Nurse Staffing Costs

Nurses Professionalism

Published

When hospitals look to cut costs -- as many of them have in the last decade -- nurses are the hardest hit. How has your employer dealt with staffing costs? How has it impacted you?

He is an individual, the wave of changes taking place in hospitals and the negative experiences you claim to have had with healthcare consultants are all generalizations. The OP has stated himself that his (third party) recommendations are often disregarded by "the powers that be." What if he is a nurse consultant who advocates for business changes supportive of nursing? After reading the emotionally charged and downright prejudiced remarks you made about him and his duties, HE has more right to be upset than you do. Here you all are trashing this individual for bothering to take your feedback into account simply by posing very neutral, non-offensive inquiries. I wouldn't be surprised if the type of unprofessional and RUDE display you spewed in his direction left a lasting impression on his values, instilling bias AGAINST us nurses, and propagating within another healthcare consultant an attitude ambivalent of the woes of nursing.

Unlike those who make hasty generalizations about ALL consultants, my experiences on this board will not impact my opinion of nurses. I know there are bad apples in every bunch -- and the internet provides a veil where people can be as nasty as they want to be without consequences. Besides, most nurses I know (friends and those working for clients) are salt-of-the-earth kinds of people; very professional and genuinely caring individuals.

IF the OP is a consultant, he knows exactly what's happening in our hospitals. Then he wants to know how that's working out for us.

I find those questions insulting, from somebody who already knows the answers.

Interesting take. Assuming it's true -- I still don't see how asking a question, the answer to which the inquisitor already knows, would be "insulting." Annoying, perhaps -- but insulting?

Specializes in MICU, SICU, CICU.
Maybe the users here should provide a good example of that, then. This person came here to get opinions from nurses. S/He obviously wants your input. I really don't understand why people felt justified in immediately attacking him/her.

Alternately flattering, "what do you think would help?" then dodging a direct question with glib double talk, or a dismissive comment such as "are you so downtrodden that you resort to self aggrandizing?" "Start a new thread. cheers!"

These are the tactics they use to deflect questions and to appear to be knowledgeable.

It is incredibly naive to think that a healthcare consultant cares about the well being of the workforce - or the patients.

dusky jewel, IF this person is who he says he is, his motive is to get management to sign a multimillion dollar three year contract to reduce labor costs. He or she is not here to act in your best interest.

Specializes in Critical care, tele, Medical-Surgical.

Ensuring sufficient nurses at all times is cost effective.

The goal should not be to cut nursing staff. It should be to provide the nursing care that is the reason for a hospital to exist without wasting money. Here are some studies:

Quality and Cost Analysis of Nurse Staffing, Discharge Preparation, and Post Discharge Utilization

Marianne E. Weiss, Olga Yakusheva, and Kathleen L. Bobay; Health Research and Educational Trust, April 2011

This study extends previous health services research on the impact of nurse staffing on patient outcomes of hospitalization by linking the unit-level nurse staffing directly to post discharge readmission and indirectly through discharge teaching process to patient readiness for discharge and subsequent ED visits. Findings support recommendations to (1) monitor and manage unit-level nurse staffing to optimize impact on post discharge outcomes, (2) implement assessment of quality of discharge teaching and discharge readiness as standard pre-discharge practices, and (3) realign payment structures to offset costs of increasing nurse staffing with costs avoided through improved post discharge utilization.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3207188/pdf/hesr0046-1473.pdf

The impact of Medical errors on 90-Day Costs and Outcomes: An Examination of Surgical Patients

William E. Encinosa and Fred J. Hellinger, Health Services Research, July 2008

A new study published in the journal Health Services Research found that the large difference in calculations for medical error expenses might mean that interventions to increase patient safety-like adding more nursing staff-could be more cost-effective than previously reported. The study found that insurers paid an additional $28,218 (52 percent more) and an additional $19,480 (48 percent more) for surgery patients who experienced acute respiratory failure or post-operative infections, respectively, compared with patients who did not experience either error. Preventing these and other preventable medical errors would reduce loss of life and could reduce healthcare costs by as much as 30 percent, the researchers said. "Many hospitals are struggling to survive financially," study co-author William Encinosa, senior economist at the Agency for Healthcare Research and Quality, said in a statement. "The point of our paper is that the cost savings from reducing medical errors are much larger than previously thought." Pointing to previous research that looked at the business case for improving RN staffing ratios, the researchers concluded: "It is quite possible that the post-dscharger costs savings achieved by reducing adverse events might just be enough for the hospital to break-even on the investment in nursing."

http://www.ncbi.nlm.nih.gov/pubmed/18662169

Nurse Staffing and Patient, Nurse, and Financial Outcomes

Lynn Unruh, PhD, RN, AJN, January 2008

This report provides a comprehensive literature review of more than 21 studies published since 2002 that, according to the author, "underscore the importance of hospitals acknowledging the effect nurse staffing has on patient safety, staff satisfaction, and institutions' financial performance." According to the report, "the evidence clearly shows that adequate staffing and balanced workloads are central to achieving good patient, nurse, and financial outcomes.

