Hospitals EXPANDING & adding beds - no mention of looking for nurses to staff them

[-jt]

I cant believe what I just read. A 2-page NY Times article on how much better the hosiptals are doing, how filled to capacity they are, how much more reimbursement theyre getting, how much of a profit they are turning over to their investors, how much they are expanding their facilities & how many more beds theyre adding.

NOT A WORD about investing that money to make the workplace one that will attract RNs back to the bedside to take care of all those pts. Notice how the few lines devoted to nurses comments were buried near the end of the article. The nurses part of the interview was censored. None of their logical comments about what are the hospitals doing to recruit & retain to manage the pts in all these new beds were allowed to be printed in the article.

This was sent to me by one of the nurses who was quoted in the article:

>

Anybody who would like to know how the hospitals plan to care for the pts in all the new beds theyre adding at the same time they are driving nurses away from the bedsides with unsafe & absuive working conditions is encouraged to write the editor:

The NY TImes

March 28, 2002

Patients Surge and Hospitals Hunt for Beds

By REED ABELSON

(2 page story)

Paul Hochenberg, the executive director of the Long Island Jewish Medical Center, was desperate to find more beds. So last year, as occupancy for his hospital climbed to more than 95 percent, he gave up his own office and his staff's so the hospital could convert the area to a 15-bed unit for patients who were being observed for a day or two.

But the new unit did not solve the overcrowding, and Mr. Hochenberg now plans to seek state regulatory approval for as many as 100 new beds for the hospital, in New Hyde Park, N.Y.

After years in which they closed beds and laid off workers, many hospitals are struggling to cope with surprising increases in the number of patients. Some are being forced to turn away ambulances. At others, emergency room patients who are admitted wait hours or even days for rooms.

What makes the increases more difficult is fewer hospitals and fewer beds. Since 1985, the number of hospitals has declined about 14 percent, with the number of beds shrinking 18 percent, the American Hospital Association says. At current levels, hospitals have almost no ability to handle an unexpected increase in patients.

Turning away ambulances was virtually unheard-of last year at North Shore University Hospital, part of the same system as Long Island Jewish. But in the first months of this year, the emergency room was closed to ambulances for 25 hours. "There is no wriggle room," said Dr. Andrew E. Sama, the physician running the emergency department.

At a hospital in California, a man who appeared stable went into full cardiac arrest while waiting to be seen, according to the doctor who treated him. "That's the inevitable result of these delays," the doctor said. The patient was resuscitated.

Hospital admissions are hovering at levels last seen in the mid-1980's. Just over 33 million people were admitted to hospitals in 2000, the latest year for which statistics are available, according to the American Hospital Association. That was up from a low of 30.7 million in 1994.

Outpatient visits have also increased, climbing 16 percent, to 521 million, since 1997. Insurers have long pushed for outpatient treatment. These patients may fill a bed for less than a day while recovering from surgery or receiving chemotherapy. But they are often cared for by the same staff or take up the same beds as inpatients, and are not included in counts of admissions.

When hospitals began cutting beds in the 1980's, everyone from private consultants to government officials was predicting that managed care companies would sharply reduce demand for hospital services by screening requests for care. Some private hospitals in the New York area even tried to fill more beds by having their own ambulances steer patients-particularly patients with health insurance-their way.

But in the last two years, insurers have loosened their controls and now allow more patients to be treated in emergency rooms or overnight. In addition, many people who lost their jobs in the last several months lost their health insurance at the same time and now rely on emergency rooms as their health care providers.

Further increasing demand, aging baby boomers are more likely to experience serious illness or injury, and medical advances are helping doctors treat conditions that patients might have simply accepted in the past.

Experts are divided as to whether the increase in patient visits is a lasting change.

"At this point, we've taken the constraints off the use of care," said Paul B. Ginsburg, the president of the Center for Studying Health System Change in Washington. "We haven't really put in our next mechanism to control use." Demand may again drop, he said, if employers shift more of the cost of going to a hospital onto their employees.

Others think that the increase in hospital visits is continuing a long-term trend that was temporarily disrupted in the 1980's. Gary Taylor, a health care analyst for Banc of America Securities, expects increasing hospital admissions for the next four decades, in line with the increases experienced for much of the last century. Employees are unlikely to pay for a significant share of their hospital care anytime soon, he said, noting how little the average person pays out-of-pocket today.

Some small hospitals still have more beds than they need. But at many others, occupancy levels are soaring, according to the Greater New York Hospital Association's analysis of industry data. Nationwide, hospital occupancy has rebounded to about 64 percent, the highest since 1993. In New York City, occupancy reached 82 percent in 2000 and appears to be climbing.

Yet the averages may not provide a true picture of how crowded a hospital may be: New York-Presbyterian, for example, had an average occupancy of 90 percent last year, but it rose to 102 percent on some days.

