Cost Cutting/Budgeting --- the patients suffer the most

[abbaking]

So, In an effort to "control costs" the hospital has taken DRASTIC and UNSAFE steps to save money. Honest to God ( NO JOKE) a partial list of the new policies are listed below. There are three 20-bed units on my floor (all general Med/Surg) keep that in mind.

- No more morning and evening shift unit secretary. Now secretary will be 12-hour shift from 9am-9pm. No more secretary on each unit. Now the secretary will spend 1 hour on each unit on the floor ("Rotating").

- No more CNA for each unit. Now CNA will rotate between all three units 1 hour on each unit.

- If a patient need to be a sitter, No more floating extra CNAs or calling in Registry CNAs. Now the CNA will be the sitter. If more than 1 patient is needed to be sitter, the sitter patients will be moved together. If patients needing sitter are ISOLATION and other are NON-ISOLATION, the new protocol is to co-hort the non-isolation "healthy" person with the isolation patient and make sure handwashing and infection control measures are followed. If 3 or more patients need to be sitters, the family conference room will be converted as a multi-bed ward for this purpose.

- No more housekeeping on the units. CNA and RN staff will be preforming housekeeping duties in addition to patient care.

- No more individual case managers per unit --- Now 1 case manager per entire floor.

- 1 Team Leader per floor --- no more individual unit team leader per shift.

Welcome to the new world order - Healthcare Nazi-ism! Enslaved and over worked staff ensure that higer ups can recieve their $5,000 bonus this year.

[kcmylorn]

This is part of the problem. When nurses work off the clock like this, it looks on paper like you are capable of handling the workload that is being asked of you.

If just one or a few nurses refuse to do this, then it is easy for them to be singled out as poor time managers.

However, if you create a culture on your unit where your federally mandated rest and meal breaks are taken and nobody stays late to finish charting (or overtime is requested either due to missing breaks or having to stay late to chart), then it will be apparent that it's not just a few "troublemakers" and that the nurses are overworked, and the idea that the nurses can handle an unrealistic workload becomes indefensible.

Agreed- this has to be done across the board, and not just in one facility but all facilites nurses work in. It's not just happening in one facility, on one unit, to one or a few nurses. This is a universal problem. It's not just a clinical nursing problem, the original poster mentioned"case managment" involved also.

This is common knowledge for all of us, nurses. it's happening in hospitals, home health and LTC. In every one of these venues the end user is the patient.

I am waiting for the 1 darn good explaination of why health has to pay a multimillion dollar( a

Sultan's" salary)to 1 individual- the CEO at the expense of the patient in these beds, homes, or where ever the patient is; just because, their marketing ability, their(tongue in cheek) "business saavy will not cut it. We are seeing progressively more and more of their dangerous, reckless, unaccoutable, continued cost cutting acts. It's getting worse and worse, it like "how low can you go under the limbo stick before the stick or the system falls down.

It's time nursing grew a pair and stood up as a large group to these CEO's. It's out profession not theirs.

If what the CMS and Joint commission lay down as regulations bother us nurses, it shouldn't. These are regulation agencies- that's their job. Why should CMS pay for hospital aquired infections because the nurse is to spread thin to closely monitor 7,8,10 acutely(2012 acutely ill patients)ill patients. It's not the CMS' job to keep feeding the fiscal mis manamgent of our greedy healthcare CZARS. It's not a reflection on the nurse at the point of care, this is a reflection on the fiscial managment of the institution they work for. The beside nurse is just the easiest one to get rid of. They can process variance/risk manage/ insident report all they want- they are still not solving the problem. There will still be another nurse who comes along and does the same thing or a variation of the same thing. Why? Try too much work for 1 person. There is something wrong with the thought process at the top, not at the point of care.- It's called "Greed based care" not "Evidenced based practice"

[time2go, MSN, RN, NP]

I completely agree about nursing growing a pair. I'm still in school but I'm in my 50s (yeah, I know, go ahead and laugh) and have been around the block in the workplace a time or five. Regulations are well and good but the people who are being pi**ed on have to do the education! I can stand up for myself and have no qualms about doing so. However, just think if every nurse refused to operate unsafely how things would change. Women in general and nurses in particular take way too much crap. Yes, it's a generalization and possibly a stereotype but basically true. You'd think that having men in nursing and women as MDs and in administration would have changed things more over the years but apparently we are all too easily indoctrinated into our roles.

I have clinical instructors and floor nurses who talk about having certain things just so or having all the information you need at hand before calling doctors or else. Or else what? The doctor will be very upset and may yell at you or hang up on you. So what? If that doctor is so immature and megalomaniacal that he or she yells at someone for not having the exact information, the problem belongs to the person doing the yelling, not the person getting yelled at. We should be good at our jobs because we care about ourselves, our patients, and our profession, not because we cower to think we might get "yelled at". Nursing talks the talk about not being the doc's handmaiden (or manservant as the case may be) but walking the walk is the only way to make the change. I'm not saying nurses don't need to methodical and do their best; I'm just saying if we're all team members, we all need to be treated equally and with respect. To get respect, you need to believe that you are worthy of respect and not accept treatment to the contrary. Nurses as a group could wield much more power than they currently do if they banded together. Ok, I'm done.

