Hospitals Firing Seasoned Nurses: Nurses FIGHT Back!

[allnurses]

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.

An Open Letter to Hospital Administrators

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

[Tomascz, ASN, RN]

What I'm loving about these posts is I'm getting an inside education before I even stick my neck out there. I couldn't pay for this stuff; nobody would tell me except you guys. This stuff is happening sotto voce and behind the scenes. The closest I got in clinicals is when I got assigned by one of my preceptors to get on the phone and straighten out some guys Zyvox script with Medicaid because even though the guy was on total disability, Walgreens had those tabs priced at $600 a pop (they sure didn't cost us that) as a take at home med and meds was the only reason he was still on the floor. Medicaid wanted to screw around for 72 hours before they'd even say yes or no?!? The provider had to get on the phone and apparently threaten to, figuratively anyway, tear the putz on the other end a new one if they didn't quit being jerks. They did, but as a GN I didn't have the ammo to deal with them and I felt like an idiot. Good lesson though.

The effed up part of the whole deal was that the guy I was talking to on the other end was some pencil pushing GS6 that was making critical medical decisions that over-rode the MD's prescribed course of trx for this pt, (and he absolutely needed it; I was helping dress his wound; trust me). That's just nuts.

[NurseDiane]

In the famous words of Nancy Pelosi, "We have to pass the bill so we can find what's in it." So, vote to pass it, then read it. That's probably what Washington does with everything, except when it comes to their own money.

[NurseDiane]

The vast majority of physicians that I know refuse to get on the phone & fight with a high school graduate about whether what they're prescribing is "medically necessary" or not. They're doing it without any compensation & it is not a part of their job. What should happen is that insurance companies should be required to compensate physicians for the amount of time it takes them to write a letter of medical necessity or telephone call to get authorizations for payment from the insurance companies---then you'd see more authorizations go through without denials for every damned thing, even routine procedures & medications. The doctors I know say that if they prescribe something & Medicare/insurance company denies authorization for payment, they will not fight with them---if something happens to the patient & the patient sues, then the doctor will drag Medicare/insurance company into the suit for denying to pay for a treatment that the doctor ordered, & that is the reason that the patient didn't get what was ordered & sustained an injury because of it. In that case, it is not malpractice----it is negligence on the part of Medicare/insurance company.

I just saw on the news that Turing Pharmaceuticals is raising the cost of an anti-parasitic drug 5000%. The spike in price was overnight & without warning. That is what the government should regulate. They won't though, because pharmaceutical companies "donate" a huge amount of money to political campaigns, and have the politicians in their pockets. I hope the assh*** CEO of Turing Pharamceuticals doesn't sell one single pill & shoulders a huge loss for his selfish & greedy action.

I've had to fight with my own insurance company, Empire Blue Cross/Blue Shield, over annual authorizations for the same medication I've been on for 10+ years. Help me understand that one. And when I do have to call them for the authorization, it's like speaking to a wall---the insurance company transfers me to the pharmacy that is subcontracted by the insurance company, then the pharmacy doesn't know what plan I have & I have to call the insurance company back, I get put on hold for 20 minutes because the insurance company representative has to call the pharmacy.............it's like taking a long ride on a carousel, around & around & around & around & around..................It's ridiculous.

[CHESSIE]

Diane, need to get the insurance companies out of health care! We need a Medicare for All, single payer system. Health care is a right, not just a privilege for a few with wealth. However, until our congress realizes this we are doomed to have people with no medical knowledge make our health care decisions for our physicians.

Chessie , RN (retired)

[NurseDiane]

I agree to an extent.

Due to the fact that practically all hospitals from coast to coast currently have a hiring freeze going on, no matter your level of education you won't be hired. So, whether you have an ADN, BSN, MSN, or DNP, you're going to be unemployed. You may get a per diem job as an NP in a primary care office or nursing home, but who wants to do that? You won't get the same job as a physician's assistant would, assisting in surgery or orthopedics or cardiology or neurology. You're better off going to school to be a P.A. It's still a graduate degree program like a an MSN/NP is, but you have far more options than a nurse does.

