I was just reading the discussion about why nurses 'allow' poor staffing ratios, and a post by Angie took my breath away with the possibilities.
There is only one real reason that nurses don't have appropriate staffing.
It's because we do not own the hospitals.
We are just employees, and nowhere in the business world do employees have any say over employment. Nowhere.
So the answer is, when nurses own the hospitals, then they will have the right to have a say in staffing.
Of course on that day, Hell will simultaneously freeze over and flying pigs will be seen cavorting in the clouds.
Now THERE'S an idea that fires the imagination! A nurse-owned hospital! I'm not so sure it wouldn't work because of the nursing expense. I hear about obscene hospital profits on this board all the time. I really wonder if such a thing could work!
I know there are probably many reasons it couldn't work, but that was true for a lot of impossible things (like the millions of transistors on a computer chip for instance, or even the electric light bulb for that matter).
Just for the sake of excitement though, let's just brainstorm this a little. Post your reasons why a say... non-profit or even for-profit hospital run by nurses couldn't succeed wildly! Remember, the administrators would be compensated in a non-profit hospital. I know that there would be no stock-holder cash pools in a non-profit hospital, but consider this: When I taught high school math, I didn't know a single teacher who would have taken a raise over a smaller teacher-to-student ratio. I would have given up a decent chunk of change for the opportunity to actually teach.
Also, when the real pros take over things, money and creativity can be found and saved in the most startlingly creative ways (does anyone remember the movie 9 to 5?)
It's probably just a dream, but I see the energy and power and intelligence in this forum and I dream that anything is possible. I mean, look, everyone who dedicates themselves to this demanding profession deserves great compensation, but what if you could have true job-satisfaction and a decent quality of life and you had to give up some (not all) of the bucks to do it? No contest? And I still don't really understand why anyone would have to give up bucks anyway. They're available in the profits we all hear about.
Finally, any real competition for patients would be no biggie since a nurse-run facility would have patients banging down the door to get in (even the well-off folks).
I guess in my vision, as crazy as it may sound, the hospital would be so democratic that all of the nurse owners would also be the front line employees as well - perhaps in some kind of rotating fashion where 1 week out of every month nurses would be assigned administrative duties instead of nursing duties. I know that really sounds lofty, but I would not want anyone in an exclusively administrator role because in my opinion, they would eventually yield to the almighty $ as the primary focus.
Perhaps you could vote for admins once a year. Give them their normal pay while they are in the job and then a reasonable bonus at the end of their admin. service? And term limits, once in every 5 years or so? Might run into problems w/ finding qualified nurses, but then if each was trained to do the job by the out going it might work. Only prob. I see is if nurses trained in admin. apply elsewhere for bigger pay and perks.
Administration is a separate, discrete skill. Assigning random clinical nurses to administrative duties one week a month would be a disaster, as such nurses would be unable to deal with the budgeting, legal, and bureaucratic requirements of administration.
An administrator's job is to make those things work in her charge. That's a necessary specialization. Thinking that anyone can do an administrative job is no more reasonable than to think that we could all rotate into a CRNA position one week a month.
Using Tenet is a bad example, they are one of the biggest hospital groups in the USA with hundreds of institutions. When the business gets that big and goes public, there's zero chance they're going to let a nurse run it unless they have successfully run lots of other very large scale businesses in the past. Thats why CEOs dominate these chains, even doctors generally speaking dont run these large systems.
The big question here is how are you going to raise money? Hospitals cost tens of MILLIONS, even for small rural hospitals. How are you going to raise that cash? No venture capital firm is going to float you unless you have a proven CEO that they trust with maximizing their return on investment, a nurse doesnt really qualify.
Its also highly doubtful that nurses themselves could raise the money. Nurses average about 60k per year, it would take many thousands of nurses to raise the tens of millions necessary to start the hospital.
Then there's public funding. But public funding wont come unless you give control over to a public authority, they're not going to let a bunch of private nurses run the show with tens of millions in taxpayer dollars. So that defeats the whole purpose of having a nurse-run hospital to begin with.
You cant rotate management on a month to month or even year to year basis. The risk of opening such a venture is enormous. Are you guys willing to put up your houses and cars for collateral? The vast majority of nurses wold say flat out NO to that.
