Published Aug 26, 2001
Low morale, budget cuts hit nursing profession hard
By Kelly Yamanouchi Medill News Service
Posted on August 26, 2001
Nursing has a morale problem.
Debra Pilgrom, a nurse for 21 years who works for Melmedica Children's Healthcare, says what she and many nurses want is enough time with each patient to fulfill all their health needs. But in the throes of budget cuts and a shortage of nurses in acute care at hospitals, that can be difficult to get.
At a hospital, Pilgrom said, "you're overloaded, you're following up behind people. Every day more and more people are added to your workload. At the end of the day, you realize all the things you haven't gotten done, and you feel bad, but you're only one person, so what can you do?"
The pressure has left many nurses unhappy, feeling overloaded by paperwork and left with little time at the bedside with patients. Eventually, some nurses move out of hospitals, where they are needed most, or out of nursing altogether for other jobs, draining the nursing profession even more.
Of those who continue to practice nursing, many are like Pilgrom, who decided to leave hospital work. She moved to home care for more flexible hours. Melmedica in Schaumburg has 500 nurses like her in the Chicago area providing pediatric home health care
In a 2001 American Nurses Association survey, 75 percent of nurses said they think that deteriorating working conditions have led to a decline in the quality of nursing care at their facilities over the past two years. More than 54 percent of nurses surveyed by ANA said they would not recommend nursing to their children or friends.
"Morale has decreased over the last five years dramatically," said Nancy Shepherd, a nurse for 25 years who works in the emergency room at Provena St. Joseph Hospital in Joliet. "A lot of the decrease is because of the working conditions and the expectations we cannot meet."
"The pressure is on hospitals to decrease costs," said Susan Macfarlane, director of human resources at Lake Forest Hospital. With nursing often making up the largest budgetary expense, it's a likely area to face cuts.
Hospitals put much of the blame on the Balanced Budget Act of 1997, which called for $115 billion in cuts by 2003 from Medicare, the federal health program for the elderly. Hospitals say the actual cuts could amount to even more.
The implications have caused enough concern that nurses are supporting legislation to alleviate the problem.
There are 136,000 nurses in Illinois, and about 6,100 are unionized under the Illinois Nurses Association, which is supporting a bill passed by the state House of Representatives aimed at improving working conditions in hospitals. The legislation, similar to bills introduced in other states, would require better assessment of how many patients hospitals can handle and prohibit mandatory overtime, according to Carol Jenkins, INA's interim executive director.
Pam Robbins, chair of the INA's economic and general welfare commission, says low morale in nursing is a deterrent to students considering future careers.
"When they listen to what's going on in the workplace, right now they're told it's really hard work. I don't get any lunch, I don't get any break," Robbins said.
No improvement is in sight. Enrollment in nursing degree programs has declined for the past five years, said Elizabeth Ritt, dean of the College of Professional Education and Continuing Studies and a professor of nursing at North Park University in Chicago.
That could mean even more nursing positions left open in years to come. Already, there are 126,000 open positions for registered nurses at hospitals nationwide, according to an American Hospital Association survey.
"I just don't think nurses are recognized for their contribution to health care as much as they should be, and it's frustrating," said Connie Schulz, who conducted a survey of nurses in Chicago who have changed jobs for a North Park University dissertation on nurse job satisfaction.
Nearly 20 percent of licensed registered nurses are not working in nursing, according to a survey by the federal Health Resources and Services Administration.
The nurse shortage has been the focus of discussions in Congress, where legislation has been introduced to fund nurse scholarships and support nursing education.
Karen Gunter, Melmedica's president, said her nursing staff is growing, but it's still not enough.
"Nurses are working a lot of hours, maybe time that they could be spending with their families. From a morale point of view, that's probably one of the biggest issues facing nurses," Gunter said. "Nursing has always gone through peaks and valleys, and this one just didn't go away."
Low prestige of the profession contributes to the exodus of nurses, and is a problem that isn't easily solved, even if hospitals are fully staffed.
For Pilgrom, a plus is that she feels "very important" to the patient in home care. "At the hospital, you're talked down to, you don't get the respect," she said. "Your position isn't as important as far as the doctor is concerned."
Visiting patients at home, however, "you have time to do the little things - holding a child's hand, singing a silly song. Little things that make a child's life right - you don't have time for that in a hospital," Pilgrom said.
While many nurses say patients seem to appreciate their work, "nurses are not looked on as professionally as they should be by doctors," said Deanna Kusmerz, another nurse at Melmedica. "I don't understand it."
To be sure, some say there are hospitals that have worked hard to keep nurse staffing levels up and to provide good working conditions. Some of the efforts to mitigate the problem show up in help wanted advertisements.
"You see enormous sign-on bonuses of five and 10 thousand dollars," Gunter said. In fact, the high demand has helped some nurses control their working conditions better, such as nurses who refuse to drive farther than a few miles to home care jobs.
At Lake Forest Hospital, for one, nurses say they aren't affected by shortages.
"Lake Forest has it pretty good. I think we're pretty well staffed" because the hospital keeps a low patient-to-nurse ratio, said acute care nurse Jan Kelley. "It's a good place to work; the people here are very caring."
