SF General nurses told not to provide bilingual services

Even after taking an exam, fluent speakers of non-English languages can't get permission to help patients.

When Lauren Cook heard that the new contract her union, SEIU 1021, had negotiated with San Francisco General Hospital included provisions to streamline the process of receiving bilingual pay, she was initially excited.

A fluent Spanish speaker who lived in Mexico for two years, Cook has worked at the hospital as a registered nurse for more than five years.  Before that, she was a volunteer at the hospital, and a student nurse there.  “I spent my entire nursing career there,” she said. “I grew up in the city, and I always knew that was the place I wanted to be – part of the safety net (of the city).”

Why is it so hard for bilingual nurses to get designated as translators?

Receiving bilingual pay under the old system was onerous, at best. Employees had to become certified by taking a language proficiency test issued by the San Francisco Department of Public Heath, which runs SFGH. Employees were then required to fill out a form each pay period documenting precisely how many hours they spent speaking a second language, get their manager to sign off on it, and then submit it to the payroll department – all to receive a measly extra $25 a week.

It was such an arduous process for such a tiny reward that hardly anyone bothered to fill out the form.  Even after getting their managers to sign off on the paperwork, the payroll department would sometimes second guess it and ask if it was really needed, several nurses told 48hills.

The new contract, which took effect July 1, promised to streamline the system.  That old, burdensome form was history, and the bilingual pay bump increased to $30 a week.

Excited that the dreaded payroll form would no longer be a barrier to receiving bilingual pay, Cook took the hour-long language test in July at a DPH building near City Hall.  She passed.

“It was pretty rigorous. I was surprised at some of the vocabulary we were expected to know,” she said. “They printed out this really fancy certificate.  It had shiny gold leaf on it, and you’re like, they spent money on this?”

Cook put a copy of the certificate in her manager’s inbox and contacted payroll to let them know she was now eligible for bilingual pay.

She got an email from Human Resources instead.

“Passing the exam doesn’t mean that you have been designated by hospital admin/HR to do bilingual services or be paid,” a hospital HR team member wrote to Cook. “We will soon send out from HR leadership new guidance/policy on how to get certified and designated to get bilingual pay.  Right now, no new requests are being processed as we are awaiting clarification.”

The email went onto say that Cook “should not be performing bilingual duties as you have not been designated to do so, and thus won’t be paid to do that work.”

But Cook, who works in the ACE Unit – providing acute care for the elderly, as part of a medical-surgical unit – has always used her bilingual skills on the job.  She just hasn’t been paid for it.

“There was never anything written, or said that prohibited me from doing so,” she said, and she estimates that somewhere between 25 and 35 percent of her patients are Spanish-speaking.

Cook said she’s often pulled into other rooms to translate for co-workers.

Translation services are also available through a phone system, but it’s a cumbersome process that often doesn’t work well with many of Cook’s patients who have hearing loss, or are experiencing dementia.

“It’s almost impossible a lot of the times to use an interpreter phone because of the hard of hearing, or baseline confusion. It’s one of the big things that keeps coming up in terms of safety and equity,” she said.

Many patients recovering from surgery don’t often understand that they need to stay in bed for their own safety and to prevent falls. If they can’t receive instructions in their own language, Cook said, patients often try to climb out of bed, which leaves nurses with few choices.

“The next thing is restraints, which is embarrassing to say, but a lot of times we do need to restrain patients because of communication breakdown,” Cook said.

Cook is hardly alone in struggling with the rules on translation services.

Christa Duran, a nurse in the Emergency Department and a union shop steward, said that of the approximately 180 nurses in the ER, 43 speak a second language, such as Spanish, Russian, Cantonese, or Vietnamese. Of those 43 nurses, only four of them are certified to receive bilingual pay. Duran herself is one of those four, who is certified to speak Spanish at the hospital.

“We have a really diverse community – we need as many bilingual people as we can get,” Duran said.  “I speak Spanish for my entire shift, I am not exaggerating. I have Spanish-speaking clients for 10 out of 12 hours of my shift.”

Brent Andrew, a hospital spokesperson, said that only 61 percent of patients speak English, according to data collected by the hospital.

Spanish speakers make up 24 percent of the patient population, and Cantonese speakers nine percent – although the hospital did not have data showing how many of those Spanish and Cantonese speakers also speak English.

Given the huge need, Duran said she doesn’t understand why hospital administration has been making it harder for bilingual nurses to become certified to receive bilingual pay.

“They have promised culturally competent care – that when people come in, they are going to get care they feel comfortable,” she said. “They are boasting to the community, on their website, everywhere, that they know how to take care of our diverse community. But they don’t want to allow our diverse staff to speak our language and establish rapport with our clients?”

Duran said that even after the email from HR was widely shared among the nurses, nurses on the floor have not stopped speaking other languages, even if they are not receiving bilingual pay. “That would be a huge disservice,” she said. “I’ve stopped patients from being intubated as a result of a language barrier.”

More bilingual nurses are requesting to take the test and become certified for bilingual pay, but are repeatedly being told that the test is not available, Duran said.

Sasha Cuttler, a nurse and chair of the SF General SEIU group, told 48hills that “Latinx nurses are not hired in proportion to our patient population, so it is particularly galling that speakers of other languages are made to beg for the bilingual  stipend. While SF is under attack for being a Sanctuary city, we need to make sure that we can support our immigrant patients.”

Andrew said that while the program had been on hold for some time, a new policy was finalized and emailed to managers in October describing the procedure for adding bilingual workers.

“So far, no managers have filed papers on it,” he said, but that he couldn’t comment on how managers for groups such as the Emergency Department were making those decisions. “I don’t know the inner workers of how that department decides how many bilingual practitioners they need.”

“I can’t explain why in this instance mangers are not filing for this, whether the outreach hasn’t yet been sufficient,” Andrew said. “I don’t know, I really can’t speak to that.”

Meanwhile, the nurses – and patients – are still waiting.