[kcmylorn]

Time2 go- I think the point your instructors are trying to make about having all the information gathered before you make the call to the physician is: the doctor yu are calling(on the phone) can't see the patient your are notifiying them about. The doctor on the other end of the phone is depending on you, who can see the patient, to paint an accurate picture to make an informed decision. SBAR. You can't just call a doctor and tell him/her The patient has a fever" and hang up - They need alot more information to make a treatment or no treatment decision.That patient is not their only patient. It's not the same as being a handmaiden. The handmaiden role is cleaning up their mess- for example: If the doctor changes a dressing or does a beside proceedure, they should throw out their own dirty dressings and wrappers and dispose of their own sharps.

As far as regulations go- we staff, bedside nurses don't have to educate the higher ups on what the Regs are- they should and do and are very well aware of them, That IS their job. That's why they get the big bucks and the holidays off. They are hoping the bedside nurse doesn't know them, that way they can pull more stuff and not be reported for it. They don't want bedside nurses calling the department of health of unsafe staffing conditions which is in the jursidiction of the state Dept of health' responsibility, unsafe staffing conditions is a public health threat and they can be closed down for it if sever enough. The State Department of Health is obligated by law to come into the facility, ask for the staffing sheets for all the unit's that day in question and investigate that. If it is found to be true, and the place was short staffed, the hospital/facility gets fined for every short staffing occurance. It used to be(2002) a $60,000/DAY/OCCURANCE fine. If the staffing is bad enough, the place can be closed to admissions, a hospital will be placed on divert, an LTC facility will be closed to admissions until reinspection of staffing. The Licensing and Inspection department within the dept of health. Currently,( as it was in 2010)- the staffing numbers( #RN's,#LPN's,#CNA's, #patients on each unit for each shift) has to be clearly & visibly/in plain sight posted on a wall- like a piece of artwork for this very reason. I have seen this in 2010 in a hospital I worked at. It is the nursing supervisor's job to keep it updated.

One of the first questions an Unemployemnt investigator asks you is about your training, orientation, working condition (Think about those thing as they relate to nursing.)"Did you have all the things you needed to perform your job satisfactorily" What do nurses need to perform their job satisfactorily- how about adequate staffing??? enough bodies to take care care of the patients!!! So, therefore, the answer to this question is, NO. Nurses when they get fired or terminated or not a good fit, #1. never go to the unemployment office, #2. never consider staffing as something necessary to do their job, or poor orientation. I have said it before, I will say it again: Unemployment is a insurance premium paid to the state by your employER. The premium is in my state $15,000/year per employEE. If the emplyER fires or lays off an employEE, they loose their $15,000 if the employEE goes to unemployment. If the EmployEE doesn't go to unemployment, the EmployER keeps their $15,000. Does any EmpoyER want an EmployEE going to unemployment- NO, the EmployER wants to keep that $15,000 An EmployER doesn't want an EmployEE around for what ever whim or flavor of the month BS but they don't want to pay for such whims either. It is no skin off their butt if the unemplyment rate in this country is up to 9.1%, their not the ones who are unemployed and they like things the way they are because they have the employEE thinking they have no control over their own situation. It's do what the bossman says or else. That bossman is protecting their bottom ine- their paycheck and bonuses, not yours- they could care less what happens to you or your family.

this is another reason why employERs(especially healthcare facilities) don't like unions- unions educate their members on state rules and regs in the department of labor and dept of health!!!!!!!!!!!

[tokmom, BSN, RN]

It says no more housekeeping on units...

That doesn't necessarily mean that they expect nursing staff to do the housekeeping. Where I used to work and where I'm about to start working there isn't housekeeping on the units...

But you page them if they're needed and they come. In the meantime, they are doing rounds where they're gathering the trash, mopping, etc.

You can't be saying that they expect nurses to fill up mop buckets and clean the floors, scrub the toilets, etc. Nobody likes change, but surely it's not THAT drastic?

Hey, I worked in a facility that had us cleaning the rooms and remaking beds, and housekeeping drawing unschedule blood draws. I kid you not. Those stupid ideas lasted a month, maybe?

OP, You must work for UHS...

[tokmom, BSN, RN]

I completely agree about nursing growing a pair. I'm still in school but I'm in my 50s (yeah, I know, go ahead and laugh) and have been around the block in the workplace a time or five. Regulations are well and good but the people who are being pi**ed on have to do the education! I can stand up for myself and have no qualms about doing so. However, just think if every nurse refused to operate unsafely how things would change. Women in general and nurses in particular take way too much crap. Yes, it's a generalization and possibly a stereotype but basically true. You'd think that having men in nursing and women as MDs and in administration would have changed things more over the years but apparently we are all too easily indoctrinated into our roles.

