Facilities are firing seasoned, higher paid nurses and utilizing younger less experienced nurses. This cost-cutting measure is putting patients at risk, working nursing and support staff to the point of exhaustion, and causing staff to leave the profession.
Updated:
This article was written by a member on allnurses. Due to the controversial and emotionally charged nature of the article, the member wanted the topic out in the open so nurses could discuss it. Because she is afraid of retribution if any of her hospital administrative staff should read this article and link it back to her, we offered to publish it for her anonymously. Please add your comments regarding this issue negatively impacting nurses and the healthcare system.
I am an experienced nurse that has watched many of my very talented colleagues leave the bedside due to the changes that have taken place in healthcare as of late. I have seen staff cut to the minimum, while patient acuity and nurse to patient ratios increase. I have seen support staff break down in tears because they have not been able to do their jobs properly. I have seen staff pushed to their breaking point, all the while administration stays in their offices, or in the meetings, determining yet more ways they can cut our resources. I see your salaries raised to ridiculous amounts, while we are denied cost of living increases, housekeeping is cut at night, and our benefits cost more, while the services are decreased.
I see our retirement cut while at the same time, the amount matched continues to be diminished or non-existent.
I see ways in which we are constantly blamed for declining patient satisfaction, increased patient falls, late medication administration, all the while we are asked to do more with less. I have seen you fire experienced staff and hire less experienced, cheaper, staff. I have seen that new staff break down because they have no resources, no experience to draw from and I have seen patients suffer from that inexperience. I have seen codes increase, inappropriate admissions to floors, transfers to higher levels of care, all because no one was there initially to advocate for a higher level of care for the patient, to begin with.
I still see you in your office. I do not see you on the floor. I see you with your graphs, your pie charts, your questions about readmission rates when I had already advocated for that patient to stay longer but was simply laughed off by doctors and not supported by you. Yet, somehow, I need to be on a committee to fix the problem.
I am now required to work extra shifts, because staff are getting sick due to stress, or leaving completely because they are tired of dealing with things. I see you develop a culture of fear, where our jobs are at stake and threatened at every turn. Yet, you still look to me for solutions.
"How can we do more with what we have?" I am asked.
My answer: There is no way to do more. We are at our limit. You are losing nurses as fast as you are gaining them, at a time when we need to be building up our profession when the baby boomers are just starting to become a factor in our healthcare environment.
My answer to this is simple. It is time to get real and start valuing your employees. If you want to be reimbursed for patient satisfaction, increase your services. Staff departments with what they need - enough nurses, enough aids, monitor techs, secretaries, ED techs, whatever. Then you will see positive results. Falls will decrease. Medication errors will decrease and medications will be given on time. Patients will get the treatment they deserve and patient satisfaction scores will improve. Your reimbursement will improve and you will stop losing money. Everyone wins: most importantly, the patients.
We need to stop the assembly-line mentality of medicine and return to the service mentality.
Yes, we are a business. But any business that has ever done well has not done well by decreasing the services to people or by mistreating its staff. Otherwise, healthcare facilities are going to see more of the same and suffer more financial penalties, less high-quality staff, and patients will suffer.
I was talking with several of my colleagues just the other day. All of us had many years of experience. Many had been at the bedside for over 20+ years. Many are leaving the bedside due to the unsafe conditions they are seeing. They just don't want to be a part of it. Perhaps this does not scare you, but it should. You must not be a patient yet.
For a follow-up article, please go to Nurses Fight Back! Why Some Hospitals are Despicable
Hospitals Firing Seasoned Nurses_ Nurses FIGHT Back! _ allnurses.pdf
Strip Nurses from the Bed:
Provocative, is it not? To the Executives in the C suite and to the Board Members to whom they are answerable, the Nurses at the bedside are not Nurses, they are Beds. Let me explain; The nursing budget is the most expensive budget in the entire hospital. The Beds†are income generators and the Nurses diminish the income that comes in from The Bedsâ€. (For those who work in locations such as the Cath Lab, the income generator is ‘procedures performed'). If Nurses could show a way to demonstrate a direct revenue stream to the hospital, the Board Members would see $$ and the value of the Nurse would increase faster than a heartbeat.
