Nurse Staffing Costs

Nurses Professionalism

Published

When hospitals look to cut costs -- as many of them have in the last decade -- nurses are the hardest hit. How has your employer dealt with staffing costs? How has it impacted you?

Well my employer dealt with it by finding excuses for firing older nurses that have cancer and then denying them Cobra or Health insurance. At least me anyway. Maybe I sound just a bit bitter, however I noticed an overwhelming trend to hire large numbers of foriegn nurses who barely spoke English and who I found out were being held hostage by the visas held by the hospital to working at least the visa period for riduculously low hourly salaries and no overtime. This is a "Right to Work State run by the GOP and there is Irony in that because it basically means that you have no voice and they have all the power to give or remove your job. I have given back my license while I fight my cancer mainly because I value my integrity and what the license represents to me. Maybe I am too old fashion for this new type of nursing. It is disheartening to see it turned into a for profit at any cost Public relations charade.

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Specializes in Geriatrics, Dialysis.

If you are truly interested in a nurses perspective financially I am sure it's been pretty well covered...but here's my $.02 anyway:

1) Pay your nurses a truly competitive wage/benefits package. Working short staffed and/or being mandated sucks, it sucks even more at lousy pay.

2) Follow up to point 1.. if we were better paid, maybe we wouldn't bail so fast! Nurses are quitting in bunches to go to facilities that pay better, leaving us seriously understaffed. A big chunk of budget waste is unscheduled overtime paid out as mandatory overtime just to have enough staff in the building.

3) Cut costs at a middle management level. Do we really need so many nurses overseeing paperwork? I work in a SNF with 6-7 non bedside nurses [one is a part time position] and 4 bedside nurses. This is in my opinion ridiculous!

4) while we are living in the fantasy world of cutting costs by reining in management salaries...how about that bonus that equals or in some cases exceeds base salary? I have seen a former administrators year end pay stub...the bonus was obscene! And you wonder why nurses that haven't had a raise in years are mad?

5) Cut even more at the top! I don't know, nor do I want to know what corporate management makes a year. That knowledge would just tick me off too much!

6) Last but not least...have a little common sense and utilize some of the suggestions received from the staff that is most impacted by cost cutting decisions. Save some money by figuring it out instead of wasting more money hiring somebody like you to figure it out for them!

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Specializes in ob, med surg.

Re: gswifty

Can be? Used to be! I used to love it here! But over the years, I have seen this site go from being a helpful friendly place, where people used to freely share knowledge and help. But I've often seen posters get personally attacked like this poster. And yes I've seen it in other fourms, for instance, new nurses asking for guidance from us experienced nurses, and being knocked about, demeaned and then being told to 'Suck it up! Don't you know that we eat our young?'

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If you are truly interested in a nurses perspective financially I am sure it's been pretty well covered...but here's my $.02 anyway:

1) Pay your nurses a truly competitive wage/benefits package. Working short staffed and/or being mandated sucks, it sucks even more at lousy pay.

2) Follow up to point 1.. if we were better paid, maybe we wouldn't bail so fast! Nurses are quitting in bunches to go to facilities that pay better, leaving us seriously understaffed. A big chunk of budget waste is unscheduled overtime paid out as mandatory overtime just to have enough staff in the building.

3) Cut costs at a middle management level. Do we really need so many nurses overseeing paperwork? I work in a SNF with 6-7 non bedside nurses [one is a part time position] and 4 bedside nurses. This is in my opinion ridiculous!

4) while we are living in the fantasy world of cutting costs by reining in management salaries...how about that bonus that equals or in some cases exceeds base salary? I have seen a former administrators year end pay stub...the bonus was obscene! And you wonder why nurses that haven't had a raise in years are mad?

5) Cut even more at the top! I don't know, nor do I want to know what corporate management makes a year. That knowledge would just tick me off too much!

6) Last but not least...have a little common sense and utilize some of the suggestions received from the staff that is most impacted by cost cutting decisions. Save some money by figuring it out instead of wasting more money hiring somebody like you to figure it out for them!

Good comments (excluding the jabs against me)

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I did not find the question of the OP offensive, nor do I find it offensive that he would like comments from nurses to add to his perspective. I do, however, understand why nurses have a distaste for consultants in general. Let me tell you about some of my experience with healthcare consultants, it may bring some understanding of the gut reaction of contempt the OP endured.

My hospital employs Studer Group. I hate their whole "scripting care" approach. It sounds fake and people see right though it. I believe my patients appreciate my genuine care and concern over any recitation of pre-scripted flowery language. Also, the care I provide is complex, I am not working at a call center. I can figure out how to talk to people on my own (thank you very much), so for all the $ the hospital has paid, forget it, in one ear and out the other. Find a robot if you want a script recited. Studer's focus, as far as it impacts my bedside care, is on touting things like patient rounding and bedside report. Both of these are great things and I can see how they contribute to better patient care.

