Nurse Staffing Costs

[stewstew03]

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?

[stewstew03]

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.

I don't "need information." Perhaps I'm a glutton for punishment, but it is helpful to read the constructive comments that many are posting. I suppose I could have disguised myself and said I was a nurse, or a student, but I didn't. I've been completely honest and transparent.

As an aside - my work focuses solely on compensation (not productivity). And, as I said in a previous post, sometimes the recommendation put forth is to increase the total rewards package for one or more groups. There have also been times (as you alluded to) when we've observed rates that are above market, but don't recommend reducing the rate because any costs recovered would be offset by increased turnover and poor employee engagement (and ultimately causing patient care to suffer).

[Esme12, ASN, BSN, RN]

You have a tough job in many respects. I don't think I could do it and I was a trauma fight/emergency department and critical care nurse for 35 years. I'm pretty tough.

Many nurses are feeling the crunch...Pay cuts...hours cut...increasing co pays/contribution. They are expected to more with less. They are constantly berated by administration for OT when they are working 2 RN's short and an CNA was pulled. We are tired and frustrated....and it is getting worse. Sad really

[emtb2rn, BSN, RN, EMT-B]

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

Because many if us have had painful experiences with consultants coming in and essentially recommending that staff "work smarter, not harder" and "do more with less" and "optimize your resources to leverage their synergy to be more customer centric while conserving costs".

The consulting issue is certainly not unique to healthcare. And my experience with consultants is they are hacks until proven otherwise.

[Been there,done that, ASN, RN]

I am not a "staffing cost" Nurses are the reason hospitals exist.

If a patient needed to be examined by a physician.... they would go to the physician's office.

If a patient needed medication..... they would go to the pharmacy.

If a patient needed lab work.... they would go to the lab.

Patients go to the hospital for NURSING care.

[imintrouble, BSN, RN]

Does the consulting firm ever suggest the "C suite" take a cut?

Does it ever suggest cutting nursing management?

Or are the cuts all at the bottom?

I'm just curious.

[imintrouble, BSN, RN]

On a previous thread the OP asked about nurses being placed on call, and how often they were called in.

I think as one AN poster suggested, we are doing the OPs job by telling him what cuts our facilities are implementing.

[brandy1017, ASN, RN]

They raised staffing ratios for nurses and aides. Cut the amount of HUCS and made them HUC/CNA's. Cut the bonus for coming in extra when they are short. Cut the pension, stopped giving any contribution to the 403b. Cut our health insurance, increasing out of pockets to thousands of dollars and added penalties for spouses, smoking and not being part of their wellness crap! Took away our sick pay and holiday pay and changed to PTO which ends up being a lot less time off than before, and made it more difficult to take a vacation because you have to have PTO in your bank months before your vacation. Cut the STD, LTD to 60% base pay and cut charge pay. Cut tuition reimbursement and added a restriction if you have a written warning in your file and then people were written up for little things like missing one of many education requirements. Cut the weekend program, but grandfathered in prior employees.

The changes lower morale, leave many employees in debt if they have a health problem. Lots of turnover esp the new grads they hire who see the reality of hospital nursing and go back to school stat to get away from the bedside and be an NP! The older employees are holding out for retirement, even as benefits and working conditions worsen. The lucky ones can afford to retire early! Of course the CEO makes millions and his pay couldn't be better!

I personally think all these cuts came from HR in order for someone there to get his/her bonus!

[dudette10, MSN, RN]

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.

As a consultant who has been hired for expertise, your argument should be that you must talk with the frontline who is better able to identify waste and inefficiency.

I want you to do something. Sit back and imagine that you're sick in the hospital. