), who says that a lack of nurses at University Hospital has led to at least one patient death in recent weeks. The piece notes that nurses from Christus Santa Rosa Hospital's ICU made similar claims last week. Balderas has organized a "patient advocacy committee" to push for staffing ratios and whistle-blower protection. The hospital reportedly disputes some of the staffing claims and says it is unaware of any "widespread dissatisfaction" among nurses. We thank David Cruz and WOAI for the report, and commend Balderas and her group for speaking out about patient safety issues despite the obvious risk to their careers.

On the WOAI site, the report is headlined "More San Antonio Nurses Come Forward About Unsafe Conditions." The University Hospital nurses reportedly say the situation is "leading to lapses in care for patients and even death." The piece notes that the nurses have been "torn between fear for their jobs and fear for their patients," but Balderas says:

Maybe tomorrow I will lose my job. But you know what? I'm no longer afraid...I used to be when I was younger...Afraid to speak up because I'm afraid to lose my job, and I was raising my kid.

Balderas's concerns appear to focus on the emergency department. She confirms that (in Cruz's words) "because there are too few nurses, patients are getting worse and some have died." She says one patient died as a result of short-staffing a couple weeks ago; we do not hear details. Balderas was "the first Filipino nurse ever hired at what was then Bexar County Hospital" in 1972, and she has worked there ever since--35 years. Given this perspective, her view of patient care at the hospital is troubling:

Coming from the Philippines you look at the U.S. as something progressive. But through the years in my nursing experience, it's just gotten worse in the quality of patient care.

The piece says that nurses from the Hospital have met at Balderas's home "to form a patient advocacy committee to address the widespread nursing shortage." They also "plan to convene outside University Hospital's Emergency Room entrance to call attention to their demands for improved staffing for better patient care." The report also quotes an earlier "release" in which the nurses stated:

"Our first obligation as RNs is to advocate in the exclusive interests of our patients."

"A top priority is to establish mandated safe staffing ratios of nurses to patients in all Bexar County facilities."

"Texas law currently provides no 'whistle-blower' protections for nurses."

One interesting part of this is the apparent effort to have staffing ratios imposed at the county (rather than state or federal) level. Some corporations might move large facilities to the next county to avoid such regulation, but we're not sure that would be easy for hospitals, for whom location would often seem to be critical, and whose physical infrastructure might be hard to relocate. On the other hand, local officials might have difficulty imposing such restrictions on some of their county's major employers.

The piece also says the University Hospital nurses are now relying on a provision of the Texas Administrative Code stating that nurses can "accept only those assignments that take into consideration client safety and that are commensurate with the nurse's education preparation, experience, knowledge, and physical and emotional ability." Of course, that kind of language can be interpreted in different ways.

The report says that University Hospital spokesperson Lenny Kirkman "said she could not comment on the specific allegations at this time." However, she did "dispute some of the staffing claims made by the nurses and added that the hospital was unaware of any widespread dissatisfaction among the nurses."

This piece might have explained, even if briefly, why it is that understaffing nurses can harm patients, e.g., nurses are the ones who use their skills to detect and prevent complications and errors, and to deliver vital therapeutic care, so if there are not enough nurses, patients can die. The piece might also have mentioned the toll short-staffing takes on nurses themselves, and its role in exacerbating burnout and the shortage. Finally, the piece might have drawn the distinction between short-staffing due to a hospital's inability to fill positions it agrees should be filled, and short-staffing due to a hospital's decision not to provide the number of clinical staff that some nurses believe are needed. The piece suggests that this situation falls into the latter category, but it might have made this clear.

Still, we thank WOAI for highlighting the key nursing issues of safe staffing, the risks to whistleblowers, and the difficulties when patient advocacy appears to create conflicts with nurses' own status in the workplace--all in a relatively short television report. Whatever the merits of the claims made by Balderas and her group, we commend them for their courage in speaking out on behalf of their patients and themselves.

Please send messages of thanks to reporter David Cruz (above) at and please copy us on the message at Thank you!

See the story "More San Antonio Nurses Come Forward About Unsafe Conditions. and see its video report.

Also see related investigative stories by David Cruz "Nurses Claim Staffing Crisis At Major San Antonio Hospital" and its video report; and "Nurses Protest, Claim Shortages Lead To Injuries, Deaths of Patients".

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