DEBRIDE the SCABS - page 8

Replacement nurses arrive to prepare for possible strike Alternately titled.... SCABS-R-US on the move...... Replacement nurses arrive to prepare for possible strike Maura Lerner ... Read More

  1. by   PeggyOhio
    Charles,
    Perhaps the problem is I am confused to what it is you are actually doing.

    In one post you say you work in a hospital setting at the bedside, as an independent contractor. This sounds to me like a fancy name for agency nurse. Only you are your own agency.

    Then you say you "create" your "own demand". How do you do this go out and knock down a few little old ladies? Last time I heard you had to be admitted to a hospital by a physician.

    It is rather hard to get an idea of exactly what it is you do.

    At any rate. For the sake of discussion I am assuming that you do indeed work as a staff nurse at the bedside in a hospital. And you do this as a "independent professional practioner".

    Let us assume that you have successfully convince nurses to follow this new "model" of "professional independent practice". It's several years down the road now everybody doing it. And since the nursing shortage created a huge demand many wages have skyrocketed, and many, many folks have decided to follow the money. And the shortage no longer exists.

    So say you have enjoyed a very nice "relationship"(formerly called "job") with your "contractees" (f.k.a. "employer"). And your contract is up for renegotiation. Since everyone is in the market now the "contractee" finds a better offer. (That is sometimes called cut-throat, or bidding wars, etc.) Your "relationship" is terminated.

    Since you are an "independent profession practitioner" you have no PTO, no Cobra. Fortunately in your contract there is a written in grace period before termination. Unfortunately the grace period has expired and you have still not found a new "contractor". For all intents and purposes you are now jobless. Without the income needed to pay your own medical, dental, and vision benefits. Unable to make contributions to your IRA, 401K, or SS, income taxes, or pay the accountant that is handling these things for you.


    I could imagine hospitals being delighted to go with this new "model" as they would no longer have the administrative costs of maintaining health benefits and retirement benefits since they would no longer have any "employees", well at least "professional" ones.

    RNPD I think you may be right about this.

    [ June 04, 2001: Message edited by: PeggyOhio ]
  2. by   Charles S. Smith, RN, MS
    Originally posted by PeggyOhio:
    <STRONG>Charles,
    Perhaps the problem is I am confused to what it is you are actually doing.

    In one post you say you work in a hospital setting at the bedside, as an independent contractor. This sounds to me like a fancy name for agency nurse. Only you are your own agency.

    Peggy...thanx for the questions...An agency is an employer or broker that extracts a cost over and above the wage paid to the employee. We bill less than agencies but are reimbursed at rates exceeding agency pay rates (cut out the middle layer). No, I am not my own agency, but I am my own contractor along with my business partners. We do not do just staffing. We also teach, consult, coach, LNC work, etc. We have established a professional practice group to allow us to continue practicing at the bedside for a fair market wage, but also allows us the freedom and flexibility to perform other nursing work (missions, parish nursing, etc) at the same time.

    Then you say you "create" your "own demand". How do you do this go out and knock down a few little old ladies? Last time I heard you had to be admitted to a hospital by a physician.

    We have value added services in our practice group and the hospitals in our area seem to appreciate them. We are not limited to bedside nursing, and offer expert practice to teach and precept, consult, etc. In addition, by keeping our numbers manageable and only partnering with expert nurses, we are well known in the systems where we provide services.

    It is rather hard to get an idea of exactly what it is you do.

    At any rate. For the sake of discussion I am assuming that you do indeed work as a staff nurse at the bedside in a hospital. And you do this as a "independent professional practioner".

    Let us assume that you have successfully convince nurses to follow this new "model" of "professional independent practice". It's several years down the road now everybody doing it. And since the nursing shortage created a huge demand many wages have skyrocketed, and many, many folks have decided to follow the money. And the shortage no longer exists.

    Peggy...I have no fear of the "shortage" ending, or all nurses following a different model. There are too many nurses who are afraid of living a full life, fearful of thinking in new ways, and are too entrenched to move out of employment. As is evidenced on this board nurses many times are more comfortable looking at others and taking pot shots than at looking at themselves and making meaningful changes (not a criticism, just an observation) Our model is innovative, yet not for everyone, especially novice nurses. The foundation is expert practice and that takes years.

    So say you have enjoyed a very nice "relationship"(formerly called "job") with your "contractees" (f.k.a. "employer"). And your contract is up for renegotiation. Since everyone is in the market now the "contractee" finds a better offer. (That is sometimes called cut-throat, or bidding wars, etc.) Your "relationship" is terminated.

    Participating in an economic market is not without its risks. Our relationship is contractual and governed by state and federal laws. We are a business offering service to another business, so it really is not "formally called a job". We all know that our services may not be needed at some point in the future, so we have taken the risk away by preparing to do other things as needed. We are pretty flexible too in terms of the venue where we practice. I can pick up and work anywhere as long as I have negotiated a contract in advance.

