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

Published

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

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

Its been like that the whole time. Every time someone brings a counterargument to his point he resorts to being personal and demeaning. Its called a debate you bring your side of the argument, others bring theirs, no need to get nasty or personal, just be open minded and realize that neither opinion is absolute.

Up Vote Up Vote ×
Specializes in Mental Health, Gerontology, Palliative.
....

What you don't seem to get is that healthcare is a business ...

Em not in all countries. Thank god

Up Vote Up Vote ×
Em not in all countries. Thank god

No, but in the United States it is, and any meaningful change towards something better in the near future is highly unlikely. Also, let's not pretend that other countries deliver healthcare without being cost conscious. Any time there are finite resources such as beds, staff, equipment, etc, there's a degree of awareness that we need to have in our utilization of those finite resources.

Up Vote Up Vote ×
Its been like that the whole time. Every time someone brings a counterargument to his point he resorts to being personal and demeaning. Its called a debate you bring your side of the argument, others bring theirs, no need to get nasty or personal, just be open minded and realize that neither opinion is absolute.

Truthfully, I'm still waiting for a counter argument that doesn't imply that i'm anti-nurse, or not experienced enough to understand, or in some way am demeaning and personal because I'm making points that aren't exactly popular among nurses, or pointing out arguments that are just factually incorrect. You said to be more open minded. I'll challenge you to do the same.

Up Vote Up Vote ×
Truthfully, I'm still waiting for a counter argument that doesn't imply that i'm anti-nurse, or not experienced enough to understand, or in some way am demeaning and personal because I'm making points that aren't exactly popular among nurses, or pointing out arguments that are just factually incorrect. You said to be more open minded. I'll challenge you to do the same.

Again I understand your perspective, if a business is running on the "red" of course you need to implement across the board cost cutting measures in order to stay afloat. The nurses being the biggest component of the healthcare team can help with cost control by a myriad of ways, as also can the other employees of the organization starting on the top.

But now comes the fallacy, why force the nurses to be accountable for every toilet paper, or gauze pack, when you see in the news that the hospital is posting record profits in years, that the CEO got a fat nice bonus, that the buildings are being renovated to make it look more like a 5 star hotel instead of a hospital. Like someone mentioned previously instead of micromanaging every little gauze pack, create a floor stock budget for these materials based on the average expense from previous years. And then from that point have the Unite Manager be more conscious of the overall floor stock budget and use.

Its easy again to look down from the top and point fingers to assign blame to others. But it is hard to look at one self in the mirror and realize that sacrifice and cost cutting has to start at the top; lead with example and others will follow.

Up Vote Up Vote ×
Truthfully, I'm still waiting for a counter argument that doesn't imply that i'm anti-nurse, or not experienced enough to understand, or in some way am demeaning and personal because I'm making points that aren't exactly popular among nurses, or pointing out arguments that are just factually incorrect. You said to be more open minded. I'll challenge you to do the same.

Coming from a business background & going into nursing gives me a slightly different perspective - I kinda see nurses catching heat for decisions made way further up the food chain. At different clinical sites, I've been able to see some of the real-world repercussions of well-intentioned changes. Like putting saline flushes in the Pyxis.. With benefits, you're paying someone $60+ per hour to go fetch a $0.25 item, instead of grabbing a handful at the beginning of the shift & working efficiently. Too often, management seems to enjoy "managing" things more than they need to, stepping over dollars to pick up dimes.

Up Vote Up Vote ×
Specializes in PICU, Pediatrics, Trauma.
Yeah the reality is that we spend to much money in things not related to healthcare delivery, we dont need fancy hospitals, we need well staffed , well supplied ones. Healthcare is not a luxury is a need, so the basics are the ones that need to be covered first, again that would be proper staffing, adequate supplies, clean environment. I know $1 dollar here and there adds up, And it becomes huge when put together. But if we start micromanaging every gauze package to the detail, is gonna become a waste of time, just account for the need of the unit and make it a part of the budged; so far I have never seen a nurse steal supplies from the hospital like I know it happens in offices across the country.

Yes medications are expensive, and why are those nurses that you mention taking more medication than what their patients are gonna receive? Thats a more serious issue than a cost problem, something is going on if more meds are being taken that what is supposed to be administered.

Educating nurses about being more cost conscious is never a bad thing, i totally agree with that. But I know when management sees studies like this they dont think about education, they say oh my god nurses are wasting supplies, NEW COMPANY POLICY, every paper clip must be accounted for and scanned; there goes half of your day scanning stuff for no reason.

And dont be delusional, any cost saving will go to the bottom line, never will it trickle down to the staff like you say. Not in the current corporate mindset; or do you forget that there are hospitals that post profits every year but still refuse to have proper staffing or at least give raises to their staff. Yes we have to save the hospital money because being wasteful is honestly a sin to nature and ourselves, but never think for a second that saving them money is gonna have it end in your pocket.

I agree 100% on your points..esp. Regarding that the cost savings do not trickle down. I laughed at that one.

Up Vote Up Vote ×
Specializes in PICU, Pediatrics, Trauma.
I didn't bother addressing your mentioning of nurses pulling meds that end up not being administered because it was irrelevant to the greater point. Nurses will at times pull an extra medication anticipating it being needed. Whether its needed or not is irrelevant as it doesn't always get billed to the patient, and is there not reimbursed, thus the unit takes a loss.