The days of doctors, nurses, or any healthcare personnel running hospitals is coming to a close. There are of course exceptions but the vast majority of hospitals are run by CEOs with a board of directors constituted mainly of people with a business background.
The days of doctors, nurses, or any healthcare personnel running hospitals is coming to a close. There are of course exceptions but the vast majority of hospitals are run by CEOs with a board of directors constituted mainly of people with a business background.
I have to question whether people with a business background have any real business running hospitals - or healthcare, for that matter.
Nurses' bottom line is the patient; business's bottom line is money.
As a patient, which would you rather have taking care of you? Someone who's going to deny treatments that you need or make them too costly for you to get, or someone who's going to go to bat for you and keep you as well as possible?
Using Tenet is a bad example, they are one of the biggest hospital groups in the USA with hundreds of institutions. When the business gets that big and goes public, there's zero chance they're going to let a nurse run it unless they have successfully run lots of other very large scale businesses in the past. Thats why CEOs dominate these chains, even doctors generally speaking dont run these large systems.
The big question here is how are you going to raise money? Hospitals cost tens of MILLIONS, even for small rural hospitals. How are you going to raise that cash? No venture capital firm is going to float you unless you have a proven CEO that they trust with maximizing their return on investment, a nurse doesnt really qualify.
Its also highly doubtful that nurses themselves could raise the money. Nurses average about 60k per year, it would take many thousands of nurses to raise the tens of millions necessary to start the hospital.
Then there's public funding. But public funding wont come unless you give control over to a public authority, they're not going to let a bunch of private nurses run the show with tens of millions in taxpayer dollars. So that defeats the whole purpose of having a nurse-run hospital to begin with.
You cant rotate management on a month to month or even year to year basis. The risk of opening such a venture is enormous. Are you guys willing to put up your houses and cars for collateral? The vast majority of nurses wold say flat out NO to that.
The days of doctors, nurses, or any healthcare personnel running hospitals is coming to a close. There are of course exceptions but the vast majority of hospitals are run by CEOs with a board of directors constituted mainly of people with a business background.
I think that a more realistic solution is for nurses to become Independant Contractors and/or form Professional Practice Groups, like physicians do.
Develop a contract that spells out pay, benefits, working conditions, like staffing ratios, floating policy,etc. the group would retain a corporate attorney to "fight its' battles" with the hospital administration, etc. Just like physicians do.
I feel that this is a more workable solution to nurses' eternal "enslavement" to hospitals and nursing homes. Nurses just don't have the financial resources to buy and build a hospital. And, in my in-your face, NY $0.02, doctors work very hard to keep it that way. So do hospital, and nursing homes. That partially explains nurses' high school dropout wages. Even in the face of the so- called "nursing shortage".
Administration is a separate, discrete skill. Assigning random clinical nurses to administrative duties one week a month would be a disaster, as such nurses would be unable to deal with the budgeting, legal, and bureaucratic requirements of administration.
An administrator's job is to make those things work in her charge. That's a necessary specialization. Thinking that anyone can do an administrative job is no more reasonable than to think that we could all rotate into a CRNA position one week a month.
I think that a more realistic solution is for nurses to become Independant Contractors and/or form Professional Practice Groups, like physicians do.
Develop a contract that spells out pay, benefits, working conditions, like staffing ratios, floating policy,etc. the group would retain a corporate attorney to "fight its' battles" with the hospital administration, etc. Just like physicians do.
I feel that this is a more workable solution to nurses' eternal "enslavement" to hospitals and nursing homes. Nurses just don't have the financial resources to buy and build a hospital. And, in my in-your face, NY $0.02, doctors work very hard to keep it that way. So do hospital, and nursing homes. That partially explains nurses' high school dropout wages. Even in the face of the so- called "nursing shortage".
Lindarn, RN, BSN, CCRN
Spokane, Washington
Two excellent posts.
A hospital administrator can have a background in nursing, medicine, business or basketweaving ... the bottom line is that he/she has to manage the institution and that includes controlling costs. No matter who runs this hypothetical hospital, the facility still has to operate in the larger health care environment, which doesn't change just because you change management.
