National Nurses United

was unsafe for patients and nurses. The union also sent detailed requests for infor- mation (RFIs) from 2022 to 2023 about the waivers, including what were the policies and procedures to request waivers and what training was available to nurses and other health care workers to ensure safe care in rooms with shadow beds. In fall of 2022, Gov. Newsom announced that California's state of emergency would end in February 2023, which meant all waivers would expire. But nurses knew that UCLA was not making any plans to stop using shadow beds or hallway beds. Fed up, their campaign began to escalate. "We held virtual town halls with members and showed them how to file complaints with CDPH," said Muellerchen, RN in a medical- surgical unit. "Management was so pushy about putting patients in shared rooms. " UCLA nurses continued to file complaints with CDPH but when the department conducted its investigations, it found a majority of RNs' complaints "unsub- stantiated" in 2022 and 2023—most likely due to investigators meeting with managers, not the nurses who filed the complaints. Most of the time nurses did not know when or if any investigations were conducted. When the state of emergency officially ended on the last day of February, the PPC was fully prepared for management's inac- tion. The next day, March 1, the RNs held a rally outside the hospital demonstrating the reality of cramming two beds in a single room by putting beds side-by-side at the event. They also delivered a petition to the CNO, signed by about 1,200 nurses, demanding that UCLA stop applying for additional space waivers or extensions to waivers and listed more than a dozen issues. Much to nurses' dismay, CDPH created a "flexibility request" that allowed facilities to continue using unlicensed beds. UCLA applied for space waivers under this new process but neglected to tell nurses. They found out about it from news reporters. CNA contacted CDPH about the flexibil- ity waivers and began surveying UCLA nurses about the impact of shadow beds and hallway beds on patient safety, delivering the survey results in June to the CNO and to CDPH offices in El Monte, which oversees UCLA facilities. "The survey included exam- ples of our concerns," said Muellerchen. "There were infection risks. Immunocom- promised patients were put in shared rooms, which was not safe for them. Patients who objected to being in a room with a shadow bed were offered medication to cope with the stress instead of being given a single room." The PPC continued to put the shadow bed and hallway beds concerns on the agenda for each quarterly meeting with the CNO and finally had a breakthrough in August 2023 when CNA was notified that shadow beds would be decommissioned until there were just two shadow beds per inpatient unit. However, more than 40 hall- way beds were still in use in the ED. In February 2024, when Cuadra learned that CDPH was conducting a site visit in her unit, accompanied by managers, she intro- duced herself to the state officer and said, "Hi, I'm one of the people who filed a complaint." She took them to a room with a shadow bed and when she opened the door, it hit the recliner chair of a patient's parent. When the CDPH officer saw the crowded room, they were appalled and agreed that it was unsafe and completely unacceptable. Not long after that, Cuadra says there was a "loose rule to limit the number of shadow beds." In March, UC nurses from across the state held a rally in front of CDPH offices in Sacra- mento, the state capital, to bring attention to their ongoing patient safety issues and CDPH's failure to respond appropriately to their concerns with thorough and transpar- ent investigations and reporting. As a result of that action, UCLA nurses won a huge victory: As of April, an existing UCLA policy is now being enforced more frequently, which states that shadow beds are not allowed unless there are no other available beds. "Bed control must go up the chain of command and can only use a shadow bed if there's a surge," said Cuadra. Chuleenan Svetvilas is a communications specialist at National Nurses United. 14 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G J U LY | A U G U S T | S E P T E M B E R 2 0 2 4

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