However, I am asked to perform bedside report on 5 patients during the 30 minutes our shifts overlap and following the shift huddle which automatically reduces that 30 minutes to 20 or 25. (We get a lot of pressure to get out on time and reduce incidental overtime). Giving a thorough nurse report (which includes medical jargon and explanation of working differential diagnosis that may not be appropriate to report to the patient yet) has been replaced by a 5 minute smiley, social, introduction time. Not that this doesn't have value, it's just that it's probably more important to take the time to I tell the next nurse the details of why the patients here, their condition and what's been done, etc. Patient's need to be informed of their plan of care but ensuring that this happens at shift change is an inconvenient time for this. It goes more smoothly if you've had time to fill the patient in on the POC and educate them on their condition before shift change, but there isn't always time for this during the shift.

The hospital, which is experiencing financial struggles just short of a crisis, also thought spending money on tablets for use during rounding was an appropriate allocation of funds. (Mind boggling, I know). I think a better solution to making sure patient's are aware of the POC would be to make sure their nurse is available during the shift for explanation and education which would require adequate staffing. (More time and money should be allocated to patient education in general, but as this is poorly reimbursed it often gets left to the wayside, a topic for another thread.) Also, the whole "hourly rounding" and "safety rounds" thing is just common sense and something we called "checking on your patients" before a consultant group gave it a fancy name. It's part of good nursing care. This of course is something that adequate staffing permits nurses to have the time to do.

And while we're on the topic of nurse time I have another example in mind. I have been a nurse for over 10 years, have done travel nursing and seen many different hospital systems. When I started at my current hospital their transport team did not bring a wheelchair or assist patients (even completely mobile ones) into it. I was shocked. You expect a nurse or tech to spend time tracking down wheelchairs to get patients to tests? Yup. I did a few patient safety reports for delay of care due to my frustration with this process (you could never find one, in part due to hoarding since you had to track them down). Not sure if anyone listened/cared, but fast forward 2 years later our shiny new "patient experience consultant" implemented a process where the transporters bring a wheelchair and are being trained to assist patients into it. It's unfortunate that they have to pay a consultant to solve a process issue that was identified and could have been addressed by listening to a nurse working in a direct care position.

Which brings my commentary full circle here; I think many nurses frustration with consultants/management/leadership is that they are paid, sometimes better than the direct care staff, to make decisions and implement processes that impact their workflow and practice while simultaneously disregarding suggestions and input from them. Many issues consultants identify could be solved by common sense and adequate staffing, thorough training, and employee engagement. When institutions invest in consultants while failing to invest in their employees the institution, the staff, and ultimately the patients lose. Not that consultants are worthless, organizations just need keep their focus on direct care staff as well.

I'm sure what the OP is experiencing is a reflection of the nurse perception that the nurse doesn't have the ability to recognize what they need to efficiently do their job and therefore a shiny new consultant must be retained to figure this problem out. It's part of a larger problem where nurses feel disrespected and undervalued by hospitals while providing services critical to the continued function of said hospital. The cuts the OP is wondering about are often part of the problem- we are tired of being the constant source of a place to make cuts in general. We work hard and wish we were valued and our opinion and input respected (and I mean, like, for real, not just lip service). Bedside nurses have knowledge of patient needs that no administrator, consultant, or even physician can fully appreciate, yet our input is often ignored, or perfunctorily requested and then promptly disregarded.

The emotions on this thread are part of a larger issue in nursing that is not new. Nurses need a voice, to be part of the process. But we have been let down and left out of many of the changes hospitals choose to make. We need safe and adequate staffing levels, time for our breaks (not just a threat of take lunch or be written up), and to be empowered to advocate for our patients' needs. We also need fair pay and nurse retention. The business model of healthcare does not value nurses, it just views them as a cost to be "cut".

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Re: Goldenhare

I do know nurses have a notorious reputation for 'eating their young'. I like to think of it as trial by fire. I'm sorry for your frustration with the discourse on this site, but i honestly didn't read any personal attacks being made against this consultant that were so egregious to be considered demeaning. This is a very emotional topic that has effected a great many of us over the past 10 years as we try to do the best job we can in what often can be a hostile and contentious environment or certainly 'challenging', if you prefer that. Maybe if we were exchanging recipes the topic would be more to your liking? Please consider the content and context.

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I believe the moderator edited or deleted some posts so we aren't getting the full picture of the assault on the consultant ;)>

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I know who you are.

This is very creepy... are you stalking me?

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Specializes in OR, public health, dialysis, geriatrics.

Wage freezes, elmination of all but pm shift differentials, new employee wage grids lowered, no education benefits, the "revamping" of the clinical ladder has been "happening" for 4 years, on-call pay decreased, and the employee discount in cafeteria eliminated.

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Specializes in Nephrology, Cardiology, ER, ICU.

This thread has deteriorated to the point of no return.....

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