Are we in danger of being forced out of healthcare all together?

  1. I have read many descriptions of situations where the nursing staff was being asked, required, demanded, to work harder without any additional compensation. I have read many comments by nurses where it is said that they feel like administration is "trying to get us to quit." Other comments such as "it feels like administration is trying to get the experienced nurses to leave."

    Consider this, in our society healthcare is about making money. Healthcare is not a right but a commodity to be bought and sold like any other. Sure, there are social programs that are tax supported designed to be a safety net, like Medicaid, and then the Medicare program for older people and some disabled.

    All of the entities that run the healthcare system are about decreasing operating expenses and/or improving revenues and/or profits. Hospitals want to make money. Government programs want to spend less on providing benefits. Commercial insurance providers want to increase profits and decrease their expenses. No matter how you look at it and from what perspective, it is about the money in the end.

    Nursing salaries is the single most expensive line item for hospitals. If a way can be found to get rid of high paid (in their opinion) nurses it will be done. Nursing care is not valued as it should be and there is the "any warm body" mentality out there. If you think I am being extreme in thinking that perhaps nursing is being shoved out of the picture, think again. The evidence is all around that if a way can be found to provice care without having to pay an RN to do it, it will be done and nurses will be out of a job.
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  2. 44 Comments

  3. by   glascow
    Unfortunately, with the nursing shortage and better places for RNs to work, administration may get what they want, low paid UAP.
    That may be what it takes for them to come begging us to come back. Without RNs, the chances of getting out of a hospital alive would be slim.
  4. by   CseMgr1
    Excellent thread...and I couldn't agree more. Three years ago, a Health care Corporation I was working for basically forced me out, when they "eliminated" my job description, then proceeded to use me as their "gopher", setting me up for failure with one unrealistic task after the other. I requested and was granted "PRN" status...only to receive a termination notice in the mail four months later, stating that I had "resigned", which was a complete out-and-out lie. Now I am going through the same scenario with the Company I presently work for, who has also set our Department up for failure, by establishing metrics so unrealistic and incomprehensible, that if we don't quit, we'll all be fired, for "poor performance"!

    Two weeks ago I went on a medical LOA, after my back went out on me and I was close to having a complete breakdown. Now that I am recovering....and have had time to think...and the more I do, the more I realize that I am being forced out again. That is fine with me, for I have already received an offer from a temp agency, welcoming me to come to work for them whenever I am ready.

    Let's face it, folks: Companies nowadays are profit-driven and mean-spirited. They don't give a damn about us...or their customers, with the end justifying their means. It's just a shame that they are doing it a time, when nurses are so desperately needed....:angryfire
  5. by   roxannekkb
    I think that hospitals are looking to "insource" with cheaper foreign nurses. Other industries outsource, like move everything to India and Bangladesh, but thus far, hospitals haven't found a way yet to oursource patients.

    So the next best thing, bring them here. Go to India, China, South Korea, where the pay is terrible, and sign them up for long contracts. This way, they are bound by their contracts, you can pay them less, not pay them ot, do whatever you want with them. They won't quit, but as soon as they begin to wise up, send 'em back and get a fresh batch.

    Don't you think that instead of paying $10,000 a head to bring these nurses over, hospitals could improve working conditions here so that their fine American nurses would stay? And that they could convince nurses who left the field to return? They can do it, but they don't want to. Simple as that.

    So I agree with ainz, either they're looking to replace nurses altogether, or at the very least, "insource" cheap foreign help.

    What a crock. I'm so glad that I'm out of healthcare. But all this garbage gives me a lot to write about.
  6. by   colleen10
    Companies nowadays are profit-driven and mean-spirited. They don't give a damn about us...or their customers, with the end justifying their means.
    A-Men to that!

    Forgive me for not being terribly knowledgable on this topic as I am just starting out in nursing school, but I thought I had read on a couple threads in the past that LPN's, CNA's, Care Tech's, etc. have steadily been gaining more RN related responsibilities because of the "shortage". If this is true, that tells me right there that hospitals are just tring to get away with pushing more responsibility on employees that they pay a lot less than RN's.
  7. by   jnette
    Originally posted by colleen10
    A-Men to that!

    Forgive me for not being terribly knowledgable on this topic as I am just starting out in nursing school, but I thought I had read on a couple threads in the past that LPN's, CNA's, Care Tech's, etc. have steadily been gaining more RN related responsibilities because of the "shortage". If this is true, that tells me right there that hospitals are just tring to get away with pushing more responsibility on employees that they pay a lot less than RN's.
    And this is one way of them "testing the waters", right? By using more and more UAPs, they can get a feel for how well they will do.

    (And yes, they CAN be trained to do quite a bit ! I had excellent skills in numerous areas of the healthcare field for the past 30 years.. but they were simply that.. skills. Now as an RN, I understand the why's and wherefores, the whens and when nots, and all that is entailed in making critical nursing judgements. I did not have this as a tech, medic, etc.)

    But it appears that the "skill" is all they're looking for. Because it's sooooooo much cheaper to use a trained person over an educated person. (not meaning all UAPs are uneducated, by any means.. just not properly educated in the HEALTHCARE field.)

    I remember about one year ago, our company .. a MAJOR nat'l corporation who nearly monopolizes the ESRD dialysis clinics in this country and abroad attempted to do the same. Our LPNs were informed (without any prior warning) that they no longer had jobs. They were being replaced by PCTs. The ONLY way they would be able to continue to work was by taking a paycut and staying on as PCT and putting their licences in their pocket... AND/OR enrolling in school to persue their RN before the summer was up.
    After 10+ years of dedication, knowledge, experience and practicing as LPNs at these clinics, they recieved THIS as their thanx... some were on the verge of retiring.. had no INTEREST in going back to school.. were ready to retire, others had kids at home and couldn't manage school, work, kids.... can you imagine???

