economics......go figure.

Nurses Activism



2,709 Posts

"The non-dollar costs could actually be greater--the loss of knowledge, of skilled workers," he said. "There's the time and energy recruiting those employees, knowledge about the business, knowledge about the customer, intellectual capital, the cost of damage of trust and credibility within an organization."

When the economy turns, it will be harder for companies that have made steep cuts to expand, said Adventis' Gordon.

"They won't have the people or the talent" to grow again, he said. "They will have made cuts that did the job for the balance sheet but caused difficult-to-repair damage to the company.">>

Any nurse who has been working at the bedside during the last decade could have told them that. This is how the hospitals ended up with the nursing crisis situation they are in now.

Originally posted by wildtime88

how true JT. but still they have these companies coming doing time studies and such. A time study is nothing more than a precurser to staff reduction disguised as cost savings.

Actually Wildtime a time study is a very costly program designed to provide normative data for patient acuity and staffing levels and mix. JCAHO requires that a hospital use some sort of system (loosely defined) to ensure appropriate staffing levels and mix based on patient need and level of care among other things. While time studies can reduce staff, it can actually have the opposite effect if done correctly. There are many articles in the literature about the different types of time studies. The bottom line is that time studies should be used as a gauge...managers should not "live and die" by the results for they really are a snapshop in time. What most managers do not realize is that the staff (if honest)can tell them quite accurately what patients need in terms of staffing without having expensive time and motion studies.




921 Posts

Great post jt!

I think it's interesting to compare this to Japan's current economic problems because of their three pillars of industrial relations: lifetime employment, the seniority-based wage system and enterprise unions. Many Japanese companies are considering lay-offs for the first time in history, in order to decrease labor costs and remain competitive in the current economy. When looking at these two extremes, maybe we can find a balance between the two.

Originally posted by wildtime88

True Charles, but they can also be used to show that nurse "A" had a total of 3.5 hours of down time during the study and that when compared to nurse "B" she took 2.5 times longer to do this or that. Which could quickly result in a higher nurse to patient ratio or the loss of a clerk or nursing assistant. Also these people have a data base in which they can pull figures out of that the mean average for doing a particular task is ..... Another name for these are productivity studies.

Employers can also use the information to find out how much it actually costs to give a tylenol or some other task and can give a reference on how much the hospitals break even point is for that function and allows them to set prices to ensure that there is a profit being made weather it be 10% or 100%.

It all depends on how the information is used.

The total of 3.5 hours is mentioned earlier is deceptive in it can be addered up by minutes, i.e 5 minutes in bathroom, 10 minutes spent at the nursing station waiting for physician to return page, 15 minutes talking to patient's family, etc... It all depends on who determines what down time is.

If time studies were used to actually benefit nursing staff we would not be in the position we are in today.

As the result of the resent study we conducted, we have concluded that nursing has the time available to do all of the respiratory threatments in house.

There is some misinformation in your statements Wild...first, a time study is based on large numbers of data that are statistically analyzed using regression analysis to predict the next data point or points on a straight line. The results give ranges of numbers. No one nurses time data is used as a basis, nor is the average or mean times used as absolute. Averages or means and medians are used to determine data around a single point (central tendency). Regression is used to plot out new points based on existing data. The differences are stark. Having been responsible for this kind of data in a very large metorpolitan hospital for a number of years, I am well aware of the uses and misuses of data. Misuse of data often occurs as a result of poor understanding of the purposes and poor interpretation, rarely for intended fraud. Poor planning and design of the study leads to poor data and information. Just like anything else...garbage in, garbage out.



Most budget reports about nursing care are in Nurse Hours Per Patient Day...NHPPD. This figure is based on a budget figure and can certainly be exceeded if acuity skyrockets. Careful and seasoned administrators look at the trends over time to determine changes in fiscal policy. Sometimes a one time blowout of the "numbers", however, can signal some extraneous, signicant event that warrants review. Yes, NHPPD translates into dollars over or under budget, but it is the overall trend that is important. Ask your nursing administrators for their rationale for interpreting the data, how the data are used, and how the general staff can learn about the process. Being well informed about the process reduces one's trepidations and might even provide some great learning.




921 Posts

I have enjoyed the discussion Wildtime and Charles about time studies and how they effect staffing levels. Both of you threw out some good information and made some good points. Nurses have got to be one of the most heavily studied professions on the planet! This comment by Charles especially rings true: "What most managers do not realize is that the staff (if honest)can tell them quite accurately what patients need in terms of staffing without having expensive time and motion studies."

Here's another type of study done to show the effect RN layoffs on patient care and hospital budgets:

Yale School of Nursing study highlights dangers posed to patients by RN layoffs

After a reduction in the registered nursing staff at an urban teaching hospital, patient falls increased substantially, and the hospital failed to realize any cost savings.

These findings emerge from an extensive study by Sharon Eck, a doctoral candidate at the Yale School of Nursing. Eck examined data from 19 units in the 800-bed hospital over a period ranging from six months before the change to two years after the hospital's reorganization. She reviewed staffing data, length of patient stay, patient falls, reports of medication errors and patient satisfaction surveys.

In the period when the hospital made the change to increased use of unlicenced personnel and reduced RN staffing, patient falls increased by 30 percent. They increased another 28 percent six months after the change before decreasing over time. Hospital patients often fall when they get up unassisted to go to the bathroom. Reporting of medication errors decreased sharply (55%) during the reorganization, then increased 67 percent six months later. Eck speculated that job insecurity may have caused under-reporting of errors during the reorganization, but acknowledged that the area needs further study.

Changes in the hospital's staff began in 1994. The reorganization design was never tested and analyzed in a health care setting.

"It's incomprehensible that we would make these kinds of changes in the way we care for very sick people without knowing if we would do harm," said Eck. "You wouldn't change the way you build bridges without testing a model. You would change the way you do air traffic control, the way you regulate emissions, and so on, without doing some study to test how the changes would work."

Eck added that different units showed different results, implying that a one-size-fits-all ratio of registered nurses to unlicenced personnel was not appropriate. "There's a difference between an obstetric unit, where a nurse is taking care of a generally healthy young woman, and a neurosurgical unit, where you have a 70-year-old man who has just had a stroke," said Eck.

The hospital labeled the staffing change "patient focused care" and predicted that a larger, unlicensed staff would be better able to give patients personal service and would thus result in greater patient satisfaction. But patient surveys showed no overall change in satisfaction.

The reorganization was also expected to reduce the cost of care, but did not. New expenses associated with the implementation of hospital redesign were estimated at $6.8 million. However, nursing costs did not decrease as a result. The study data do not clearly reveal why no cost savings arose. Eck raised the possibility that low morale and high turnover resulting from

the reorganization caused increased sick days, overtime and training expenses. She would like to do further work to test that hypothesis.

"Nurses have been studied extensively. We know that when nurses become dissatisfied with a health care organization, they walk," said Eck. "Part of the present nursing shortage can be linked to these kinds of radical changes."

The implications of the Yale School of Nursing study are that hospitals should do systematic measurement to evaluate their practices, that clinical innovations should be pilot tested, and that institutions should examine their organizational change policies.

In a relatively short period of time, the hospital decreased its nursing skill mix from 81 percent RN hours to 63 percent RN hours. The period of change was marked by dramatic increases in falls and increases in length of patient stay. Eck noted that the reduced force of registered nurses may have spent an increasing amount of their time supervising unlicenced personnel rather than providing patient care.

This topic is now closed to further replies.

By using the site, you agree with our Policies. X