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As the president of St. Joseph Health in Sonoma County, I'm extraordinarily proud of the compassionate, high-quality care our registered nurses provide at Santa Rosa Memorial Hospital. I've been privileged to witness the life-saving difference their expertise makes for people of our region every day. No hospital north of the Golden Gate provides the complexity of care that we do at Memorial, and we could not act as the region's medical safety net without the hard work and dedication of our RNs.

Registered nurses picketing this week include those who've devoted years of service to our patients, along with others who are equally committed. I, along with fellow leaders who represent our ministry at the bargaining table, deeply respect and value them all. The difficult balance we must achieve between fairly compensating these valued co-workers and responsibly stewarding resources to meet our communities' future health care needs in no way diminishes that respect.

The gap between the Staff Nurses' Association's position and the hospital's position comes down to the very different lenses through which we view the future of health care in Sonoma County and the impact it will have on our community's largest hospital.

As health care professionals, we all are obligated to look forward to ensure Santa Rosa Memorial can deliver the affordable, competitively priced care that consumers and employers demand. We're obligated to lower our expenses to offset declining reimbursements, while at the same time reinvesting our revenues to ensure we continue meeting community needs — whether through a $15 million expansion of our emergency department or a new $3 million MRI. As the regional trauma center that treats the most critically injured and ill patients from here to the Oregon border, we cannot look back and base our decisions on history. To do so would jeopardize access to services on which residents, visitors and health partners across the North Coast rely.

A full-time RN at Santa Rosa Memorial averages in excess of $150,000 in pay and benefits annually. We believe that RNs should be well compensated. However, at a time when U.S. employers are seeking solutions to de-escalate payroll and benefits costs, and one-third of California hospitals are operating in the red, we believe the double-digit pay raises the union is seeking are unwarranted and financially risky.

The nurses' union has characterized our operating margin as "profits." We are a nonprofit ministry which does not post profits or reward shareholders. Rather, we reinvest our surplus back into the community, maintaining much-needed facilities, services and outreach, including care for our most vulnerable neighbors.

Last year, we provided $41.2 million in care for patients who are underfunded and cannot afford to pay for their care. We must maintain an operating margin that enables us to continue providing state-of-the-art treatment while caring for all who come to our doors, regardless of their ability to pay.

These are challenging times for all of us. The tough choices before us call for cooperation and trust, and I hope that through collaboration we can reach resolution and compromise.

Back at the bargaining table, I'm confident we can negotiate a mutually acceptable agreement that honors and supports our nurses so they can get back to the bedside and do what they do best: provide excellent care to our patients every day.

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