After 22 years at Kaiser San Jose, emergency room nurse Jenny Robledo thought she knew just about every one of her coworkers at the South Bay medical center — until COVID burnout hit the health care industry.

“In my department,” Robledo said Friday, “the turnover rate is so high right now that I can come to work any day and look around and say, ‘I don’t know anybody here.'”

This week, thousands of Kaiser health care workers across the Bay Area walked off the job in support of striking engineers whose job it is to keep Kaiser’s medical centers up and running.

The labor action forced the health care giant to shutter some labs, transfer some patients and postpone some surgeries. But the strike is just one symbol of broader pain in a health care industry battered by a pandemic with no end in sight, as mounting stress has exacerbated staffing challenges.

Kaiser said in a statement that it has hired “hundreds of nurses and other care team members in recent months” in Northern California, including roughly 1,800 “experienced nurses” by the year’s end, along with 300 nurses set to graduate from the HMO’s own residency program.

OAKLAND, CA – NOVEMBER 19: Nurse Jennifer Parker holds up picketing signs in solidarity with striking Kaiser engineers outside Kaiser Permanent Medical Center in Oakland, Calif., on Friday, Nov. 19, 2021. Union engineers from Local 39 enter their 63rd day of strike. (Ray Chavez/Bay Area News Group) 

But Kaiser also acknowledged that “staffing continues to be a challenge across health care,” with California in particular facing an “acute shortage of nurses.”

The Oakland-based health care system is not alone.

In a September report, the UCSF Health Workforce Research Center on Long-Term Care said the state will be hit by a shortfall of registered nurses over the next half-decade, with the pandemic making matters worse. According to the report, the state currently needs about 40,500 nurses it does not have, and that shortage — a 13.6% gap — is expected to last until 2026. About 30% of the nurses working in the state are over the age of 55, according to the report, and many are planning to retire or quit amid the intense demands of the pandemic.

About one-fourth of registered nurses ages 55-64 said they plan to leave in the next two years, up from 12% in 2018, a shift the report says is likely due to burnout and wanting to protect vulnerable family members from COVID-19. Combine that with what the report says is a reluctance among health care providers to hire inexperienced nurses during the pandemic and fewer students graduating, in part because programs struggled to put students in clinical environments as COVID-19 was raging, and the workers on the frontline are struggling to keep up — and demanding better pay and working conditions.

Jessica Nunez is one of those worn-out nurses. “It’s gotten worse over the pandemic because a lot of nurses have transferred to other positions, have quit (or) retired,” said Nunez, who along with Robledo joined the sympathy strike Friday outside Kaiser San Jose.

SAN JOSE, CALIFORNIA – NOVEMBER 19: Jessica Nunez, a RN for over 20 years from San Jose, stands for a portrait outside Kaiser Permanente San Jose Medical Center in San Jose, Calif., on Friday, Nov. 19, 2021. Nurses are supporting the IUOE Stationary Engineers, Local 39, who have been striking since their contract expired on Sept. 17 in a bid for higher wages.(Shae Hammond/Bay Area News Group) 

Beyond having to suit up in N95 masks, face shields and gowns every day, there’s the exhaustion and stress of battling an invisible deadly infectious disease that not everyone is willing to take seriously.

“There’s definitely burnout,” Robledo said. “This hospital has gone through a lot because we were one of the epicenters of the pandemic and we were dealing with our own outbreak. We’re dealing with the stress at work and we don’t escape it when we go home. Right now, since with COVID, everything is stressful everywhere, there’s no way to get away from it. You have to educate your patients about COVID and they have their own theories, whether they don’t believe in vaccines or COVID. Then you go home and have to do the same with your family members, spouses or children. The burnout is a real thing. We’ve had a lot of people who left nursing altogether.”

Just how big of an impact the staffing crisis is having locally isn’t clear. Health systems across the Bay Area either did not respond or declined to go into detail about how much outside help they’re bringing in — or how much they pay — and insisted they are prepared for a possible winter surge in COVID cases.

SAN JOSE, CALIFORNIA – NOVEMBER 19: outside Kaiser Permanente San Jose Medical Center in San Jose, Calif., on Friday, Nov. 19, 2021. (Shae Hammond/Bay Area News Group) 

“We’ve been preparing for surges since we received our first two patients in February 2020 and have continuously balanced the numbers of patients with COVID-19 against the numbers of other patients in our hospitals,” a spokesperson for UCSF said, adding that the number of health care workers at the health provider has increased nearly 10% from 2020 when the pandemic began.

“We will adjust staff as appropriate should we have a seasonal increase in patients with COVID-19 or other illnesses,” said a spokesperson for Santa Clara Valley Medical Center, adding that the county is “not seeing any extraordinary retirements or staff leaving our hospitals.”

But workers say health providers are relying on traveling nurses and short-term help, and paying handsomely to get it — even as they push back on union demands for higher wages and other benefits.

“They were offering quite large amounts of money,” said Robledo, the Kaiser nurse. “It’s been easy to get travelers in California because they can pay better than other parts of the country.”

Trusted Health, a startup that matches nurses to jobs in the Bay Area and elsewhere, said it is seeing high demand in Northern California and rates of $120-$165.

Yet hospital administrators say the pandemic has hit medical centers hard, too. For a time, they had to halt lucrative elective procedures and scramble to stock up on masks and other protective gear for workers.

According to the California Hospital Association, the state’s hospitals lost more than $8 billion in 2020 due to the pandemic, even after the federal money they got through the CARES Act. And they’re projected to lose up to $2 billion in 2021, with operating margins expected to drop between 19% and 65% because of COVID-19. Kaiser posted a net income of $6.4 billion in 2020, down about 14% from 2019.

“At the heart of the issues in bargaining is this: Health care is increasingly unaffordable, and escalating wages are half of our costs,” Kaiser said in a statement Friday. “The challenge we are trying to address is that if we continue to increase costs so high above the marketplace, our members will not be able to afford to get the care they need.”

But the unions representing Kaiser’s workers and others say that if the industry doesn’t become a more desirable place to work, there won’t be enough workers to care for those patients.