There was a mass entry into nursing school about 5 to 10 years ago, because a total lie was spread about nursing---that there was a "critical nursing shortage" across the country, and if you went back to nursing school, you'd were "guaranteed" a job upon graduation due to the shortage. Bachelor's degrees were not stressed---2 year programs made a KILLING on this because that is what people thought was all that as needed to be a nurse & get a job. All those people graduated & found a much different story: That there was no nursing shortage & in fact, the opposite was true. There were too many nurses. And then the ACA happened, which further compounded the problem. Those 2 year programs are still around, which should be changed by the folks in Washington: If hospitals won't hire nurses without BSN's, the government should step in & get rid of the 2 year programs. But, it will never happen, and do you know why? Because the federal government makes an OBSCENE amount of money on student loans. They WANT people to default on their loans because it increases their profits through default fees, higher interest rates, and late fees. All this talk about $1 trillion in unpaid student loans is total bullsh**. The student loan industry abounds with corruption at a federal level. When the federal government allows organizations like Sallie Mae to "service" student loans, it is corruption at the highest level. If you're interested in how corrupt the U.S. Department of Education is, Google Massachusetts Senator Elizabeth Warren & read some of her stuff. Read the letters she has written to Congress & Sallie Mae about their relationship that have gone unanswered. Google & read about the $1 million "loan" that Sallie Mae made to Chaka Fattah, a long time Pennsylvania congressman that was running for mayor of Philadelphia. Two political consultants have pleaded guilty to participating in a $1 million campaign laundering scheme on behalf of the Congressman. Albert Lord, the CEO of Sallie Mae, wrote a check directly to a consulting firm working with Fattah because there was a limit to how much a single donation to his campaign could be. Lord's motive with this "loan" was to influence Fattah in Washington & to "spread the word" about Sallie Mae & keep the relationship between the U.S. Dept of Education & Sallie Mae secure. I'm not going to type out the rest of it because you can look it up yourself-----but if you don't think financial corruption is at the very core of higher education and healthcare, you had better re-examine your thinking. It is a very tangled web, indeed. The thing is, most people don't know about it or care to know about it.

In 2014, Sallie Mae "agreed" to pay the feds $200 million in penalties for cheating active duty troops & charging them unlawful late fees when they were called to active duty. There was a lot of pressure from politicians for the U.S. Department of Education to sever its ties with Sallie Mae due to their ongoing schemes, but guess what? Sallie Mae is still contracted by the U.S. Dept. of Education to "service" student loans. Just follow the money, folks. It's very simple.

After all these nurses went back & got 2 year degrees, the whole "Magnet" program started, and every hospital across the country was falling over themselves to be designated a "Magnet Hospital". It is impressive to the public that their hospital is a "Magnet" hospital, and they automatically think the nursing care is better. The truth of the matter is that hospitals can say that all of their nurses have doctorate degrees----if there are not enough nurses working on the units & the units are grossly understaffed with very acute patients & high patient-to-nurse ratios, the care will be horrendous. People only find this out when they're admitted to a hospital. You don't hear about the problem on the news because "they" don't want people to know about it. "They" (meaning the liberal media) don't want the public to know that the ACA further destroyed healthcare as we knew it to be---it mandated huge staffing cuts by facilities because of the sh***y reimbursement from Medicare & the insurance companies. "They" want people to think that the ACA was the greatest thing to happen to this country since the end of World War 2, and that's the furthest thing from the real truth.

When a patient is admitted to the hospital, there is one question that a person is asked, either by the admitting person or by a nurse, and that question is "Have you been admitted to a hospital within the last 30 days?" Do you know this question is asked? Because Medicare/insurance companies will not pay for a hospital admission if it is within a 30 day period of time. All of those patients in the ED holding area on "observation status"? They are there in "observation" because the hospital won't be paid if they are admitted. Here's a kicker too: Medicare/insurance companies won't pay for an "observation" either, so the patient finds a big, fat bill in their mailbox a couple of weeks later. This ACA was directly responsible for this. So, patients are discharged before they're ready to go home because Medicare/insurance companies have "menus" for what is an "appropriate" admission time for each diagnosis. Patients are discharged whether they're ready to go or not, and then if they decompensate at home & end up back in the ED, it is a battle between the patient, doctor, hospital & Medicare/insurance company to get them re-admitted. You're damned if you do, you're damned if you don't. Doctors & hospitals are caught up in the web of government regulations that result in poor quality patient care.

But, let's blame the nurses for poor quality care. It's all their fault.

So, for those who think that a "national union" will help nurses, think again. The root of the problem goes much father than you could ever imagine, and until a national nurses union is formed that donates a CRAP TON of money to the politicians in Washington, nothing will ever change. The teachers have a strong union because of their political ties. I find it ironic how a hospital won't get a nurse to cover a sick call, and the extra work is just put on the backs of the nurses already working, but when a teacher calls out sick, a substitute teacher is assigned to that class. Why should nursing be any different than that? If the school did not have a teacher for the class, they would not get federal/state funding for that day. Why shouldn't a hospital be penalized when they don't cover a sick call? They're getting federal/state money too. Oh, that's right----an education is a RIGHT for American citizens, but health care is not a right, it's a privilege. Disagree with that statement if you choose, but it is absolutely true.

