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.

[RN2007]

Todd, that was very rude of you to say, "Listen Stupid", regardless of what her board Username was.

I think it is sad how so terribly many nurses are known to "eat their young" and basicly treat each other like crap., and I have heard this over and over and over on this board and from nurses themselves! You would think that all nurses could rise above this so that maybe one day nursing would really be viewed by the public as a profession. Sad but true that "professionals" are generally thought to be those individuals who have earned at least a graduate degree and/or are a doctor, lawyer, architect, etc. Stereotypes are hard to break but it is up to each nurse to do their part to help break it.

FYI, when I first came to this board about a year ago or so, I was really planning on becoming a nurse. However, because of the interaction and conversation with so many on this board and really peeking into this field by reading loads of posts, I decided against it for many reasons, although I still plan on working in a hospital in the future. I have already started back in college to get a Degree in Health Information Management along with a specialized diploma in medical coding and am happy that I did this because I am pretty sure I will have job security due to the 3 different certifications that I plan on getting as well. The field I am going into is very interesting and not nearly as back biting as nursing, and as I gain more job experience my income will not be capped like that in nursing.

So, I am very thankful for taking the time I have reading all these posts over the past year because it certainly caused me not to make a dreadful career mistake, however I think that nursing is very admirable career but not for me, and not for anyone who cannot present themselves as kind hearted and very intelligient caregivers, not sarcastic, eat their young types, of which I have run into several of these who cared for me while I was in the hospital for different surgeries and procedures. And I have given many wanna be nurses from other websites this website address so that they can find out more about nursing before jumping in, because at least they would have quality informed consent. I do hope that nursing will one day get the respect that it deserves and/or that many of you feel like you are not getting, however in the mean time, why don't we ALL just concentrate on becoming nicer people, more caring and compassionate employees and people, and stop all the back biting and learn how to treat everyone who we come into contact with?

Best Wishes Always, April

[RN2007]

Todd, I do not like sending PM back and forth to people I do not know, because I like to keep out in full view for others to see. According to your PM that yo sent me, you did not see where you did anything wrong by addressing another poster as, "Listen Stupid", although you saw fit to erase this comment from that post? Regardless of your logic, what I said I meant and to erase it would mean that I did not mean it. You were simply rude by addressing another person that way, Period. Now, if you understand that, well go on your way, because I have no beef with you, I was just stating the obvious. And if you continue to address this issue you are wasting your time. You made the comment, I did not. I like to think before I talk, write, etc.

[sjoe]

"Todd, that was very rude of you to say, "Listen Stupid", regardless of what her board Username was."

According to Miss Manners, and Emily Post, it is rude of ANYONE to publicly refer to someone else as rude.

And a reminder that it is very easy on this BB to completely ignore someone's posts. Simply go to any one of that person's posts, click on "profile" then click on "add...to your ignore list". Viola! You will see no more of that person's posts. Much simpler than trying to convert her/him to your version of "good manners," or "the truth."

[sjoe]

"I once heard that nurses make up the largest percentage of workers in the US "

You heard wrong.

[RN2007]

sjoe, I do not go through life with blinders, setting up my computer to ignore this or that person, how childish that is and you would never get to see the real emotional climate of a thread that way. However, if I see someone else being unjustly dealt with, they need to be called on it. That is exactly what I did, after all Todd had the gall to publicly address another person as, "Listen Stupid". Oh, and I do not care to convert anyone but also do not take crap from others and do not like to see someone else being mistreated, therefore when I speak up it is because I believe what I am saying.

[Todd SPN]

Originally posted by RN2007

Todd, I do not like sending PM back and forth to people I do not know, because I like to keep out in full view for others to see. According to your PM that yo sent me, you did not see where you did anything wrong by addressing another poster as, "Listen Stupid", although you saw fit to erase this comment from that post? Regardless of your logic, what I said I meant and to erase it would mean that I did not mean it. You were simply rude by addressing another person that way, Period. Now, if you understand that, well go on your way, because I have no beef with you, I was just stating the obvious. And if you continue to address this issue you are wasting your time. You made the comment, I did not. I like to think before I talk, write, etc.

I apologize to the users of this board for having to endure what I feel should be a private matter. It is really quite simple. RN2007 took offense to one of my posts. I edited that post and removed what RN2007 felt was offensive. I then PMd her asking if she would be so kind as to edit the part about me being rude and if she ever again had a problem with something I posted to PM me so I could rectify the situation. I did mention that I felt attacking me in public was also rude. Anyway, I don't know what more I can do to make her happy. As far as I am concerned, this is the end of the matter. Again, my apologizes to the board for having to read what is her response to my PM. :kiss

[tgibson3770]

Education, education, and more education. Make yourself better than the average bear. Go higher than being an RN. The sky is the limit. You choose your destiny. Marketability is the key factor to contentment on the job. It's all on you!

