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

[ainz]

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.

[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.

[OC_An Khe]

Are traditional nursing duties being deskilled to less educated workes? Of course but this has been going on for decades. It is not all bad either. Just read nursing duties from the past, including doing the laundry, cooking for the patients, washing floors and windows, etc.

The converse is also true in that nursing over the decades has assumed duties and responsibilities that historically were in the MD province. For example taking a blood pressure, starting IV's and other invasive procedures, doing any type of physical assessment (listening to lung sounds was a no no), etc.

The key is what's best for the patients in the long run. But since nursing has the fatal availability (available 24/7/365) administrators will try and get nursing t do other peoples work. We must resist this type of added burden.

Those employers that treat all employees fairly will survive and prosper wihile those that don't will wither away.

[roxannekkb]

Originally posted by ocankhe

Are traditional nursing duties being deskilled to less educated workes? Of course but this has been going on for decades. It is not all bad either. Just read nursing duties from the past, including doing the laundry, cooking for the patients, washing floors and windows, etc.

The converse is also true in that nursing over the decades has assumed duties and responsibilities that historically were in the MD province. For example taking a blood pressure, starting IV's and other invasive procedures, doing any type of physical assessment (listening to lung sounds was a no no), etc.

The key is what's best for the patients in the long run. But since nursing has the fatal availability (available 24/7/365) administrators will try and get nursing t do other peoples work. We must resist this type of added burden.

Those employers that treat all employees fairly will survive and prosper wihile those that don't will wither away.

You are very right. Nurses have been wanting to assume more responsibility and to "do more." Thus, they have picked up a lot of the doctor's jobs. This includes invasive procedures as well. At one hospital, some nurses trained to put in PIC lines, and then the doctor still billed for them!

What is happening now is that nurses either have too much to do--as hospitals fire ancillary staff. No ward clerk? Guess who does it. Minimal housekeeping? Guess who cleans up the puke.

At the other end, hospitals will hire more unlicensed personnel, and less RNs. The RN is then really responsible for a greater load of patients, and for any mistakes made by those working under her.

I really think the RN role needs to be better defined. Obviously, a nurse can't do everything. I don't think that a regular staff nurse should be taking on more and more of the doctor's role, thus blurring the distinction between nurse, nurse practitioner, and doctor. There is no reason for it. And nurses need to resist taking on their former roles of housekeeping and secretary.

[sjoe]

rox writes: "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."

Right you are on all counts.

And by the same token, don't most of us buy consumer products and/or have services done for us (taxes, etc.) based to a large degree on cost?

Do we "Buy American" at all times, regardless? Do we give primary consideration to the working conditions that often prevail in the factories abroad which produce many of our goods? Are we willing to (or more to the point, DO WE) pay more for goods produced in factories which treat their employees better?

Do we all drive domestically-made hybrid vehicles because we are concerned about otherwise damaging the environment, and thus the health, of our fellow citizens?

It this because we are heartless, mean, or ungrateful? No, it's because we're trying to get the maximum bang for our bucks. We're all part of the same system along with hospital administrators, who are trying to do the same (usually to make themselves look good to their bosses).

The argument that somehow healthcare is "special" and needs to be evaluated by different criteria holds no water, since that is simply NOT the way things are done in the US. (The same "special" argument could be made for food, for housing, for clothing, etc.) That is simply not part of our social contract. If most people truly wanted, for example, a national healthcare plan, we would have one. RNs are simply cogs in the present machine--no more, no less--however "special" we might think we are.

It makes little sense to endlessly criticize our present dysfunctional and haphazard "system" because it is NOT a universal or national plan, or because RNs don't run it. The same energy would be better spent in designing or supporting a more functional system, IMHO.

If we want things to be different, we need to work on MAKING them different, rather than just pointlessly and endlessly complaining about the way they are now. Unfortunately, RNs don't even have the beginnings of an organization which might be useful in that pursuit.

[jnette, ASN, EMT-I]

Excellent post, sjoe. Wish so very much I didn't have to agree with it, but I do.

[ainz]

You hit the nail on the head sjoe.

Their is no national "conspiracy" there is no grand plan to force nurses out and replace them with cheaper labor etc.

Healthcare is a business, it is all about the money. If you think differently than that then you are uninformed and niave. Once nurses can (if ever) accept this fact, then perhaps we can develop strategies to advance the profession. It is not an evil thing, it is not a bad thing, it is not a greed thing, it is capitalism, free-market economics that every other business in America engages in. Even the so called not-for-profits have to manage their money. They must take in more than they spend. They are all looking for ways to get more money in the door and reduce their operating expenses.

The emotionally charged attitude that healthcare is a right out of sheer desire to help all people and promote dignity, liberty, brotherhood, etc., etc., falls on deaf ears.

When an administrator looks at the cost of running a hospital, they look at their expenses. Each category of expense is labeled and what it costs to operate them is calculated on a month-by-month basis. Some of the categories are salary, supplies, benefits, depreciation, outside services, etc., etc. The salary line is by far the most expensive and nurses make up the vast majority of that expense. As with any business person worth their weight, they will zero in on their largest expense and find ways to reduce it and at least control it.

Again, there is nothing wrong with this, it is just sound business practice.

The challenge for nursing is to either a) demonstrate their contribution to the hospital making money and changing their status as a consumer of resources and expense to one of generating revenue and making money for the hospital, or, b) removing themselves from the hospital payroll, such as being reimbursed directly from the Medicare, Medicaid, or insurance company much like the doctors are.