    Needless to say, all the clinincs this company owns/operates across the country went bonkers !!!

    They all raised such a united stink, and all the clinic MDs came to the nurses' defense. Being the clinic medical directors, these docs were not obligated to the "company" in any way, and they raised such cain about this, that in the end, the company had to back down.

    But it was three months of pure hell for these nurses.. uncertainty, .. "job or no job.. what about my retiremnet, hell no I'm not putting my licence in my pocket.. what do you mean I can't even give a stinking tylenol now..." etc., etc.

    It was horrible. A nightmare for ALL of us... our DON wept for days for these girls, and we all joined her.

    I still think the co. should have been sued for emotional trauma.

    So yes.. they wanted to keep one RN per shift, and cover everything else with PCTs. Meaning that the one RN would have had full responsibilty over all the patients, as well as the supervision of the PCTs, would have had to draw and administer ALL the meds ..plus weekly med changes as needed by lab results..by HERSELF (difficult enough with several nurses, never mind just one). On top of that, do all the other things that PCTs can't or aren't allowed to do.. again by herself... PLUS her own full patient load ! No way, Jack ! No freakin' WAY !!!

    SO. There it is in all its shining glory.. Corporate Greed.
  8. by   Todd SPN
    Very good topic for the GPN. A few comments: At the clinic where I did clinicals I was talking to a Dr about the future of LPNs in the hospital setting. His wife was a nurse at the hospital where I did my clinical. It was his opinion that there would be no opportunities for LPNs and the hospital would really like to see RNs with more education like BN. About a month ago there was an article in the newspaper stating how this hospital was thinking about replacing RNs in OB with LPNs. The union, of course, was having a fit and was not going to allow this to happen, but two weeks later I heard two of my newly graduated classmates had been hired on in delivery.

    About hiring nurses from other countries: The head of nursing at our school was asked by a school in India to help them set up a nursing program. There is going to be some kind of affiliation with our school. Mind you, our school has a waiting list (as most I'm sure), but the state has cut school funding and the school cannot afford to hire more staff to accomodate those on the waiting list. All the while, the unemployment rate is higher then ever and our governor is spouting about how we need to get more people into the workforce.
  9. by   VickyRN
    ITA and I have warned about the "deskilling" of our profession in many of my posts. In just 10-15 short years, we will face an all-out "nursing crisis" as aging baby boomers meet the retiring RN work force. Whole floors of hospitals will have nursing vacancies as the nurses retire en masse. The public outcry will be enormous. This "crisis" will be just the excuse the hospital executives (and their legislator buddies) need to loosen training or licensure requirements for many of the skilled tasks of nursing (such as giving medications, assessment, etc) and immigration restrictions for foreign nurses. Just pull any Jack or Jill off the street and train them in 10 weeks to do our job. Oh, at 1/4 of our wages. Bit by bit, we are loosing control over our profession.
  10. by   ainz
    We are bit-by-bit loosing control as the powers that be continue to chip away at the foundations that hold nursing in the healthcare system.
  11. by   talldollNYC
    Do you fee like this "deskilling" is occurring throughout the medical profession? It seems to me that it is. Duties that were once just performed by doctors are being taken over by NP's and PA's. Anesthesiologists are replaced by CRNA's who are then replaced by anesthetic tech's.

    When I was a kid, my mom worked as a Nursing Assistant. She took a six month course to be certified. Now, it would be a four week course to be certified for the same job.

    Additionally, I do not think that it is nurses in particular whose jobs are under attack. It seems to be endemic of big businesses move to crush the middle class into the dust. CPA's are being replaced by bookkeepers who are being replaced by "customer financial representatives".

    Talldoll
  12. by   ainz
    Good points talldollNYC. I agree with your observation. As I have stated in many of my posts, money is what drives the healthcare system. Every entity involved is either trying to increase profits, decrease costs, or both.

    If it can be demonstrated that less qualified people that can be paid less can get the job done to a minimally acceptable standard that the public will tolerate, then the more qualified and more expensive people will be displaced by cheaper labor. It is inherent in our capitalistic society for this to occur.

    You better believe that nursing, in particular, is under attack. Nursing department salary expense is the single, largest, line-item expense a hospital has, so, it is definitely on the radar screen and in the cross-hairs.

    As long as our healthcare system remains as it is today, our only chance of advancement and survival is to clearly demonstrate the ECONOMIC benefit to the organization of good, high quality, nursing care. The people running the system are accountants, MBAs, MHAs, doctors, and the vast majority are interested in making money. The touchy-feely, warm fuzzy stuff that nurses are famous for is absolutely ineffective with these guys, they do not care. Again, we need to learn how to speak the language they do and clearly and quantitatively demonstrate our contribution to their margins and our patients' health.
  13. by   Geeg
    When the AMA sees that this nursing shortage is not going away, they will see more $$$$$ being spent on nursing and less on their trinkets. I foresee the AMA drafting proposals, as they have tried before, to replace us with unliscensed personnel.
  14. by   roxannekkb
    Originally posted by Geeg
    When the AMA sees that this nursing shortage is not going away, they will see more $$$$$ being spent on nursing and less on their trinkets. I foresee the AMA drafting proposals, as they have tried before, to replace us with unliscensed personnel.
    Unlicensed personnel, cheaper foreign labor who are bound by contracts...I think it's the plan all along. Let's face it, hospitals can't be all that stupid not to know why nurses are leaving. The good ones have no problems with staff retention or recruitment. Their turnover is low, primarily for the normal reasons--retirement, going back to school, relocation, maternity leave, and so on. Not because working conditions are unbearable.


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