[ainz]

In a previous post I said I had ideas on how to eliminate agency and have nurses wanting to work in your hospital, not how to have us all making tons of money!! :)

The point is this, nursing is viewed as expensive by administration and administration often questions the need for high cost RNs versus LPNs or even unlicensed personnel. If there was a way to legally get rid of nurses and use cheaper labor to get the job done you can bet hospital executives would do it.

To overcome this view we must demonstrate objectively the value we bring to the hospital and change the view from nursing being seen as a consumer of resources to one of generating revenue. This should be relatively easy to do.

I have talked in some detail, perhaps too much detail, in other posts on this subject. First of all, we must get rid of the attitude that administration is evil, greedy, and exploiting and using the poor nurses for their own ill-gotten gain and that we are poor helpless victims. This will get us absolutely nowhere. Adminstration does not have to, nor will they, work on changing their perception of nursing (as someone suggested in an earlier post). We must take the initiative and demonstrate objective reasons why administration should change their attitude and if you show them in dollars and cents then you will get their attention.

One way is to use the JCAHO staffing indicators that are now required. Every JCAHO accredited hospital has to do this. Many quality managers and HR directors don't quite know how to use these indicators and are doing the absolute minimum just to get by and avoid a type I recommendation. If these indicators are used properly you will have a mint of objective, quantified data that ties your staffing levels and skill mix directly to patient outcomes. It is a great way to begin to demonstrate the value of nursing. Couple this with the coming changes to Medicare where they will start looking at quality ratings to determine how much they will pay hospitals and we have an excellent opportunity to show what nurses can do and how they bring value to the hospital.

The nursing leadership needs to begin to demonstrate how unique nursing interventions contribute to patient outcomes and how that contributes to the hospital's financial performance. Good example is to find a patient with a long length of stay, preferably on a unit that is notorious for having staffing problems, high turnover, high agency usage (sorry agency nurses, nothing personal). If you have someone examine the chart closely and find where things were not done as ordered, treatment delays, delays in starting medications, where IVs had to be restarted or patient had to be stuck multiple times to get an IV, etc., etc. Then calculate the cost in supplies and staff time for all of these mistakes and low quality care. I would choose a Medicare patient or one paid on a DRG through prospective payment and you will certainly find that the hospital has lost some serious money. You could prepare this as a case study and present it in your case management meetings, QI committee, or other committees that look at utilization of resources. This will get administration's attention, especially if you look at days where many mistakes or omissions occurred and relate the staffing level and skill mix. If you look hard enough at a long length of stay patient, you will find the mistakes.

Again, these things will provide objective, quantified data, much of which can be expressed in dollars and cents as well, that helps demonstrate the value of skilled professional nurses. This will BEGIN to change the perception of nursing. There is no quick fix.

Having objective data linked to financial performance has a much better chance than a DON or nurse manager complaining and griping about staffing and throwing out unrelated, unsubstantiated claims of poor patient care that can be proven.

[pickledpepperRN]

One class required when going back for my BSN was statistica. I called it "How to lie with numbers"

This was something I learned as a child saying, "Gonna be a teenager next year."

My sister, "But you're only eleven."

Yes but I turn twelve this year and NEXT year thirteen."

Don't think that kind of deception was done in this article. Sorry for the summary only. I paid for it once and gave away the copies. Anyone think it will convince management. It has helped a lot in a couple systems. Some administrators disregard it though.

Vol. 288 No. 16, October 23, 2002

Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

Linda H. Aiken, PhD,RN; Sean P. Clarke, PhD,RN; Douglas M. Sloane, PhD; Julie Sochalski, PhD,RN; Jeffrey H. Silber, MD,PhD

JAMA. 2002;288:1987-1993.

Context The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice.

Objective To determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention.

Design, Setting, and Participants Cross-sectional analyses of linked data from 10 184 staff nurses surveyed, 232 342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999, and administrative data from 168 nonfederal adult general hospitals in Pennsylvania.

Main Outcome Measures Risk-adjusted patient mortality and failure-to-rescue within 30 days of admission, and nurse-reported job dissatisfaction and job-related burnout.

Results After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in the odds of job dissatisfaction.

Conclusions In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction.

Author Affiliations: Center for Health Outcomes and Policy Research, School of Nursing (Drs Aiken, Clarke, Sloane, and Sochalski), Leonard Davis Institute of Health Economics (Drs Aiken, Clarke, Sochalski, and Silber), Department of Sociology (Dr Aiken), Population Studies Center (Drs Aiken, Sloane, and Sochalski), and Departments of Pediatrics and Anesthesia, School of Medicine (Dr Silber), University of Pennsylvania, Philadelphia; and Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pa (Dr Silber).