OCEANSIDE - While Tri-City Medical Center administrators said this week that new cost-control measures have staunched the flow of red ink from the hospital's budget, some nurses say they're worried the changes could hurt patient safety.

Hospital chief Art Gonzalez said the changes, which included minimizing overtime and rearranging nursing shifts, have put the hospital back on track to realize a modest profit by the end of the year.

"So far, it's looking very good," he said in an interview Thursday.

But some Tri-City nurses, who are represented by the California Nurses Association, the state's largest nursing union, say the changes are spreading them too thin, especially during low-volume periods such as the early morning.

Anna Hall, a full-time emergency room nurse who works the overnight shift, said that she and her fellow nurses regularly find themselves scrambling when a glut of patients comes in after 3 a.m.

She said during a recent shift, four "acute" patients came into the ER after 3 a.m. One had a stroke, a second an overdose, and two more had internal bleeding, she said.

"Those are all very dangerous situations," Hall said, adding that extra nurses were pulled from other departments to help handle the wee-hour surge.

"I'm concerned with the potential of what could happen," she added. "Overall, we don't think the patients are receiving the same level of care."

Suellyn Ellerbe, Tri-City's chief nursing executive, said patient care has not suffered. She said that, while the hospital has adjusted its staffing levels to more closely match the times when the most patients arrive, there are backup plans in place.

"I realize that the changes we have made have been hard for some of the nurses to adjust to, and we acknowledge that we are still tweaking the staffing," Ellerbe said. "There is always back up available for the (Emergency Department) to address atypical increases in the patient volume."

The changes came after the public hospital's governing board voted June 28 to hire Delta Health Systems, a national hospital consulting firm, to conduct a five-month audit of Tri-City's operations. The move came after Tri-City ended its 2006-07 fiscal year with a projected $2.4 million loss.

The consulting firm - which was paid $685,000 and completed the work in November - surveyed all of Tri-City's departments and recommended changes that Gonzalez said are on track to save Tri-City $7 million by June 30.

Gonzalez and Ellerbe said there had been no job cuts as a result of the Delta study. Rather, they said, the hospital is calling in fewer "registry" nurses who work at various hospitals throughout the region as need dictates. Registry help, they said, is more expensive than using nurses and other employees who are already on staff.

Gonzalez said a similar effort is under way to cut back on supplies, especially in the use of rental equipment. He said he understands that the changes are not necessarily easy for employees.

"This isn't a crash diet, it's more like a change of lifestyle," he said. "Changing a lifestyle doesn't mean it's fun, or happy or anything, it takes discipline."

Ellerbe said she met Thursday with about 70 union nurses and their union representative. She said she knows that some are not happy about the changes, which can mean fewer helpers for nurses, less downtime during their shifts and fewer overtime hours.

Ellerbe said she learned at the meeting that some nurses were not getting their breaks and that she has since taken steps to add nurses to fix the situation.

"That was not OK with me for nurses to not get their breaks," Ellerbe said. "I can guarantee that this is not a sweatshop."

During Delta's survey, consultants tried to gauge the effectiveness of Tri-City's 2,400 employees by watching them work, tallying time spent on each activity and compiling it in a computer system that administrators say will help can help managers decide how to structure shifts.

Union representative John Stead-Mendez said he has questioned the validity of the work Delta performed. He said many nurses believe that the methods used to measure nursing productivity were unfair and inaccurate.

"It was pseudoscience," Stead-Mendez said. "Essentially, they're saying that there was idleness, but if you talk to the nurses, they are always busy."

Gonzalez says he was confident that patient care has not suffered as a result of the changes. He said that every patient admitted to the hospital gets a survey card in the mail that asks detailed questions about the care they received at Tri-City.

Contact staff writer Paul Sisson at (760) 901-4087 or psisson@nctimes.com.