I know this post is already long enough, but I just have to tell this story. When I worked at a major NYC hospital many years ago, there was a cardiac surgeon who was brilliant. He did adults, pediatrics, valve replacements & was one of the first surgeons in the world to do a CABG. However, his personality was that of a drill sergeant with bi-polar disorder. He always had a scowl on his face, walked around in wooden clogs with the rubber soles worn off, so one could hear him "clop, clop, clop" all the way down the hall. I wouldn't hesitate to have this man operate on my heart if I needed it, even though his bedside manner was atrocious. The way I look at it, I didn't have to be his friend, go to lunch with him, go to his house for dinner----all he had to do was his job, at which he was brilliant. He didn't have to impress me with smiles & laughter----his reputation spoke for itself. I'm not condoning being a nasty nurse--but the job you do matters a whole lot more than how accommodating you are for the personal demands from patients. How you manage your patient load is more important than serving hot coffee at 8am. How you change dressings, or start IV's, or interpret monitors or do your part during a code is more important than fluffing somebody's pillows before they go to sleep. When the actual JOB of nursing is appreciated more than the big smiles & "What can I do for you?", maybe things will change.

[NurseDiane]

Just follow the money, Chessie. I don't think we'll see a single payer system in my lifetime because the insurance companies have too much clout in Washington. Congress doesn't care one iota about people----they care about money, just like the big companies they get money from. As long as healthcare is a business, and not something that is treated as a "right", nothing will change & it will only get worse. Insurance companies deny authorizations for payment based on what a computer says, not what an educated medical professional says. If the ACA was so wonderful, every member of Congress would have jumped on the boat. Did they? Hell no. They got on the big, luxury cruise ship of insurance coverage while everybody else had to get on the lifeboats offered by the exchanges.

[lindarn]

We have the ANA and the State Nursing organizations to blame for this mess. If the ANA had just made the BSN as the entry into practice from the get go, hospitals would have to hire nurses with ADNs, and if there are any, though not many, Diploma nurses, and they would have to pay for educational programs for nurses to earn BSN.

They could not demand they you have a BSN in so many years or be fired. They would have to pay for it. Just like they did in PT, OT, and Pharmacy, when they increased the entry into practice. They had the classes on site in the hospital, on hospital time. No one lost their job if they did not have the higher degree. The ANA has let the marketplace determine the entry into practice. That is not in the scope of the marketplace. It is the scope of the professional organization that governs the profession-The ANA. And as we say in Brooklyn, the ANA is about as useful as tits on a bull.

Why is nursing not being afforded the same consideration? Because there are now too many of us, we have NO clout, and no one cares. Nurses are so used to be treated like dirt, it is just another day at work, being stepped on and being treated like an unimportant cog in the wheel.

Older nurses are being shown the door, in spite of having been devoted employees for many years. It is the same practice all over the country with globalization. Unfortunately the PTB cannot export our jobs to China or India.

Smart individuals go for the higher educational level, whether required or not, to ensure that they meet market expectations, now and in the future. It has not been a secret, that the BSN as a requirement was coming. As I stated above, individuals who are looking to change careers, would do well to research these issues before spending several years of their life, and many thousand of their own money, only to find themselves unemployable in today's employment climate.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN(ret)

Somewhere in the PACNW

[NurseDiane]

I totally agree with you lindarn. And, thank you for FINALLY allowing me to figure out what "PTB" means, LOL!!! Now I can use the shortened version instead of typing out the whole thing.

The ANA & state nursing associations are all about money. They'll gladly take your money for absolutely NOTHING in return. They have no lobbying power, no bargaining power, nothing in Washington, where the real power is. The ANA is about as useful as tits on a nun, which equates to not useful at all. Nursing unions are only good to negotiate contracts for nurses. It used to be that a union would protect older nurses from losing their jobs, but not anymore. Older, "seasoned" nurses are losing their jobs all over the country. The PTB DO NOT CARE that seasoned nurses have the experience to be more time-efficient, the education to teach newer nurses the things they know, and the wisdom/common sense to know when something is urgent & something is not urgent. The PTB care about one thing: $$$$$$$$$. New/less experienced nurses cost less. If they hire new/less experienced nurses, it cuts down on salaries, expenses for health insurance, pension plans (if you're even lucky enough to have one anymore), FICA taxes. To the PTB, every penny counts & they cut every little thing they possibly can, but not their own salaries or bonuses. Funny how that works, isn't it? Even unions don't help to protect a nurse's job anymore---but they sure do take those union fees, don't they?

As I said in my previous posts, FOLLOW THE MONEY. The ANA doesn't have power as far as entry into practice. They are just an organization that writes opinion papers. They can suggest a minimum education level---then the state nursing boards has to pass it into law. The ANA does not govern the state nursing boards. State nursing boards are part of state government. And government, whether on a federal level or a state level, is ruled by MONEY. Colleges = student loans = interest & default fees & late fees for both state & federal arms of the student loan industry. If the minimum entry into practice was a BSN, can you imagine how much money the government would lose from all the people that would not go back for a 4 year degree? Two years is not that much time out of somebody's life, but 4 years is. You rarely hear of people going back to school for engineering, or accounting, or political science. But you ALWAYS hear of people going back for nursing. Why? Because they can get a 2 year degree.