I'm not knocking the idea, not at all ... and in hospitals where I have worked or had other exposure, several executives at the vice-president level and higher have been nurses. But when you're a VP, you're a VP, you're not functioning as a nurse.
Let's consider the larger environment. Payment for services rendered often significantly lags behind true costs. The cost of health care services is beyond the financial means of most people, thus we have developed the current impossibly convoluted system of insurance products and government assistance, which are industries in and of themselves.
I agree with LindaRN -- the only way for nurses to have a seat at the table is to deal with hospitals and other facilities as a group.
I don't see why not. The CEO's of our local hospitals (non-profit) have a salary of over 500,000/year. Nurses run them anyway and they pay less than $30/hr. Even the ones that have been there for years. I think that is a crock.
You guys get less than 30 an hour, I feel sorry for you there.
In regard to group bargaining for nurses, how would that work? Would such groups be organized by county? state? facility? nation-wide? speciality? Could nurses choose not to join? How about foreign nurses working in the states? I'm having a harder envisioning how that concept would work versus a nurse-owned hospital.
The biggest difference I see between MD groups and nurse groups is the sheer number of nurses (at least in hospitals and LTC) needed. This is very different from the need for MDs.
I think that a more realistic solution is for nurses to become Independant Contractors and/or form Professional Practice Groups, like physicians do.
Develop a contract that spells out pay, benefits, working conditions, like staffing ratios, floating policy,etc. the group would retain a corporate attorney to "fight its' battles" with the hospital administration, etc. Just like physicians do.
I feel that this is a more workable solution to nurses' eternal "enslavement" to hospitals and nursing homes. Nurses just don't have the financial resources to buy and build a hospital. And, in my in-your face, NY $0.02, doctors work very hard to keep it that way. So do hospital, and nursing homes. That partially explains nurses' high school dropout wages. Even in the face of the so- called "nursing shortage".
Lindarn, RN, BSN, CCRN
Spokane, Washington
Lindarn, I love this idea. It gives nurses the unity of a union w/o the huge numbers that are not necessarily responsive to the personal preferences of some members and also w/o paying dues that may be used in ways that not all members agree w/. How does one start this? Hosps. have no interest in hiring groups like this so we would not only have to organize it but also sell it to health care facilities. I would think any nurse currently working for a hosp. would find her/his job in jeopardy if s/he tried to organize such a group. Can you give us some more info on how this could be done?
Specializes in Jack of all trades, and still learning.
I think that a more realistic solution is for nurses to become Independant Contractors and/or form Professional Practice Groups, like physicians do.
I don't know that contracts are a good idea, as nurses already aren't recognised for our role in the system. I don't think we have the power to bargain, as say, consultants do. I'm sure the hospitals think nurses are expendable, even if they are screaming out for more of us
I think that a more realistic solution is for nurses to become Independant Contractors and/or form Professional Practice Groups, like physicians do.
thats all fine and good, but thats got nothing to do with owning/running a hospital.
Develop a contract that spells out pay, benefits, working conditions, like staffing ratios, floating policy,etc. the group would retain a corporate attorney to "fight its' battles" with the hospital administration, etc. Just like physicians do.
Forget that and just start up a union.
I feel that this is a more workable solution to nurses' eternal "enslavement" to hospitals and nursing homes. Nurses just don't have the financial resources to buy and build a hospital. And, in my in-your face, NY $0.02, doctors work very hard to keep it that way. So do hospital, and nursing homes. That partially explains nurses' high school dropout wages. Even in the face of the so- called "nursing shortage".
So you think there is an organized conspiracy by doctors to keep nurses wages suppressed? Since when do doctors dictate nursing salaries? Those come down from upper management, and upper management is dominated by CEOs and business types, not doctors.
Nurses have one HUGE advantage over doctors: they can unionize. Its absolutely illegal for doctors to unionize at all. The SEIU (hospital workers union) is dominated by nurses. I'd suggest you think about starting up a local chapter.
Nurses have one HUGE advantage over doctors: they can unionize. Its absolutely illegal for doctors to unionize at all. The SEIU (hospital workers union) is dominated by nurses. I'd suggest you think about starting up a local chapter.
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James Huffman
473 Posts