Unions are a Temporary Band-aide:
You can send your money to a well meaning union who will try their best to intercede on the injustices that occur in relation to Nurse vs Bed. However, it will not make the problem go away. The Unions are very helpful in trying to soften the blow of how Nurses are treated as Beds, but the Union's focus is not quite broad enough to see the value of getting the Nurses out of ‘Beds'.
Value Based Healthcare:
The opportunities are beginning to present themselves, folks. The time is coming when reimbursements are being tied more and more to what nurses DO, rather than an inanimate object; The Bed. The hospitals are being forced to look more to what happens to increase reimbursements. People come to the hospitals to get treated by the Nurse. If they only needed the Dr's care, they would be treated and released to go home, or have an outpatient procedure, or go to the clinic. The value of Nursing as a whole is glaringly underestimated in budgets all across the nation.
The Answers:
I don't have all the answers, but I see a solution beginning to come into focus. Maybe some bright, newly minted Nurse out there has some of the answers – and is just waiting to ride The Maverick that is Value Based Healthcare Reimbursements in. I hope I'm still in Nursing for when that time comes.
Anna S, RN said:I'm sure that The Powers That Be love it when nurses blame the dismal state of nursing jobs, wages, and pt care on whomever is in the oval office, and/or turn it into an ADN VS BSN VS MSN, and/or union vs. non-union etc. argument, because that keeps us fighting among ourselves and never actually able to do anything about the situation.
Exactly. I can understand why historically, the ANA and others saw a great chasm between LVN/LPNs and RNs, ADN vs BSN, etc. but the advent of online learning and other alternatives to either technical/vocational school or brick and mortar colleges changed the dynamic. There is an upward trajectory of people who became RNs by bridging from LPN and know what is actually done in the workplace vs a political advisory intended to create distance between the two roles.
California ratio laws apply to all licensed nurses, but LVNs are represented by the SEIU, RNs by the formerly ANA affiliated CNA/ NNU. Given the many options we have now to bridge from LVN/LPN to higher levels of education it would have been a better strategy if the CNA/NNU had adopted the attitude expressed in the 2010 IOM Report.
Bridge programs and educational pathwaysbetween undergraduate and graduate programs—specifically programs such as LPN-to-BSN,ADN-to-BSN, and ADN-to-MSN—are designedto facilitate academic progression to higher levelsof education.
and...
Bridge programs and seamless educationalpathways also offer opportunities for increasingthe overall diversity of the student body andnurse faculty with respect to race and ethnicity,geography, background, and personal experience.
The emphasis now is still one that splinters licensed nurses from each other. Until that changes we're going nowhere. I don't engage in the ADN vs BSN vs anything else anymore because it only serves the purpose of people who see dollar signs and not the intrinsic value of nurses. If nurses at higher levels actually facilitated the progression from one level to the next in word and deed our situation would be greatly enhanced.
Secretperson said:I have taken your response to my comments a little personal.It appears you took my comments a tad personal too huh? Interesting how everything in your responses are about you and everyone else is to blame for your outcomes. Please understand no one can assume they know what hardships you have faced, but its a little bit selfish to think you are alone in having a difficult time. If in fact everything you state is true then you have an amazing case for EEOC.
Perhaps the most offensive thing you bring up is your disabled spouse, as if to tug at the heart strings of us idiot nurses who just don't know how hard it is. I am having a hard time controlling my language right now ma'am, how dare you, you think you are alone with a disabled family member? You think that your career and life somehow trumps the career and life of another!! Enough!!
Do not feel the need to patronize me by stating you "forgive me" for a general statement, of which you cut and pasted only one part of what you took offense to.
Philosophical ha.... pretentious much? Repeat this twice and enjoy your time off: I will not sit in the corner and treat my colleagues like **** new or old, I will not be unbending, and I will embrace things that make me, my patients, and my profession better.
I don't know what your problem is and I don't understand how you can be offended because she is caring for a disabled spouse. Do you lack a heart! Where do you get off! Where has she said that her life/career trumps yours or anyone elses!