As long as nursing is viewed as a necessary and expensive thing for running a hospital, things will never change. They will try to address the necessary part, that would be find a way to run the hospital without nurses or reduce the number of nurses, or try to reduce what it costs to pay them, therefore, recruit cheaper sources of labor.

Getting unions involved only perpetuates the perception that nurses are a blue-collar labor force.

The issues concerning professionalism in nursing today also perpetuate that nurses are a blue-collar labor force.

To rise above this we must be viewed as autonomous professionals who bring business and revenue to the hospital, not cost the hospital money.

To be viewed as such we must resolve the "age-old" issues that prevent us from becoming a true profession, like defining a "nurse," defining what a "nurse" does that is unique and necessary for society, defining the single avenue it takes to become a "nurse," doing away with LPNs, ADNs, BSNs, MSNs, PhDs, all being called "nurse" and not being able to tell anyone the differences in the levels.

We must also be able to understand and communicate effectively in terms of financial management and business. By this I mean we must at least have some representation that can do this at the grass roots level in each organization where nurses work.

Doctors can do this and they are not taught it in medical school. Nurses should be able to as well. It requires self-motivation to learn.

[pickledpepperRN]

It is about money, but it is about power and control too.

Money being equal a nurse has responsibility for the very life of a person.

To have the number of patients assigned by a matrix created to be in line with the budget while having the full responsibility for nursing care makes no sense. No professional will do that without a protest.

Here are some links to laws passed with our hard work for improving care.

http://www.leginfo.ca.gov/pub/99-00/bill/asm/ab_0351-0400/ab_394_bill_19991010_chaptered.pdf

http://www.dhs.ca.gov/lnc/default.htm

http://cna.igc.org/cna101/govrel.htm

http://www.calnurses.org/cna/gr/

http://www.calnurses.org/cna/gr/back.html

http://www.calnurse.org/finalrat/ratio7103.html

http://cna.igc.org/cna101/nursingpractice.htm

http://cna.igc.org/cna101/govrel.htm

http://cna.igc.org/cna101/top5-4.htm

http://cna.igc.org/cna101/top5-5.htm

[-jt]

A new ADN nurse at my hospital starts with $56,000 year. By contrast, one MD on staff is paid $800,000 yr. I can only imagine what the CEO is getting.

[pickledpepperRN]

Originally posted by -jt

A new ADN nurse at my hospital starts with $56,000 year. By contrast, one MD on staff is paid $800,000 yr. I can only imagine what the CEO is getting.

Yes. And the CEO plus all the administrators cal go away for a couple weeks while the hospital runs just fine.

[agent]

threads like this discourage me as a new student.

maybe i should go back to pre-med...

[KMSRN]

ainz, I very much appreciate this post and others I have read. For some time now I have been thinking that nursing (as we know it) is in real danger of being phased out. You stated the financial and political reasons much better that I could. I think there are many things that tie into this situation.

Education, or lack of it. Nurses, who are responsible for patients lives and coordinating all of their care, are the least educated "professional". All the other professions (physician, pharmacist, dietitian, PT, OT) all have a minimum of a bachelor's degree and most have master's or higher. A bachelor's degree is minimum to be considered a profession and associate's degree is not consider, by most, to be a college degree.

Nursing education, at all levels, is inadequate. It is still operating at the Florence Nightengale level and while Flo was a radical in her time, the rest of health care has surpassed nursing. Entry level for nursing should be BSN (should have happened many years ago) and the content needs to be much heavier on science, math, assessment skills, disease process, etc. Sadly, many nurses are unable to do basic math calculations to determine drug dosages, don't know rationale behind assessments, and lab values. And please loose the inane nursing diagnoses and nursing theory and include a course in health care administration and finance so nursing understands this side of the health care industry. Medicine has advance greatly in the last 100 years and physician have had to change to meet the patient needs but nursing has adamantly refused.

Professional appearance is important. First impressions are based on appearance (like it or not) and nurses tend to align themselves (in appearance) with the CNA's, housekeeping, and transporters while the professionals wear scrubs or street clothes with a white lab coat. The former is the only group who wear looney toons, cows, puppies, and pig's butts.

Scheduling and staffing is in chaos. The front line of any profession needs to be full-time, dedicated professionals and this is not the case in nursing, at least not where I work. We are into "flexible scheduling" meaning that many nurses work part-time, prn, float, and agency. These nurses dictate when they will work and the full-time people fill in around them. And now, with the nursing shortage, adminstration is so afraid of losing nurses, that it is willing to go along with this. This greatly reinforces the idea that nurse is a nurse, an hourly wage worker, who can be stuck anywhere to cover patients in 4 hour increments when in reality nurses should be highly trained and specialized to provide continuity of care in their specific areas. Nursing needs a good , strong prn and float staff but at this point I think we are putting the cart before the horse.

These aren't the only issues but these have been on my mind. I think most nurses do a good job of patient care and they certainly want to take good care of them but I see trouble ahead if we don't become more savvy in the business side of health care and if we don't improve our knowledge and education and our professional dealings with others in the system.

[sjoe]

kmsrn writes: "And please loose [sic] the inane nursing diagnoses and nursing theory..."

You got that right. From the very first I saw of this foolishness, it reminded me of nothing so much as the "secret passwords" on the old Little Rascals films they would generate when they created a new club. A kid-level imitation of what sounded to them like grown-up talk.

It is an embarrassment to one and all.