Sometimes you don’t know at first how strong a spine you’re going to need.

But let’s start at the beginning…back when Alvin Nadal, an Oncology Nurse at Providence St. Joseph’s Hospital in Burbank, first decided to become an R.N.

“I like to joke that I went into nursing for all the wrong reasons, but stayed for all the right ones,” he says. “I liked that it was in the field of science and that you could work most of your weekly hours in just a few days. But I soon loved my job for completely different reasons.”

Alvin was certified in chemotherapy just months after getting his license to be a Registered Nurse. It was in the Oncology Department that he learned how helping patients emotionally and spiritually is as much a part of his job as the physical.

“Just last month, a former patient’s mom stopped by. Her daughter passed away several years ago, but she was in the neighborhood and wanted to give me a hug,” says Alvin. “The idea that despite her daughter’s battle with cancer, she not only remembered me, but wanted to see how I was doing…I can’t imagine being a car salesman and meeting someone I sold a car to and have them stop me to hug me with tears in their eyes.”

Another day stands out for Alvin.

Like many nurses at many California hospitals, Alvin and his colleagues report chronic low staffing in their department. Alvin had heard through the grapevine that some union nurses at other hospitals had refused to break the law by taking extra patients that would put them out of state-mandated ratios. These nurses believed that hospitals were cutting corners and they began to demand that management call in additional staff.

On this one particularly bad day in his department, all the nurses were all out of ratio. To make matters worse, they didn’t have enough nurses’ aides on the floor that day, either.

Alvin decided that he would join those other union nurses he’d heard about and refuse his unsafe assignment. He wasn’t prepared for what happened.

“My supervisors said they would fire me on the spot,” says Alvin.

Looking back, Alvin wishes he hadn’t believed them.

“It was while I was giving an infusion that day that my other patients suffered. Chemotherapy is lifesaving, but it’s also life-threatening. While you’re infusing a patient, so many things can go wrong. It takes constant monitoring. Sometimes a patient has a severe allergic reaction. And I once saw a patient’s skin eaten away where some of the infusion filtered into extravascular space. I swore I would never let that happen to a patient of mine,” he says.

One of Alvin’s other patients called for toileting assistance. Typically, Alvin would have been able to ask another R.N. or nurse assistant to give him a hand. He and his co-workers consider themselves a team. But with the entire floor out of ratio, no one could assist.

“In the 30 minutes that the medication was infusing, I wasn’t comfortable leaving that patient. In the meantime, other patients didn’t get important medications on time. And the patient who needed the bedpan ended up soiling himself,” he says. “Understandably, he was humiliated and angry.”

Alvin had been forced to choose between a patient soiling himself and a patient who could potentially die from chemo.

“That’s the day I decided, other than in an emergency, I would never accept an unsafe assignment again.”

Since that day, Alvin has refused several unsafe assignments. Now his supervisors know better than to even ask. But it’s still happening to other nurses at his and too many other hospitals.

“This just isn’t what medicine is supposed to be,” he says. “We’re here to help people—but for hospital administrators, it just all boils down to how much money they can save.”