    Since you are an "independent profession practitioner" you have no PTO, no Cobra. Fortunately in your contract there is a written in grace period before termination. Unfortunately the grace period has expired and you have still not found a new "contractor". For all intents and purposes you are now jobless. Without the income needed to pay your own medical, dental, and vision benefits. Unable to make contributions to your IRA, 401K, or SS, income taxes, or pay the accountant that is handling these things for you.

    Ah..but there you may be underinformed. We are a business and there are contingency plans in all businesses, certainly in ours for the issues you raise. My crystal ball is a bit rusty these days, but it still shows a pretty fair picture of continued work down the road (until my cane gives out and the wheels on my wheelchair fall off). Businesses prepare for economic contingencies and we have done the same with some work left to go. We don't have to beg for benefits. We can make our own and change or enhance them anytime we choose. Can you say the same of regular employees? I think not.

    I could imagine hospitals being delighted to go with this new "model" as they would no longer have the administrative costs of maintaining health benefits and retirement benefits since they would no longer have any "employees", well at least "professional" ones.

    And you know...that is a marketing concept that we use...the hospitals do not have the burden of all of the extras. We take care of that and they are, as you say, more than willing to participate with us. Our group is reliable, dependable and hard working. The hospitals get a pretty big bang for the buck so to speak and we come out far ahead in terms of work satisfaction, life satisfaction and financial satisfaction. So far, it has been a win-win. We do know that anything can change and that is what we are not afraid of...change.

    What I find interesting is that a different model of practice is threatening to nurses. Nursing has a long history of trying new things and this is only one in a long string of them. Often we are critical about that which we are underinformed or of that which we are frightened. Nurses really ought to look at new and innovative ways to create a brighter nursing future. I say bring on any and all ideas. It can only enhance our profession in the long run. Why stay in a rut when all you can see is mud (or at least that is what the complaining is all about)?
    I had my share of complaints too, until I woke up one day and said...no more. I will take total control of my life and I did. I am far happier than ever. I would only pray that others will want total control over her/his life as well. It is a wonderful place to be.

    RNPD I think you may be right about this.

    Thanx again Peggy...just try to imagine what it might be like to really choose......

    chas

    [ June 04, 2001: Message edited by: PeggyOhio ]</STRONG>
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  3. by   PeggyOhio
    Charles,
    I can see many of my assumptions were incorrect. Thanks for the clarification. It seems that you have really made a nice niche for yourself.

    However you readily admit, "Our model is innovative, yet NOT FOR EVERYONE, especially novice nurses. The foundation is expert practice and that takes years." Yet you infer that those who do not or choose not to follow this model are, "nurses who are afraid of living a full life, fearful of thinking in new ways, and are too entrenched to move out of employment."

    Risk is a big part of what you are doing. As you state, "We do know that anything can change and that is what we are not afraid of...change." Not everyone can be, "flexible too in terms of the venue where (they) practice. Or,"can pick up and work anywhere...."

    Bully for you that you can!

    [ June 04, 2001: Message edited by: PeggyOhio ]
  4. by   Charles S. Smith, RN, MS
    Originally posted by PeggyOhio:
    <STRONG>Charles,
    Thanks for the clarification. I can see that you have really made a nice niche for yourself.

    I also see that risk is a big part of what you are doing. And bully for you that you can take those kinds of risks. </STRONG>
    Thanx Peg...it is a niche and certainly not without risk. My mother, God rest her, told me a long time ago that the worst failure in life is to refuse to try. This from a woman who knew the Depression and World War II intimately. There are others out there who will enjoy learning to take calculated risks and I am here for them, one by one.

    regards
    chas
  5. by   RNPD
    chas, it sounds like a great concept. I am happy that you have been able to raise nursing practice at the bedside to a new level. But by your own admission it is not for everyone, especially the timid and the novice. Also, could the fact that you're a man have anything to do with your success? Are any of your partners women? If so, do they have children and families?

    You see a lot of nurses are either supporting families, or work less than full time. And being women is a disadvantage from a business perspective in the eyes of a potential "client" (i.e. healthcare facility). So you are right, your model is not for everyone, and may never be a viable alternative for the bulk of the profession.

