bridge the gap: Article Hospitals must educate nurses about health care costs

Nurses Activism

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Article talks about bridging the gap for nurses to have clinical skills and business skills to improve health care and patient care.

It doesn't really matter if something is billed directly to the patient or if it is floor stock. It still has to be paid for. If it is not directly billed to the patient, then the cost is built into the room rate or some other charge.

If the employees use more supplies than was forecast and built into the charges, then the hospital loses money.

Most employees don't realize how much supplies really cost. They think in terms of what an item would cost for them to purchase it on their own. They don't realize that the cost of the item includes the cost of the purchasing agent to negotiate the price with the supplier, cost of the shipping/receiving dept to receive the items, paying someone to stock the item, cost of tracking the use of the item to know when to purchase more, cost of issuing a purchase order, cost of processing the bill from the supplier, cost of pharmacy employees, etc.

Suddenly that 50cc of D5W that cost $1.50 on Amazon costs $64 in the hospital.

One place I worked looked at what it cost them to issue a purchase order. It cost $150 just to issue a purchase order.

Every employee should have a basic understanding of how the business end of a hospital works and how their actions impact the financial health of the hospital. Nurses are the largest single group of employees in a hospital. They could make a big impact on hospital finances.

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You make a really important distinction here in what's technically reimbursed vs floor stock since nursing budgets are usually built into room rates in some fashion. What's crazy is that some hospitals take inventory and floor stock to more extremes than others. I've seen hospitals that keep all of the personal care items in omnicells. The nurse actually needs to log in and take out tooth brushes, mouth wash, iv tubing etc under the patients name so that it's billed or at least associated with the patient. So while things are technically considered floor stock, they're still budgeted in some way through the room rates of the unit. It gets into a whole other issue of how nursing services should actually be billed, but i think that's a whole other thread in itself.

The hospitals that keep all personal care items in the omnicells may be billing the patients for each item.

Alternatively they may be using the omnicells to help track what is used so they know when to restock and reorder the items by pulling reports from the omnicells.

They may be using the omnicells to help them track how much it actually cost them to provide care for a patient which would be useful when they negotiate reimbursement rates with the insurers for the next year.

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Yes, nurses can help cut costs in some ways, that's a no brainer. HOWEVER, hospitals are blowing their budgets on things like embossed card stock for thank you notes to send home to every patient that walks through their doors, on "serenity gardens" outside the cafeteria, and on fancy bronze statues in the parking lots and lobbies. Think I'm making this up? Those examples come straight from my FORMER place of work. Why do you think I left? Staffing and morale were in the toilet, but by God the aesthetics of the place were lovely and patients had those pretty little thank you notes that management beat into our heads to make sure got sent home. Yep.

A large part of the healthcare budgeting crisis lies the push for higher patient satisfaction scores resulting in hospitals trying to turn themselves into Hiltons and 5 star resorts instead of focusing on actual patient care.

Most nurses I work with are VERY cost conscious and are ALWAYS doing things like making sure charges are entered, etc., etc.. We can only do so much. I find it interesting that every single problem that comes up in healthcare almost always trickles back down to being the responsibility of the nurse. Funny, that.

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Also, I would like to point out that said hospital where I left that had the pretty note cards and the lovely serenity garden and nifty statues and all the fancy aesthetic "upgrades" but chose to ignore the staffing crisis is now paying mightily for it on the back end. That hospital USED TO BE a hospital where people stayed their entire careers. It was *hard* to get a job there because no one ever left. Now? Now they are having to pay out sign on bonuses in the thousands of dollars just to staff bare bones where they can't cover with expensive travel nurses.

I think the administrators need to look at the bigger picture here and reflect on CEO bonuses, gift baskets, thank you cards, and other "little" costs that add up big time after a while and also tend to drive away nurses, resulting in more money spent just trying to cover their butts with emergency staffing and risk management. Believe me, it has been drilled into my head just how much not only supplies and procedures, but also room fees cost in my place of work. I am well aware of costs, as it has been shoved in my face repeatedly over the years, along with AIDET, Press Ganey, "managing up" and a score of other failed "cost saving' measures. It's the modern day equivalent of rearranging deck chairs on the sinking Titanic.

Start with the CEO paychecks and bonuses, then work your way down. That's where you'll find the money running out of the budgets like a leaky faucet.

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Yes, nurses can help cut costs in some ways, that's a no brainer. HOWEVER, hospitals are blowing their budgets on things like embossed card stock for thank you notes to send home to every patient that walks through their doors, on "serenity gardens" outside the cafeteria, and on fancy bronze statues in the parking lots and lobbies. Think I'm making this up? Those examples come straight from my FORMER place of work. Why do you think I left? Staffing and morale were in the toilet, but by God the aesthetics of the place were lovely and patients had those pretty little thank you notes that management beat into our heads to make sure got sent home. Yep.

A large part of the healthcare budgeting crisis lies the push for higher patient satisfaction scores resulting in hospitals trying to turn themselves into Hiltons and 5 star resorts instead of focusing on actual patient care.

Most nurses I work with are VERY cost conscious and are ALWAYS doing things like making sure charges are entered, etc., etc.. We can only do so much. I find it interesting that every single problem that comes up in healthcare almost always trickles back down to being the responsibility of the nurse. Funny, that.

Well said!