Like Long Island Jewish, some hospitals are contemplating adding beds. North Shore is expanding its emergency room, and New York-Presbyterian has applied for permission to expand. Tenet Health Care, one of the nation's largest hospital chains, is expanding at several sites around the country.

As hospitals have merged and gained sway with insurers, many have been able to demand higher payments for the first time in years. As a result, total spending on hospital services increased 5.1 percent in 2000, according to Mr. Taylor, the fastest rate of increase since 1993. Overall spending on health care rose 6.9 percent.

The for-profit hospital operators, like Tenet, are already benefiting from the increased spending, delivering their investors higher profits. . But many not-for-profit hospitals, which care for many patients who depend on government reimbursement programs, say the payments they are receiving remain below their actual cost of providing care. "Just because you're full doesn't mean you're doing better," said Michael J. Dowling, the chief executive of North Shore-Long Island Jewish, which oversees 18 hospitals.

Given an overall staff shortage, hospitals say their labor costs are rising.

Wendy Z. Goldstein, the chief executive of Lutheran Medical Center Health System in Brooklyn, said that in addition to paying her regular staff overtime, she must also use temporary nurses, adding significantly to costs. "When you're at 98 or 99 percent occupancy, you're losing money," she said.

Nurses are also concerned about the rise in volume.

Judy Sheridan-Gonzalez, a registered nurse who works in the emergency room at Montefiore Hospital in the Bronx, said, "Patients tend to come in a lot sicker, and there's definitely more volume."

She arrived at work one day to find herself responsible for 13 patients. After she protested, another nurse was asked to stay on overtime, leaving Ms. Sheridan-Gonzalez with seven patients. One of them became critically ill and had to be rushed to the operating room. "I could have easily missed that," she said. Montefiore declined to comment.

Earlier this month, Mary E. Foley, the president of the American Nurses Association, testified before Congress that nurses are increasingly worried that inadequate staffs threaten patient care.

In a survey last year, three-quarters of nurses said the quality of nursing care where they worked had declined over the last two years.

Many hospitals are closing their emergency rooms to ambulances when they do not have enough beds or nurses to provide adequate care. For about 12.5 days out of every month, Piedmont Hospital in Atlanta has to ask ambulances not to bring some patients to the hospital, sometimes for two to three days at a stretch, said Steve Taylor, vice president for medical services.

At Brooklyn Hospital Center, emergency room patients were waiting more than two days for beds last year, according to Frank J. Maddalena, the hospital's chief operating officer. In January, to handle the higher volume, the hospital reopened 19 beds and may open more.

Many for-profit hospital systems are able to respond quickly to the surge in demand by expanding. Tenet, for example, is adding 80 new beds at Delray Medical Center in Florida and expects to have no trouble filling the beds in a new 10-story tower at USC University Hospital in Los Angeles. "We just don't have the capacity," said Thomas B. Mackey, Tenet's chief operating officer.

A 2002 industry study concluded, "After 10 years of downsizing in the 1990's, hospitals are making new building plans." It predicts that hospitals could spend $5 billion in new construction over the next five years. The report was issued by the Society for Healthcare Strategy and Market Development, a unit of the American Hospital Association, and other industry groups.

Some not-for-profit hospitals are also adding beds, although finding the money to expand is more difficult. In Naperville, Ill., Edward Hospital is in the middle of a $45 million project that will add 71 beds. American Fork Hospital in Utah just completed a $32 million expansion, including about 20 more beds.

In the New York area, the Saint Barnabas Health Care System is considering adding beds at three of its hospitals, including its namesake in Livingston, N.J. Occupancy there averaged 89 percent last year and went as high as 95 percent.

Many hospitals are trying to operate more efficiently, discharging patients more quickly when possible. At Lutheran Medical in Brooklyn, the average stay in the medical-surgical units has been reduced by a full day, and administrators hope to get it down by another half-day, to around six days.

But many hospital executives say they are struggling to come up with solutions.

"We're really kind of up against it," said Herbert Pardes, chief executive of New York-Presbyterian. "It's a real dilemma."

http://www.nytimes.com/2002/03/28/business/28HOSP.html

[shay]

TYPICAL!!!! That's all I can say...typical, typical, typical....let's make lots of $$$, but heaven forbid we actually CARE FOR PATIENTS. Man.....they'd probably let the patients simply care for themselves...self-service nursing care....if they thought they could get away with it.

[-jt]

California is a state with one of the worst staffing shortages at the bedside. What is Tenet going to do to attract nurses back to staff that new 10 story tower at USC? Not a word mentioned about that. Like nurses just dont count in their equation. And they wonder where we get the impression that we are disrespected & devalued. Tenet may not have any trouble filling 10 stories worth of beds with pts but what is it going to do about filling 10 stories worth of nurses stations & comply with their potential staffing ratio law? Not one iota of an indication that they even have given any thought at all to improving the environment to attract nurses back. All they focus on is putting bodies in the bed & dont even acknowledge that they will have to have nurses to care for them. Its just so amazing.