    That said, why is it that you and others who have had success within the profession (the percentage of which is low when discussing bedside care) feel that those of us who are unable to follow your indepedndent practice model and negotiate better conditions for ourselves are someone the less for joining a union to try to get the best situation that they can given THEIR circumstances? I don't have the business ability or financial wherewithall, or even the desire to work as hard as I would need to to be an independent contractor. Why then, should I not take advantage of having a designated leader (i.e.union) to speak for me and others like me to negotiate the best possible deal for MY circumstances?
  6. by   PeggyOhio
    Charles,
    I agree your ideas are unique. But I also think it is naive to think that you are immune to competition. I imagine if nurses as independent contractors became the norm it would become extremely cut-throat and competitive.
  7. by   Charles S. Smith, RN, MS
    Originally posted by RNPD:
    <STRONG>chas, it sounds like a great concept. I am happy that you have been able to raise nursing practice at the bedside to a new level. But by your own admission it is not for everyone, especially the timid and the novice. Also, could the fact that you're a man have anything to do with your success? Are any of your partners women? If so, do they have children and families?

    You see a lot of nurses are either supporting families, or work less than full time. And being women is a disadvantage from a business perspective in the eyes of a potential "client" (i.e. healthcare facility). So you are right, your model is not for everyone, and may never be a viable alternative for the bulk of the profession.

    That said, why is it that you and others who have had success within the profession (the percentage of which is low when discussing bedside care) feel that those of us who are unable to follow your indepedndent practice model and negotiate better conditions for ourselves are someone the less for joining a union to try to get the best situation that they can given THEIR circumstances? I don't have the business ability or financial wherewithall, or even the desire to work as hard as I would need to to be an independent contractor. Why then, should I not take advantage of having a designated leader (i.e.union) to speak for me and others like me to negotiate the best possible deal for MY circumstances?</STRONG>
    Gender really has no bearing on the success of any idea or concept. Passion does, however. We have passion and drive... As for the demographics of our group, we are highly diverse: ages from 29-60, men, women, married, single, 0 children to 5 children, African American, Guyanese, Hispanic, ADN to doctoral candidates, Advanced Practice Nurses, Nurse Lawyer...In a nutshell, we are all unique individuals with passion.

    I support anyone who has the drive to make a change for her/his life. I do not and have not made disparaging remarks about collective bargaining on this website. There has been a need for this activity and I am open enough to see that. I merely take offense at name calling and labeling. So, I applaud your efforts for yourself and your co-workers. Just be open to look at different ideas along the way!

    regards
    chas
  8. by   nurs4kids
    so, chas...are you in essence saying you too are a "scab"??
  9. by   PhantomRN
    Just as an FYI. Possibly the reason that the nurses who cross the lines can work multiple shifts is because when there is a strike.

    THE HOSPITAL IS MANDATED BY FEDERAL LAW TO STAFF AT 1 AND A 1/2 TIMES THE NORMAL STAFFING PATTERN OF THE FLOOR, DURING A STRIKE.

    So think of your own floor now. Mine a 25 bed staff 6 nurses during the day, so if they strike they would staff my floor with 9 nurses.
  10. by   MollyJ
    Chas, this is really the most complete explanation I have heard you give of what you do and it has been really great. Typically, when you are at the bedside are you staff nurse, mentor or problem solver or case manager or something else? Just curious.

    I worked for a nurse entrepeneur here in KS who had sub-contracted to do Case Management for tech dependent kids. She started out being humored by her hubby ("Nice little job. Hope you're having a good time.") and ended up making more than he did in his job. But I found being a sub-contractor is pretty all-consuming and found that I was not built for being on call virtually 24 hours out of the day, 7 days per week. (I think some of my former colleagues would disagree and I think there has to be a certain ability to shut the job off--I never could.) Still, I think she [my former sub-contracting "boss"] would describe the sensation much as you do. High Autonomy=high control=high accountability and for her high satisfaction. Truly there was a sense of ownership of outcomes that pretty uniquely awesome.

    Do you see, Chas, all bedside nurses becoming entrepeneurs? My sis-in-law (also a nurse) got really excited by this idea, but I did not see a way around that nursing services are "content of service" of the hospital stay. The trend in insurance reimbursement is toward bundling as much reimbursement as possible and unless nurses could see the worth of their services itemized (somehow) and reimbursed not as part of a bundled reimbursement, I don't see how this will work. Any nurse here would love to see nursing services itemized--ie the care of the normal post-op thoracotomy person vs the person with a septic, contaminated post-surgical abdominal wound that gets wound packed mutliple times a day.

    I hope that nurses will also be aware that the real profiteers in health care, I think, are insurance companies. When I did CM, people shied away from us (being m/caid) because of low reimbursement, but now I am told we are actually one of the better reimbursers compared to commercial insurances. I believe the balance of power in health care is not toward docs, hospitals, or the patient but toward the insurors and I believe there is some abuse of power there.