Efforts to improve care, recruit and retain nurses, and enhance financial performance must address nurse staffing and workload. Indeed, nurses' workloads should be a prime consideration. If a proposed change would improve care and also reduce excessive (or maintain acceptable) workloads, it should be implemented. If not, it shouldn't be."

http://journals.lww.com/ajnonline/Abstract/2008/01000/Nurse_Staffing_and_Patient,_Nurse,_and_Financial.35.aspx

The Impact of Nurse Staffing on Hospital Costs and Patient Length of Stay: A Systematic Review

Petsunee Thungjaroenkul, RN, MS, Nursing Economics, Vol. 25, 2007

This study provides a comprhensive review of the research on the impact of RN staffing ratios on hospital costs and patient length of stay (LOS). It identified 17 studies published between 1990 and 2006 and concluded: "the evidence reflected that significant reductions in cost and LOS may be possible with higher ratios of nursing personnel in hospital settings. Sufficient numbers of RNs may prevent patient adverse events that cause patients to stay longer than necessary. Patient costs were also reduced with greater RN staffing as RNs have higher knowledge and skill levels to provide more effective nursing care as well as reduce patient resource consumption. Hospital administrators are encouraged to use higher ratios of RNs to non-licensed personnel to achieve their objectives of quality patient outcomes and cost containment."

http://www.medscape.com/viewarticle/565604_2

Improving Nurse-to-Patient Staffing Ratios as a Cost Effective Safety Intervention

Michael Rothberg, et. al, Medical Care, 43(8): 785-791, Aug. 2005

Improving RN-to-patient ratios could save thousands of lives each year and is more cost effective than clot-busting medications for heart attacks and strokes, and cancer screenings.

http://www.biomedsearch.com/nih/Improving-nurse-to-patient-staffing/16034292.html

Nurse Staffing, Quality, and Hospital Financial Performance

Barbara Mark, Ph.D., et al., Journal of Health Care Finance, 29(4): 54-76, Summer 2003

Increased staffing of registered nurses does not significantly decrease a hospital's profit margin, even though it boosts the hospital's operating costs.

http://nursing.unc.edu/research/improving-healthcare-quality-patient-outcomes/nursing-staffing-financial-performance-and-quality-of-care/

From this site:

http://www.pennanurses.org/pac/ratio-research/

...

It is incredibly naive to think that a healthcare consultant cares about the well being of the workforce - or the patients.

dusky jewel, IF this person is who he says he is, his motive is to get management to sign a multimillion dollar three year contract to reduce labor costs. He or she is not here to act in your best interest.

Yes, exactly icuRNmaggie. I'm here on allnurses-dot-com because I'm hoping to expropriate all your comments and then strike it rich by signing a 3-year multimillion dollar contract with an unsuspecting hospital CFO. Brilliant. What was that you were saying about naivete...?

Specializes in ob, med surg.

The treatment of this poster is why I rarely come to this site anymore.

Specializes in MICU, SICU, CICU.
Yes, exactly icuRNmaggie. I'm here on allnurses-dot-com because I'm hoping to expropriate all your comments and then strike it rich by signing a 3-year multimillion dollar contract with an unsuspecting hospital CFO. Brilliant. What was that you were saying about naivete...?

I know who you are.

Specializes in hospice.
I know who you are.

Cloak and dagger, the plot thickens....

Specializes in Anesthesia, ICU, PCU.
I know who you are.

That's kind of personal, vaguely threatening, and creepy to be honest. Probably something in the ToS against it too...

Specializes in ICU, PACU, OR.

To get back on track. The number of patients entering health care with untreated/undiagnosed chronic diseases is on the rise and is expected to increase dramatically with the new health care law implementation. If this expectation is true, then health orgs must anticipate the need for improved nursing education, improved on-site orientation efforts, better ideas on service demographics, and improved health communication within the communities served.

Pay for performance, care non-payment for re-admissions is a constant threat now and orgs need to understand that it is not only the nurse's responsibility but all players are in it-that includes nutrition, therapists, pharmacy and medical.

That means that the org must catch up to the snowballing effect of this new challenge-which only a few hospitals and community public health services are on top of.

To reduce staff at this time is non productive, and will in the long run cost more money. Even the small things will save the orgs money and guarantee solvency to pay staff for needed services. Smart and collaborative leadership pays off and the biggest thing in my opinion that is lacking is those nurses who are not truly passionate about leading. You don't have to have a formal title to lead. Those with titles have to listen to the grunts, assist in removing barriers to getting the job done. Quickly. Instead of piling on, get rid of the redundancy-the paper work-the fear and get in there and be available, knowledgeable and compassionate instead of "I got mine...now you get yours".

Specializes in Emergency.

One of my previous comments was deleted, but let me try again in a different tone.

My facility was recently told that by a consultant that we're overstaffed while at the same time management is calling folks on their days off to come in because we're overloaded.

This is why consultants are disliked in general.

To Goldenhare:On the contrary, considering the nature of the subject and the strong disagreement many have expressed here, I think he's been treated with civility. You obviously don't frequent other forums, because if you did your sensibilities would be asunder at the discourse that can occur. This is a very nice place. :)

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