Nurse Staffing Costs

jadelpn, LPN, EMT-B · Sep 30, 2014

If there are ineffective, inexperienced, and uninvolved nurses who cost the facility $20 bucks an hour, the general theme is that this is a heck of a lot better than effective, experienced and involved nurses who cost $30 an hour. Hence why there's scripting and checkboxes. And oh, yeah, make sure you JUST do enough to not have a readmission within a certain time (no money in that) a pressure ulcer develop (or make sure that you note a bit of redness upon admission--could cover them) or that a patient does not get an infection while they are patients. If they do, then by all means, we can put a spin on that one.

Patients are numbers not people. Smile, be nice, and get them the heck out. Don't forget your meaningful use. And get rid of the COB's--they cost the most money, and are way too invested in the wrong thing.

To this new group make it next to impossible to get a vacation, time off, put down a bunch of mandates. They will feel fortunate that they even have a JOB...so work it. The CEO can not take a month off in February to go to Turks and Caicos otherwise--there's a LOT of "conferences" there apparently.

And please do NOT forget the sparkly stickers. We all endevour to be employee of the week based on the turn around time of admission to discharge with the most monetary value to the facility. AND that means we actually GET lunch that day!!

If you are a consultant and this is not homework, you need to speak to the nurses that any decision would affect. Directly. Be their advocate, as poor patient outcome due to less than stellar, or stellar nurses in impossible ratios will come back and bite the facility. But no matter, as I am sure that top administration has quite the pension to fall back on when the place closes.

Esme12, ASN, BSN, RN · Sep 30, 2014

We don't always recommend cutting costs -- sometimes we recommend raising shift differentials or even base wages to align with market conditions.

In this climate and economy I cannot see how increasing shift differentials or base wages are a primary focus of consultants these days. As an administrator in the recent past nd I nurse for 35 years....cutting costs has ALWAYS been on the table. I have seen many consultants and the phenomenal amount of money spent to get to the the bottom dollar.

Cut costs.

Esme12, ASN, BSN, RN · Sep 30, 2014

Out of curiosity, why arent more ex nurse managers/leaders healthcare consultants?

Because "ex" managers are "ex" because we couldn't cut any further and advocate for safe staffing and patient care...which is NOT the focus of current Senior Administrations. WE grew tired of haring about the salary of nurses and how they "whine"...I mean really "how much do they really do?"

TheCommuter, BSN, RN · Sep 30, 2014

How has your employer dealt with staffing costs? How has it impacted you?

1. The wage grid under which people are hired and paid is not competitive, so our employee turnover rates are high. People don't stick around at $25/hr.

2. Staffing is cut to the bone. Management has been getting away with nurse/patient ratios of 1:9 during all shifts, which causes nurses to bust their butts.

3. PRN employees do not receive holiday pay when scheduled to work on holidays. Therefore, I cannot blame them when they call out on holidays.

4. Some floor nursing positions have been turned into salaried and exempt status, which means no time and a half.

stewstew03 · Sep 30, 2014

Sometimes having a fresh pair of eyes from the outside looking in can be a good thing. They don't have the blinders on, or the hate glazed over them. My dad is an outside consultant. Not like this hack though. The first thing he does when he gets to a new job is sits down with the employees, the grunts. And asks them what would make their job easier/better and how they would do things. He then takes it back to the execs and says this is what we need to do. Might be why he has never had to look for an ounce of work in his life, the companies keep coming to him.

Nice. I'm a "hack" because... why exactly?

stewstew03 · Sep 30, 2014

In this climate and economy I cannot see how increasing shift differentials or base wages are a primary focus of consultants these days. As an administrator in the recent past nd I nurse for 35 years....cutting costs has ALWAYS been on the table. I have seen many consultants and the phenomenal amount of money spent to get to the the bottom dollar.
Cut costs.

What we recommend versus what the CFO / CNO / CHRO decide to implement are not always identical.

stewstew03 · Sep 30, 2014

1. The wage grid under which people are hired and paid is not competitive, so our employee turnover rates are high. People don't stick around at $25/hr.
2. Staffing is cut to the bone. Management has been getting away with nurse/patient ratios of 1:9 during all shifts, which causes nurses to bust their butts.
3. PRN employees do not receive holiday pay when scheduled to work on holidays. Therefore, I cannot blame them when they call out on holidays.
4. Some floor nursing positions have been turned into salaried and exempt status, which means no time and a half.

Appreciate the thoughtful contribution...

Esme12, ASN, BSN, RN · Sep 30, 2014

What we recommend versus what the CFO / CNO / CHRO decide to implement are not always identical.

I agree. It's tough putting a dollar value on good patient care. I had to get out of administration/management. I could not in all good conscience sacrifice patient care for cost saving cuts.

stewstew03 · Sep 30, 2014

Perhaps one measure might be to "consult" with the staff directly involved before paying large sums to an outside entity. Too often cost cutting measures are imposed based on recommendations from those who have no direct connection to the impact of those decisions.

I agree. But what often happens is that the administration will bring in consultants to do the "dirty work" so to speak. Either the administration is unable to implement and effect change, or they want to distance themselves from what must be done to keep the hospital doors open.

stewstew03 · Sep 30, 2014

No antipathy yet. Perhaps you could answer the question instead of dancing around it with half hearted apologies.

I don't have shareholders - and the firm that I work for is a private entity.

stewstew03 · Sep 30, 2014

Perhaps one measure might be to "consult" with the staff directly involved before paying large sums to an outside entity. Too often cost cutting measures are imposed based on recommendations from those who have no direct connection to the impact of those decisions.

Usually the only people we are allowed to meet with when we're on site are the C Suite (usually CFO, CNO, and CHRO) and nurse management.

HouTx, BSN, MSN, EdD · Sep 30, 2014

I think that my fellow AN'ers may be a tad miffed because OP did not fully disclose . . . he gets paid for the information that PPs are providing for free.

I have only seen one consultant/firm that clearly articulated the hidden costs of ratcheting up the workload - which always increases turnover and has a negative impact on clinical quality and safety. Based on the standard estimates of RN replacement costs @ ~ $60k - $80k, this turnover churn eclipses the payroll savings.

If you add in the financial costs of increased patient harm, decreased HCAHPS, increased re-admission rates, etc.... it becomes obvious that the productivity "experts" are only selling short term solutions. But since the C-Suite folks who engaged them will undoubtedly be long gone before all those chickens come home to roost (with their executive bonuses for improving the bottom line) -- it will be the next guy's problem.