Not trying to start anything...but

[DeacJn]

So, here in the northeast we are starting to feel the beginings of layoffs in both hospitals and LTC facilities. Everyone keeps saying the same things "medicare funding is being cut" "hospitals are are inefficient" yadda yadda yadda. But as a second carrer nurse, who worked in administration, personnel management to be specific, of a large not for profit, I was wondering, has the nursing "business" simply outgrown itself?

I mean there seem to be many nurses who are in roles other then direct nurse positions, case managers, discharge planners and on it goes. YES I know its all part of the nursing "process" and please believe me when I say that I am not advocating anybody loose their jobs. But similar to teachers who move up in the Education bureaucracy and do "consultant" work but never teach, why pay them as teachers? And it is at least worth thinking about that as the level of education for nurses has risen, and more and more highly educated nurses try and enter the field, I wonder if the powers that be will simply decide that all the acquired education is not worth paying for.

In speaking with some of my co workers in these types of positions, they see themselves as nurses, fulfilling an essential nurses role. So do I. Problem is I don't think management does. Yet with mandates from medicare, JACHO, DOH and on it goes what else can be done. As the title says I'm not trying to start anything, except perhaps a discussion.

[netglow, ASN, RN]

Ah, but case managers are essential to seeing that the hospital's resources are being used efficiently. They are valuable from a financial aspect for the facility. A case manager is a money person in essence.

I'll add that in the corporate world (which is healthcare now) the closer you are to saving money or better, to bringing it in, the safer your job.

I'll also add that a case manager position is one that would be retained over a staff nurse position. In my area case management especially a sort of newer avenue of outpatient case management for large hospital networks that deals with even more collecting and keeping of corporate cash but from the outside in... is quite the hot ticket in the corporate eye.

[2011NursingStudent]

The economy is still crap. I just heard today something like 700k houses were foreclosed on the last quarter, but 2.1 million should have been foreclosed on, and the banks are not foreclosing just to skew numbers and make things look rosier than they are. So until the economy REALLY improves, nursing will not improve. You can look at small details, but the root of it all is the economy, which was just destroyed by the housing market as a result of bad loans, ARMS, etc and until that problem is fixed, this is not going to go away and no restructuring of nursing will truly fix it.

[realnursealso/LPN, LPN]

No layoffs in this part of the northeast. Lots of jobs in the paper, RN's, LPN's, CNA's. Central New York State here. Almost forgot, even GN's jobs.

[linearthinker, DNP, RN]

I think it is way more complicated than you realize. Every expense in the organization is going to be categorized as either fixed or variable, direct or indirect and budgeted for accordingly. A Case Mangement position is likely going to be classified as fixed, and be less sensitive to volume and gross contribution margins. A staff nurse is ALWAYS going to be classified as variable and direct. This means that the staff nurse positions are always going to be the first to go. Health care is a business, and it is about finance, not patients. It has nothing, nada, zip, to do with trends in nursing. It's the economy stupid. Some may think/wish that were not the case, but it is what it is, and I wouldn't be taking out any new mortgages based on a fairy tale.