I have clinical instructors and floor nurses who talk about having certain things just so or having all the information you need at hand before calling doctors or else. Or else what? The doctor will be very upset and may yell at you or hang up on you. So what? If that doctor is so immature and megalomaniacal that he or she yells at someone for not having the exact information, the problem belongs to the person doing the yelling, not the person getting yelled at. We should be good at our jobs because we care about ourselves, our patients, and our profession, not because we cower to think we might get "yelled at". Nursing talks the talk about not being the doc's handmaiden (or manservant as the case may be) but walking the walk is the only way to make the change. I'm not saying nurses don't need to methodical and do their best; I'm just saying if we're all team members, we all need to be treated equally and with respect. To get respect, you need to believe that you are worthy of respect and not accept treatment to the contrary. Nurses as a group could wield much more power than they currently do if they banded together. Ok, I'm done.

Why would we laugh at you being in nursing school at 50? Many men and women have second careers. We see many of them here.

[HazelLPN, LPN]

Reading these posts made me glad I'm retired! I do miss critical care nursing very much...but I hated when nursing decisions were made by non nursing professionals without the consideration of nurses who take care of the patients.

When "manged care" replaced primary nursing we were told "no patients on 1:1 care" and that we were to pair our sickest pts with the stable one and everyone could pitch in and help. We had the transport team nurses who could pop down, or the house supervisor and the charge nurse could pitch in of course. Everthing would be great (and cost effective to make more money for upper management)

When nurses complained about unsafe staffing levels, they were basically told to stop whining and "does unsafe care mean somebody doesn't get a bath at night?"

How many of us update our assessments during bath time? How many times do we find something just not quite right during bath time?

Again, this was dismissed.

One horrible shift our charge nurse had to call the director of critical care nursing to report a staffing emergency. She was supported by the house supervisor and our head intensivist. The director herself came in and took a patient assignment in the MICU. Granted, it was the easiest assignment we could give her, but she hadn't take care of patients in years. She did manage to keep them alive somehow, but it shook her up enough to realize what we were up against.

We never had to work that short again and if a patient needed to be on 1:1 care, no questions were asked.

I remember the days when your nurse manager was called your "head nurse" and still took care of patients once a week and was very much in touch with bedside nursing. Perhaps if we went back to this, we could be better advocates for our patients and our managers could be better advocates for us as well.

Again, I'm glad I'm retired!

Mrs H.

[Ntheboat2]

Hey, I worked in a facility that had us cleaning the rooms and remaking beds, and housekeeping drawing unschedule blood draws. I kid you not. Those stupid ideas lasted a month, maybe?

OP, You must work for UHS...

That's nuts! Housekeeping doing blood draws? Is that even legal? Haha...

I've seen a lot of facilities where the nurses are supposed to keep the beds made and the room "clean" just meaning trash/clutter free. Of course, that task usually falls to the aides and is one of their main jobs along with bathing.

[monkeybug]

It says no more housekeeping on units...

That doesn't necessarily mean that they expect nursing staff to do the housekeeping. Where I used to work and where I'm about to start working there isn't housekeeping on the units...

But you page them if they're needed and they come. In the meantime, they are doing rounds where they're gathering the trash, mopping, etc.

You can't be saying that they expect nurses to fill up mop buckets and clean the floors, scrub the toilets, etc. Nobody likes change, but surely it's not THAT drastic?

I actually worked in a labor unit that did not have housekeeping at night. The RNs were expected to mop the rooms during the recovery period. We were LDRP, our doctors usually managed to make each delivery room look like a slaughterhouse by the time the baby arrived, and we had to have a presentable room that wasn't a hazard. I hated it! It was so embarrassing to drag the housekeeping cart in the room after a delivery and try to clean while discussing breastfeeding. This was a subsidiary of HCA, by the way. Before it was all over, we had a mini-revolt. If at all possible, we would simply move the patient to a clean room and leave the abbattoir for the day shift housekeeper. This is also the hospital that cut our secretaries and gave the nurses cordless phones. they finally gave in and let the ER housekeeper come up and clean up after our deliveries, but only after a cesarean was delayed because the Chief of Obstetrics had to mop the OR himself.

[up_all_night]

banding together, thats called forming a union, you should check out the NLRB or call National Nurses United

[CrunchRN, ADN, RN]

Is this for real? Patients in the conference room? I hope it is exaggeration......

[carolinanurs]

Sounds like what they are doing here in Winston-Salem, North Carolina. Baptist hit the news here announcing they are laying off 1000 people. But they say the nurse ratios are sacred and will not change. I worked on those floors at Baptist and let me tell you that if they lowered the number of nurses there wouldn't be any nurses to care for patients. The nurses I know tell me they now lack PCTs and secretaries and have to pick up even more. The other hospital in town is just as bad. NOVANT is putting in all of these computers and got rid of 289 people just a while back. My friend works on the EPIC team and she tells me most of them are getting tossed to the curb too. She tells me more people are going to lose their jobs next year at both NOVANT and Baptist. Forget trying to find housekeeping if the floor gets wet because we have to do it now.

[kcmylorn]

Makes you wonder why Nursing managment still has a Nursing license, doesn't it.