F Grade Hospital

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Hi,

I have a job offer for my dream department but the hospital just received an F grade from leapfrog and that is making me nervous. Do any nurses here work for a lower grade hospital or have friends who do? I'd love to hear how that has worked out for you.

Thanks!

Specializes in Critical Care.

Generally hospitals that provide good working environments for their nurses have no need for these contracts, beware of the ones that know they are so bad to work for that they need to contractually obligate their employees.

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I don't know if my current hospital has ever been evaluated by leapfrog (is this a regional thing?) but we are a small safety net facility that has been on the brink of closing in past years and rumors are this place may not be here in 5-10 years. Our administrative staff turnover is crazy. I've been here for 3 years in 2 different units and have had 2 different CEOS, 2 CNOs, gone through 2-3 sets of nurse educators, and about 3-4 nurse managers either fired or left (most just leave) not to mention managers of other units and assistant directors who have left, RN turnover on certain units is crazy as well.

Numerous attendings have left including about 5 of of 10 long time general surgeons that just left in the past 2 months.

*sigh*

I maybe getting away from your question a bit here but It is rough working for a failing hospital. A lot of the long time staff believe this place will never close down but IMO the writing is on the wall.

my last two facilities were very good institutions with good management, people weren't as warm as my current job and management ran a tight ship. Here at my current job staff here gets along better, but management is very lax (any correlation?? lol) Honestly in retrospect I would have stayed at my last two jobs (I fell for the grass maybe greener line of thought and guessed bad, but I'm thankful for a job), Of course no place is perfect but I like a well oiled machine even if staff isn't super close. I like structure and order and it's virtual non-existent at my current job.

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There are some states where these contracts are not binding, but in other states they are perfectly legal and the employee can be held to the penalties. A contract must offer both sides something of value, but courts commonly see a job and the income that goes along with it as something of value.

Yes, having a job is certainly of value and were that the extent of this idea it would be a different matter entirely; I should have said "training" rather than "something" in my comment. Hospital corporations specifically target largely a group they know requires (relatively extensive) additional training and then attempt to justify the contract by the very fact that training is required. Meanwhile, they cannot operate without nurses. Some number of nurses will have jobs in hospitals, contracts or no contracts. There's absolutlely no reason to not just decide to look at it as the fairly even trade that it is and leave it at that. The nurse can't work in the hospital without training and the hospital can't do business without nurses.

I hate to hear of new generations of nurses being treated this way. They will decide how they feel and what they believe about this "opportunity vs. risk" scenario, but I will encourage careful consideration. I simply can't come out on the side of a corporation vs. a singular nurse as far as this particular topic is concerned.

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Specializes in OR.

If you read the website on the Leapfrog survey, there are reasons why a particular hospital may not even receive a grade. if a place is a critical access hospital (little "band-aid" barn in the middle of no where) they are not going to even get a grade. This has no bearing on what kind of a place they are. They could be a scary as all get out ***hole (i've worked in places like this. i'll die on the way past them before I'll be a patient there type) or the nicest little "let's get you stable and packed up for transport to "big-city hospital."

It's all about data abstraction across a number of different measures. You can't grade a facility on the outcome of total joint procedures if they don't do those procedures. If they are missing enough of those measures = no grade. No grade = just means not enough information, not bad facility.

In a nutshell, leapfrog can give you a good general idea of outcomes in a facility but it's not a great first line parameter to use when deciding to work there. There are plenty of other things to consider first when considering a job offer. That contract thing is a much much much bigger red flag to me than some organization's data abstraction, statistical manipulation tool that's directed at the public. Is it worth it to take note of? Sure, but not in isolation.

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Leapfrog also takes data collected from the previous year with IC and CMS data varying.... It's entirely possible plans have been put into place since then that would improve scores. I'd check out what the scores were over a few years to get a better sense of what's going on. If they have Fs multiple years running, I'd be more concerned that admin knows they have issues and haven't done anything to fix it. Could also mean the quality/ PI department is poorly staffed. A lot of variables go into it.

If the hospital gets its business more from elective procedures than ER, the F could make the facility lose business as patients may choose to go somewhere else. Depends.

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No I didn't I think that's why I have hesitation and they want a two year contract from me. I understand for the training but I'm scared to be tied down like that..

I would NOT sign a two year contract. Why do they need you to sign a contract for that long if they're planning on treating you well?

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Specializes in Pediatric Critical Care.
If you can have a lawyer read over that contract before you sign it! Ask if you can have a shadow day and get at least an idea of how things are before commiting. Best of luck.

Yes, ask to shadow on the unit for half a day or so, so you can see what the environment is really like for yourself.

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Even though you have mixed feelings about the job offer, congrats! You're doing something right in the application process. I'm not 100% sure (and someone feel free to correct me) but when I look at how these ratings are based (i.e. CLABSI, CAUTI) I wonder if they take into account the populations these hospitals are caring for? Do they control for illness/injury severity, comorbidities etc? The hospital I worked at previously scored more poorly than some of the smaller regional hospitals. However, we were also a referral centre and took care of the sickest patients in our area who were more susceptible to these infections. Not to excuse a poor rating, or diminish the components that cause a hospital to rate poorly, but it is maybe something to look into a bit further if this rating matters to you.

As others have said, 2 years might be a long time to sign a contract for. I would consider whether you have to stay on this unit the entire time (or if you could transfer), if the hospital is a teaching hospital, nurse turnover rates on the unit, how long your training will be etc. Keep in mind, you can always interview for this position but keep looking at other opportunities. As someone else mentioned, it's also probably not a bad idea to have a lawyer look over the contract if you have any concerns.

Good luck with your job hunt!

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Specializes in public health, women's health, reproductive health.

Unless you are offered no other opportunity, don't get yourself into a contract situation unless you have a lot of information about what it is like to work there and you are certain about how it will fit into your goals. There would be very few, if any, reasons I would ever sign a two year contract as a nurse.

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