They can have 100 beds but if they have only 5 nurses what good are all those beds? How blind can all these MBAs be?

No wonder the editor wouldnt let the nurses comments about this be printed.

(how big does a CEOs office have to be to fit 15 monitored beds & pt equipment in it? lol)

[grouchy]

Unbelievable! But thanks for posting this. It's interesting that they mentioned Delray in Florida - I've been following a thread on the Delphi traveler's forum regarding the already unsafe conditions there.

Makes me think I should get out of nursing and into construction - specifically hospital construction. Then again, God forbid I got injured and had to go to the ER!

[grouchy]

P.S. - I wonder if the increasing limitations on VNA services for Medicare recipients has anything to do with this trend of increased hospitalizations?

[Dr. Kate, BSN, RN]

Isn't it interesting how quick we all are to pick up on the need for more nurses to staff those extra beds both for profit and not for profit hospitals are adding. (The only real difference between fo profit and not for profit is tax status--that's what the COO of the not for profit where I work said on 3/26/02.)

The NY Times article mentioned in passing the increased demand for hospital care that no one seems to have been able to predict. The cutbacks of the 80s and 90s have left hospitals and healthcare unprepared for the demands of the new millenium. Good grief, most urban areas don't have enough schools, fire fighters, police, rapid transit, and other services to meet the needs much less demands of their populations. Nurses are the product of school systems that have been allowed to deteriorate from lack of funding. In CA, the addition of one clinical instructor for a group of 12 RN students (the max allowed by law) costs upward of $70,000. If all 12 of those students finish the RN program, and all 12 pass boards, it would be cheap at twice the price. But, funding to schools has been consistently reduced. Nurses cost money both before and after they get licensed. Schools providing basic nursing education are closing or threatening to close on a regular basis. Schools must be funded from somewhere and if there is no funding schools and programs close, it's that simple. No nursing schools=no new nurses.

It isn't simply a matter of enticing nurses back to work with more money and sweeter benefit packages and working conditions. What's needed is a long term commitment from everyone involved, and if you ever even think you'll need healthcare you're involved, to funding education.

k

[-jt]

There are 500,000 experienced, licensed nurses across the country right now who are not working in nursing. A sizable % of them said that they are not working because of current working conditions but that if those conditions were to be improved, they would consider returning to the bedside. Youd think after that info came out, hospitals would have been rushing to do exactly that since they need nurses so badly and if only a fraction of that available pool came back to work, the problem would be solved in every state.

But instead, hospital administrators just refuse to address this available pool of nurses & keep talking about funding new students for the future. How long will all those new grads be there once they find the unsafe conditions they are expected to work under. Theyll be bolting too. Instead of building more & more wings & towers & not having the staff to care for those pts they put in them, they should be using some of those profits theyre bragging about & make the improvements current nurses say they need in order to come back to work. Instead, hospitals talk about expanding & adding beds & never even mention nurses - except to complain about how much we cost them.

The NYSNA nurses who were interviewed at that hospital told it like it is - the NY Times just didnt feel their safe staffing concerns & questions about haing staff nurses for all thosenew beds were important enough to print in their big-business - administration-friendly article.

[VickyRN, MSN, DNP, RN]

The AHA is very arrogant and has many dirty tricks up their sleeves, one of which is to demand slackening of emigration laws to allow (I believe) 130,000 foreign nurses per annum importation to the United States. These AHA people are ruthless and will stop at nothing to "keep nurses in their place" and destroy us as a profession.

[lever5]

Those foreign nurses have to pass boards first. Hospitals have taken advantage of them, using them as cna's and housing them in horrible conditions. There was quite an uproar about that a few years ago. They could actually put someone through school here for less money.

So folks, how old will I be when I retire from hospital nursing? 65? 70? How far ya think I can make it? Won't it be interesting to see.

[OC_An Khe]

Yes the AHA is not pro nursing or pro anything that detracts from profitability. In once sense that is OK, however as long as the hospital has a virtual monopoly on in patient/ out patient services they will only give lip service toquality care. Nursing needs to exert its considerable power to offset this dynamic. Of course Nurses must realize and believe they have this power before it can be excercised.

[oramar]

"Given overall staffing shortages hospitals say their labor cost are increasing" one wonders if they had treated their staff in even a minimally decent manner during the late 80's early 90's if their labor cost would be so great at this time. I don't know this for certain but I bet they are going to pay back every buck they saved during those cost cutting orgies ten times over in the next 3 to 5 years. I would laugh but as a health care customer as well as a provider I am going to pay those cost just like everyone else.

[babs_rn]

Typical. All facade and no substance. Remodel, build new, the house may be pretty, folks, but the foundation is crumbling....

B.