The other side of the argument from the Hospitals, thought I would post these together:
What's ailing hospitals?
Price increases are blamed on spiraling wages
By KEVIN O'CONNOR Staff Writer
People think competition usually leads to price cuts. So why will Vermont's 14 hospitals ask the state this week for rate hikes as high as 12 percent?
"You ask any hospital CEO what's driving increases and they'll say labor costs," says Thomas Huebner, president of Rutland Regional Medical Center.
Huebner's hospital employs 300 registered nurses who each earn between $15.75 and $24.22 an hour. But a shortage of such professionals has led other health-care employers to lure away workers with higher wages.
Central Vermont Medical Center in Berlin, for example, pays nurses between $17.52 and $27.51 an hour. Fletcher Allen Health Care in Burlington pays between $19 and $23.75 an hour.
Every hospital in Vermont will ask the state this week to approve price hikes to pay for rising salaries and a variety of other plans to retain professionals and stay competitive with patients.
Consumers may wonder why someone doesn't cap such spending and stop the financial leapfrogging.
"We're not only competing within the state," Huebner replies. "It's a regional and national marketplace."
Take Dartmouth-Hitchcock Medical Center on the border of neighboring New Hampshire. It's paying nurses as much as $29.73 an hour-more than $2 an hour more than the highest comparable salary in Vermont.
"Salaries are going up because the marketplace for salaries is going up," Huebner says. "We have to work hard to keep up."
Local hospital leaders are expected to tell many more such stories when they reveal their fiscal 2002 budget plans at state hearings this Tuesday, Wednesday and Thursday in Montpelier.
Each of the state's 14 hospitals is proposing a price hike for the fiscal year starting Oct. 1 ranging from 2.5 percent for Fletcher Allen to 12 percent for North Country Hospital in Newport.
The state's 10-citizen Public Oversight Commission will voice its recommendations about the rate hikes this week and the Department of Banking, Insurance, Securities and Health Care Administration will issue a final decision by the end of September.
But local hospital leaders already are taking the offensive, hoping to convince government and the general public of the need to increase their budgets a collective 12 percent and health care salaries an average of 7.3 percent.
Huebner, for example, is polishing an hour-long slide presentation that shows hospitals in a seemingly never-ending race to keep professionals through higher wages.
A hospital pharmacist earns between $25.28 and $36.75 an hour in Rutland. But that same person can make between $27.11 and $40.67 an hour at Fletcher Allen.
"Our salaries are going up dramatically because we need to stay competitive in the marketplace," Huebner says. "Our employees deserve to get paid what everyone else gets paid, but we need to raise our prices to do it."
Central Vermont conducted a market survey this spring that showed 500 of its 800 full- and part-time positions paid less than comparable posts at surrounding hospitals.
The Berlin hospital therefore has increased salaries this year anywhere between 3.5 and 15 percent, with a few employees receiving raises of up to 30 percent. It plans another wage hike averaging up to 3 percent this fall.
"Some positions we're seeing almost quarterly bidding wars," says Stephen Moss, Central Vermont's vice president of finance. "Even at the entry level we're having to make adjustments to keep stock clerks and housekeeping because McDonald's was bidding up all the time."
Hospitals ironically also face the same problem plaguing other employers: Skyrocketing health insurance costs.
Rutland, for example, last year budgeted a 15 percent hike in health insurance costs for its 1,300 full- and part-time workers, only to see the actual bill rise 45 percent. The hospital projected a similar jump this coming year, but through coverage changes will keep the increase to a still high 25 percent.
Such problems are echoed statewide.
"The bulk of our budget increase is based on salary increases and group health insurance," says Kim Nichols, spokeswoman of the almost 500-employee Springfield Hospital.
Brattleboro Memorial Hospital, like other Vermont counterparts, also is paying more to find out-of-state nurses and technical staff for positions that can't be filled locally.
"The budgets will need to increase this year, in part, because of the cost of fringe benefits, the spiraling costs of utilities and the necessity of contracting outside services for temporary employees," Brattleboro Memorial President Brian Mitteer says.
(Nichols adds in Springfield: "The shortage isn't just nursing, it's lab services, X-ray services. Can you encourage people to go into these fields?")
The state will open its hospital budget hearings with a public overview Tuesday from 9 to 11 a.m. at the Capitol Plaza hotel in Montpelier.
Fletcher Allen, the state's largest and only teaching hospital, will talk about not only salaries, but also rising demand for services.
"We're in a slightly different situation because of the type of institution we are-people with acute illness and trauma get referred here, and there's been growth in our referrals from both Vermont and New York," Fletcher Allen spokesman Michael Noble says.
"The population over (age) 50 is a huge factor in this. That group of people accounts for the largest number of patients seen. As that group grows, we're going to see more patients."
Reviewers with the state Division of Health Care Administration are expected to voice concern about rising numbers of hospital visits, services and revenue. Hospital leaders, for their part, will counter that less money coming in means higher bills going out.
"If you don't have growth going on," Huebner says, "you have to have a larger rate increase."
Contact Kevin O'Connor at [email protected].
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