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Also, I would like to point out that said hospital where I left that had the pretty note cards and the lovely serenity garden and nifty statues and all the fancy aesthetic "upgrades" but chose to ignore the staffing crisis is now paying mightily for it on the back end. That hospital USED TO BE a hospital where people stayed their entire careers. It was *hard* to get a job there because no one ever left. Now? Now they are having to pay out sign on bonuses in the thousands of dollars just to staff bare bones where they can't cover with expensive travel nurses.

I think the administrators need to look at the bigger picture here and reflect on CEO bonuses, gift baskets, thank you cards, and other "little" costs that add up big time after a while and also tend to drive away nurses, resulting in more money spent just trying to cover their butts with emergency staffing and risk management. Believe me, it has been drilled into my head just how much not only supplies and procedures, but also room fees cost in my place of work. I am well aware of costs, as it has been shoved in my face repeatedly over the years, along with AIDET, Press Ganey, "managing up" and a score of other failed "cost saving' measures. It's the modern day equivalent of rearranging deck chairs on the sinking Titanic.

Start with the CEO paychecks and bonuses, then work your way down. That's where you'll find the money running out of the budgets like a leaky faucet.

There is no reason why hospitals should be offering sign on bonuses and such, there are plenty of nurses to go around but they choose not to work in those places because of many things ranging from crappy pay to horrible staffing, or administration.

The bottom line is important for any business but they need to remember that those in the front lines are the ones running the show. If those in the front all of the sudden go away, no matter how many fancy degrees or buzzwords are used, no care is gonna happen; or they will have to hire expensive traveler nurses that could cost as much as 2 or 3 FT Nurses.

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Specializes in Critical Care, Trauma, CCU/MICU/SICU.
Yes, nurses can help cut costs in some ways, that's a no brainer. HOWEVER, hospitals are blowing their budgets on things like embossed card stock for thank you notes to send home to every patient that walks through their doors, on "serenity gardens" outside the cafeteria, and on fancy bronze statues in the parking lots and lobbies. Think I'm making this up? Those examples come straight from my FORMER place of work. Why do you think I left? Staffing and morale were in the toilet, but by God the aesthetics of the place we

A large part of the healthcare budgeting crisis lies the push for higher patient satisfaction scores resulting in hospitals trying to turn themselves into Hiltons and 5 star resorts instead of focusing on actual patient care.

citation to support this claim, please. hospitals that are non-profit status can use their profits for capital improvements to get tax breaks. Claiming that "a large part of the health care budgeting crisis" can be attributed to this is spurious at best.

Here are a few examples of mechanisms for hospitals to obtain grant monies or tax exemptions for capital improvements Federal Resources for Capital Financing

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Never mind not even worth it.

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Specializes in Critical Care, Trauma, CCU/MICU/SICU.
Are you kidding? No. Go find your own citation. You're the one arguing that nurses need to have the extra added burden of managing the hospital's finances. You're the one who needs to defend your position, you started the thread. Quit being deliberately obtuse.

Let me just put this succinctly for you so you'll not waste your time here: I don't care what the folks in the business offices have to say about what nurses should or shouldn't do, especially about finance. It is the folks in the business offices who have killed healthcare in the first place by turning it INTO a business. If you need a "citation," look at the evolution of healthcare over the last 30 years. There's your citation.

I will always side with the nurses, and right now nurses are being crushed under the weight of increased patient loads, increased paperwork, increased charting, increased regulation, and decreased staffing. We are told to work that AIDET and push those Press Ganey scores to the sky so that we can get good HCHAPS scores and get that money, honey. Of course, that money never seems to make it into the staffing pool. It always seems to make it into another wing of the hospital or remodeling the cafeteria or a bonus for the CEO. These are the things I have experienced in my *19* years at the bedside, in 5 different hospitals, so I think I have a clue.

I like how quickly this turned into being for or against nursing. Such a typical reaction. So isn't touting 19 years of experience as a justification for not being able to back up a claim.

That aside. I'll say again that the reason nursing gets stomped on when it comes to budgeting is because few nurses actually want to learn about how the budgeting works. When I say that getting involved with cost savings and having strong nursing leadership can help bring money for continuing education and reinvestment back into nursing like staffing, equipment, etc, I'm saying it because I've seen it work in my, granted, humble **ten** years of experience in multiple settings ranging from large academic tertiary centers to small community hospitals. Oh, and my work on my PhD in **Nursing** and **health policy** where I actually studied nursing budgetary patterns and staffing trends. Fun fact: There's a difference between 19 years of progressive evolution in a profession and just doing the same thing for 19 years while the world around you changes.

My argument remains that there should be nurses at the bedside and in the business office, and that nursing should be the ones dictating budgetary constraints and needs, not some finance guy with an MBA and a finance degree. But in the absence of nursing doing its part as the largest healthcare group, guess who takes on that role? The finance guys and MBA types fill that role.

Nursing remains its own worst enemy on this one, as it tends to do.

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Specializes in Critical Care, Trauma, CCU/MICU/SICU.
Never mind not even worth it.

Yes. Run along now.

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Yes. Run along now.
Darling, it's called choosing my battles. You aren't worth it.
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Specializes in Critical Care, Education.
Yes. Run along now.

Very nasty response. Disappointing, in light of implied erudition in previous posts.

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