The "entry level" into nursing practice is the NCLEX (which was known many moons age as "state board exam"). Two, three and four year nurses take the same exam----there aren't 3 different tests for the 3 different nursing degrees.

As long as two year colleges offer associate degrees in nursing, they won't disappear because the government makes too much money from the student loans that people take out to go there. State & federal government won't change the minimum entry requirements because of this. They're certainly not sitting around in Washington at the U.S. Department of Education looking at loan defaults & trying to find out if the student came from a two year program or 4 year program & couldn't find a job. All they know is that the person is not paying back the loan. so they stick them with late fees, default fees, & higher interest rates.

FOLLOW THE MONEY.

[dishes, BSN, RN]

@lindarn ANA does not have the authority to make BSN entry to practice, the BONs are the ones with the power to set nursing education requirements.

[NurseDiane]

In fact, 45 years ago the ANA put out an opinion/position paper about what they believed to be the minimum level of education for entry into practice. They believed that a BSN should be the minimum required education level for entry into nursing practice.

That was 45 years ago. Nothing has changed, except now 2 year degree nurses can't get jobs. 2 year programs still exist. People are still attending 2 year schools for nursing under the guise that they'll be employed right out of school.

Healthcare, education & government are involved in a very intricate web---all having to do with money. As I have posted before, the state & federal governments make a crap ton of money from student loans, and even more from defaulted loans. Places do not want to hire 2 year nurses, so they can't get jobs & they're unable to pay their loans back, so they default. The state will not make 4 year degrees the minimum education level for entry into practice because of this. Imagine how much money to government would lose if that happened.

It makes me laugh when I watch the news & I hear something about student loan debt being $1 trillion. They make it sound like the government cares about people & politicians even say that they want to lower interest rates, blah, blah, blah. A lot of talk, no action. The ONLY politician that has taken any action is Elizabeth Warren, the Senator from Massachusetts. I do not even live in Massachusetts, and I am an independent, so I am not putting her name out there to further my own political agenda. She has written letters to Congress about Sallie Mae that have gone unanswered. She has written letters to Congress about the interest rates that have gone unanswered. If the government gave a crap, they'd reduce the interest rate to zero & be more flexible with the payback terms, as well as subcontracting companies that aren't corrupt to service the loans. The sad truth is that they would much rather stay with companies like Sallie Mae, because the majority of people do not, and will not, question the terms of their loans----mainly because they can't figure them out & Sallie Mae (as well as other loan servicers) does not do anything to help them. They know exactly what they're doing. Did you know that 90% of people that get a bill in the mail just pay it without reading it? True fact.

[CHESSIE]

Diane, that is exactly what I said, this congress would never agree to a Medicare for All type of health care. We need a Democrat in the WH and a strong voice of Democrats in the House and Senate. We, also, need to get money out of politics, so that the insurance companies do not "own," congress.

[NurseDiane]

CHESSIE---Your comment made me cheer & laugh at the same time.

Neither Republicans nor Democrats would agree to a single-payer system. They're all in the pockets of big pharma, big medical supply companies, companies that manufacture radiology machines, etc. This whole "Affordable Care Act" was just a way for the government to sign more people up to private insurance companies so they can profit from it. If they make adjustments for more people to qualify for Medicaid, then of course they have to increase the insurance company's profit because it's really the people paying for private insurance that are funding Medicaid. The easiest way to increase the insurance company's profits is to force people to have insurance or fine them on their taxes. FORCE people to buy insurance. FORCE people to pay premiums for plans that are useless & don't pay for anything.

There is something fatally wrong with healthcare because when a medication costs $600 in this country and the same medication can be purchased for $11 from a pharmacy in India. There is something fatally wrong when a person cannot afford to pay for an office visit to see a doctor in this country but can go to another developed country & see a doctor for $10 or $20.

I am not going to get into a political debate, because I don't think there is any fundamental difference in Democrats & Republicans----both are driven by money, both are bought with big campaign donations, both only give a crap about re-election & getting their seat back in the House of Representatives. They're all a lot of talk & no action. They speak a great game when November is approaching, but after they get elected, they do absolutely none of what they spoke about. What we need are term limits----that would ensure that the members of the House of Representatives are not completely bought by big companies. Set term limits for 4 years, and that's it. I was stunned when I read how many Reps were 70 and older!!! Go check it out. What other job would they be working at at 70, 75, 80 years old?

No Congress is going to vote for a one payer system----not in my lifetime, anyway. The influence from insurance companies is too strong in Washington.

"Get money out of politics"----another thing that will NEVER happen.