    Thanks again,
  11. by   Charles S. Smith, RN, MS
    Originally posted by nurs4kids:
    <STRONG>so, chas...are you in essence saying you too are a "scab"??</STRONG>
    I almost did not respond to your question nurs4kids because it seemed as if you did not read any of the foregoing. But maybe you did, so being the tolerant soul that I am, I will simply point out that you missed the point...the label is offensive and continued pejorative remonstrations solve nothing. Look deep inside and know that providence has a way of putting us in the path of that which we fear and loathe the most. The person you label today could be the person who is caring for you tomorrow. I see both sides of the cause.

    chas
  12. by   Charles S. Smith, RN, MS
    Originally posted by MollyJ:
    <STRONG>Chas, this is really the most complete explanation I have heard you give of what you do and it has been really great. Typically, when you are at the bedside are you staff nurse, mentor or problem solver or case manager or something else? Just curious.

    I worked for a nurse entrepeneur here in KS who had sub-contracted to do Case Management for tech dependent kids. She started out being humored by her hubby ("Nice little job. Hope you're having a good time.") and ended up making more than he did in his job. But I found being a sub-contractor is pretty all-consuming and found that I was not built for being on call virtually 24 hours out of the day, 7 days per week. (I think some of my former colleagues would disagree and I think there has to be a certain ability to shut the job off--I never could.) Still, I think she [my former sub-contracting "boss"] would describe the sensation much as you do. High Autonomy=high control=high accountability and for her high satisfaction. Truly there was a sense of ownership of outcomes that pretty uniquely awesome.

    Do you see, Chas, all bedside nurses becoming entrepeneurs? My sis-in-law (also a nurse) got really excited by this idea, but I did not see a way around that nursing services are "content of service" of the hospital stay. The trend in insurance reimbursement is toward bundling as much reimbursement as possible and unless nurses could see the worth of their services itemized (somehow) and reimbursed not as part of a bundled reimbursement, I don't see how this will work. Any nurse here would love to see nursing services itemized--ie the care of the normal post-op thoracotomy person vs the person with a septic, contaminated post-surgical abdominal wound that gets wound packed mutliple times a day.

    I hope that nurses will also be aware that the real profiteers in health care, I think, are insurance companies. When I did CM, people shied away from us (being m/caid) because of low reimbursement, but now I am told we are actually one of the better reimbursers compared to commercial insurances. I believe the balance of power in health care is not toward docs, hospitals, or the patient but toward the insurors and I believe there is some abuse of power there.

    Thanks again,</STRONG>
    Molly...thank you and I am pleased I cleared up some stuff for you. I did not intentionally mean to be vague previously. Teaching what we do is about a 2 day seminar (which we hope to begin in the fall, by the way) so it is sometimes difficult to be succinct, yet clear.

    In the best of all worlds I would love to see nurses move from the ranks of employed to the heights of entrepreneurship. Realistically, this will not happen in my life time, nor will we get close. But....my dream is intact and so is my long term vision. There is a real opportunity now for nurses to begin examining models of practice/reimbursement that moves them into the 3rd party arena. Nurses produce the bulk of the work in healthcare. As you know from your own experience that case management models can be high quality and cost effective. What would it be like if nurses were aligned in their own private practices to produce nursing work both inpatient and outpatient for certain populations of patients. Using business, case management and even parish nurse models to the fullest extent possible might just allow us the autonomy we seek. We might also be able to demonstrate improved outcomes for patients and at the same time help to lower healthcare costs. It is all possible, but not without a great deal of effort, re-education and political saavy to get reimbursement privileges. I believe in my heart that we have a bright future ahead of us and that in the future nurses will rise out of the ashes, so to speak, and really take the lead in healthcare and become the gatekeepers to the healthcare system. I have faith in my colleagues who follow in the next generations. My mission now is to help nurses regain their resolves to make things better for those that follow, hoping to stimulate some changes for the better in the here and now.

    I would love to have a discussion with you one-on-one. email me if you like.

    best regards Molly
    chas
  13. by   nurs4kids
    Originally posted by Charles S. Smith, RN, MS:
    <STRONG>I almost did not respond to your question nurs4kids because it seemed as if you did not read any of the foregoing. But maybe you did, so being the tolerant soul that I am, I will simply point out that you missed the point...the label is offensive and continued pejorative remonstrations solve nothing. Look deep inside and know that providence has a way of putting us in the path of that which we fear and loathe the most. The person you label today could be the person who is caring for you tomorrow. I see both sides of the cause.

    chas</STRONG>
    Chas,
    Thank you for your reply and your patronizing tolerance. Quiet to the contrary, my question arose only AFTER I read your description of what you do. You still did not answer my question, or were rather evasive, so I am only left to assume. I apologize if the term is offensive to you, but this is a country of free speech. Just as you are offended by the term, so are many of us by the actions of a "scab". Only those with flexible lives (not the primary caretaker of children, family, etc) benefit by scabbing. Those same people hurt those of us who do NOT have the flexibility. Were there no scabs, the hospitals would be more flexible to our needs. A hospital would do all possible to prevent a strike if it knew it had no scabs to take the place of regular nurses. So, you see we are all offended or hurt one way or another.

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