What you don't seem to get is that healthcare is a business but not like other private sector industries because while there are private hospitals, for profit hospitals and not for profit hospitals, their reimbursement and customer base is a wide range of reimbursement types depending on insurance status, type of insurance etc. We also provide a different type of service, like you said. But, nursing being the largest workforce, and woefully unprepared, as evidenced by this fruitless back and forth, for the responsibility that involves, business types with accounting degrees and MBA's run the show and budgets. In institutions where you see nursing leadership with more education and higher positions within the organization, you see tend to see better staffing, better continuing ed resources and other things like that.

I think the IOM report on the future of nursing puts it best at basically saying that nursing will be a driving force in healthcare delivery modeling. It's just woefully unprepared for that level of responsibility and involvement because most can't see the bigger picture beyond staffing ratios. Or rather, they can't see that better ratios come from having a seat at the table and the other things that I already mentioned.

Also, I'm ignoring the communism comment because it's absurd and you're from Florida.

I'm jumping in here to say: I have been a nurse more than 30 years in all sorts of settings from large teaching medical centers, non-profit religious affiliated and of course, corporate for profit (which is more and more now-a-days. It has been at least 20 years since I have worked on a unit with adequate staffing, save for the occasional "slow" shift. I am no expert in finance or hospital budgets, but I see the corporate owned hospitals make huge profits and yet the nurses have no raise or a tiny one, have benefits reduced, insurance plans changed costing more out of pocket for the employee with less coverage, and the list goes on. The biggest issue though is poor staffing. It is more costly for a number for reasons, but trying to deliver excellent, or at the very least safe care, when you are pressured, fatigued from constant high acuity situations, high patient turnover, working extra shifts or extra hours, constant interruptions and lack of supplies causing you to hunt and search, all costs money. As nurses become more efficient out of necessity to keep all the plates in the air, there will be more waste, errors, forgetting to go back to charge for a supply or med or whatever...Under-sraffing is costly on a lot of levels. There simply is too much to do in too little time and often simultaneously that keeping the patient safe becomes the number one priority.

Up Vote Up Vote ×
Specializes in PICU, Pediatrics, Trauma.

Instead of demeaning us for our impressions on how things work, why not explain a bit here and there as you gave the example of tax breaks and capital improvements. None of us wants to think this way...It is what we see. Yes, could be very helpful for nurses to learn more about finance and expense in running a hospital. Yes, it sounds like a great idea to have nurses be in charge of that as opposed to an MBA with no background in nursing. It seemed to me that quazar was saying it felt like one more thing for the nurse to be responsible for as opposed to a nurse being in the role of finance. I think your point of view would be better taken if explained professionally, instead of defensive sarcasim.

Up Vote Up Vote ×
Specializes in Mental Health, Gerontology, Palliative.
No, but in the United States it is, and any meaningful change towards something better in the near future is highly unlikely. Also, let's not pretend that other countries deliver healthcare without being cost conscious. ......

Yea, but its not my concern

My focus is on best possible health outcomes for my patient.

The problem with 'the bottom line of business' is that its remarkably short sighted. f

or example I had a patient called Betty (name and identifying details changed) sent back to my facility after amputation of a necrotic toe. The hospital put a VAC dressing on because the post op wound needed to heal from the bottom up.

My facilities response was that they would not be paying for the ongoing use of the VAC dressing and we would need to use something else (cheaper). As it was, a colleague advised me that the VAC dressing would be paid for by the hospital department that prescribed it and this lady got her VAC dressing.

The wound healed within six weeks. It was changed twice weekly in that time. If we had to use the cheaper dressings we would have had to be dressing it daily and there is a fairly good chance it would have taken 12 months to heal. Cost of VAC 12 times over 6 weeks versus cost of daily dressings over 12 months. The VAC saved my organisation alot of money, unfortunately the bureaucrats were too damm short sighted to figure that out on their own

Up Vote Up Vote ×
Specializes in Research & Critical Care.

The ideas that corporate needs a better understanding of their front-line conditions and that nursing needs to understand cost containment and budgeting constraints are not mutually exclusive. I'm not really sure where the argument is. They both need improvement, hands down.

It's no secret that the top can be incredibly short-sighted. They want better satisfaction scores but then give a nurse seven patients. They want to improve employee retention but don't listen to their nursing staff. They want to save money, but then opt for the solution that will cost triple in the long-term.

But on the other side, nursing has a lot to learn. My experience is minuscule compared to some here, but I can't tell you how many times I've received patients in pain days into admission, or how many times I have patients that don't understand what a medication is or why they're getting it. How many times have you personally walked past a call light? I can admit I'm guilty. Every one of these things is tied to HCAHPS, which in turn is tied to reimbursement.

It's a complex issue with no easy answers, but no one should be fooled into thinking it's all administration or all nursing.

Up Vote Up Vote ×
Specializes in PICU, Pediatrics, Trauma.
The ideas that corporate needs a better understanding of their front-line conditions and that nursing needs to understand cost containment and budgeting constraints are not mutually exclusive. I'm not really sure where the argument is. They both need improvement, hands down.

It's no secret that the top can be incredibly short-sighted. They want better satisfaction scores but then give a nurse seven patients. They want to improve employee retention but don't listen to their nursing staff. They want to save money, but then opt for the solution that will cost triple in the long-term.

But on the other side, nursing has a lot to learn. My experience is minuscule compared to some here, but I can't tell you how many times I've received patients in pain days into admission, or how many times I have patients that don't understand what a medication is or why they're getting it. How many times have you personally walked past a call light? I can admit I'm guilty. Every one of these things is tied to HCAHPS, which in turn is tied to reimbursement.

It's a complex issue with no easy answers, but no one should be fooled into thinking it's all administration or all nursing.

VERY well said....

Up Vote Up Vote ×
+ Join the Discussion