Frankly I find your comments rude and disrespectful! Yes one can go to the EEOC but the Supreme Court has made it very difficult to prove age discrimination. The govt has basically turned a blind eye saying yes it's illegal to fire someone for age discrimination, but we will pretend we don't see it so you can make more profits. Layoffs of senior workers is now a common practice in virtually every industry. The only thing that can stop it at this point is a strong union and unions are virtually extinct now outside of govt! Going back to school and taking out student loans to get a higher degree whether BSN or MSN or whatever will not protect you! In fact it may put your financial life in jeopardy as you will pay them till you die or 20+ years if you have to use income based repayment. Your college degree will not protect you from a layoff. Even NP's get laid off. I remember a few years back the major medical college laid off a bunch of their NP's. Now guess who they are hiring new grads out of school! Who knows what happened to all those who were laid off!
I don't understand your judgement and hostility toward this nurse who was let go from her job probably related to her age, pay and spouses medical problems. These type of firings happen every day and you never know it could happen to you one day or anyone of us. As for me, I'm aware of this risk and so am doing everything I can to save money in a Roth IRA that will be accessible to me in an emergency without penalty. Many Americans were laid off since this economic crisis and then were doubly penalized, forced to use their 401K and then forced to pay penalties just to make ends meet!
I don't know who you are or what age you are, but school is not always the answer. One needs to save for emergencies and retirement and to maintain maximum financial flexibility given the unfortunate negative economic realities and the fact that the govt is turning a blind eye and is not supporting workers rights!
EwaAnn said:Anna S. RNOne of these days it will be you that will be tossed on your booty for your wage. Trust me they will replace you too.
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You didn't get the point of my post.
I am an RN. I have been a nurse for 23 years. My post is my theory of how the hospital industry manipulated the so-called shortage in order to make more money for themselves, and keep nurses oppressed.
I wrote it in POV perspective. Sigh.....
looking at the American scenerio vs Canada..we are not much better up here. Unions in our hospitals, but the govt is STILL cutting back. CUrrently we have a battle going on with the nurses in LTC/home visits, who want parity for union hospital nurses. Good luck, but you need to make noise for the boss man to hear you. Info pickets are good, but not knowing the scenerio in the usa. We noted for example..Uninet in Arizona reminds me of a Tim Hortons franchise here in Ontario. Their in it to make..MONEY! YEs, experienced nurses cost money. PLUS benefits. Our govt is working to end that with cost cutting and reducing fringe benefits. YET, we are entering the massive baby boomers era. Damn that WWII and all the babies (us) that were made after the war.
Hi Roy Hanson:
To get off the subject for a moment. I am familiar with Tim Horton's. I used to live in NewYork now I live below the Mason Dixon line. Whenever I go back to NY I stock up on their cappucino mix. I love the ice caps. Sorry back to nursing now. Hang in there and enjoy a cup of Joe from Timmy Ho!
®Nurse said:Strip Nurses from the Bed:Provocative, is it not? To the Executives in the C suite and to the Board Members to whom they are answerable, the Nurses at the bedside are not Nurses, they are Beds. Let me explain; The nursing budget is the most expensive budget in the entire hospital. The Beds are income generators and the Nurses diminish the income that comes in from The Beds. (For those who work in locations such as the Cath Lab, the income generator is procedures performed'). If Nurses could show a way to demonstrate a direct revenue stream to the hospital, the Board Members would see $$ and the value of the Nurse would increase faster than a heartbeat.
Value Based Healthcare:
The opportunities are beginning to present themselves, folks. The time is coming when reimbursements are being tied more and more to what nurses DO, rather than an inanimate object; The Bed. The hospitals are being forced to look more to what happens to increase reimbursements. People come to the hospitals to get treated by the Nurse. If they only needed the Dr's care, they would be treated and released to go home, or have an outpatient procedure, or go to the clinic. The value of Nursing as a whole is glaringly underestimated in budgets all across the nation.
The Answers:
I don't have all the answers, but I see a solution beginning to come into focus. Maybe some bright, newly minted Nurse out there has some of the answers – and is just waiting to ride The Maverick that is Value Based Healthcare Reimbursements in. I hope I'm still in Nursing for when that time comes.
The primary reason for the existence of hospitals is to provide nursing care. I've never understood why administrators and bean counters don't understand that nursing care is not a "cost" of doing business, the services we provide are the "product". We are the business.
If the cost of the nursing care was stripped from the cost of the room/utilities/laundry/housekeeping, billing and reimbursement for nursing care could be based on the patient's actual acuity level.
inshallamiami
203 Posts
Hospital adminstrators ONLY care about money, the numbers, and covering their a*&. the "patient safety" words are the CYA stuff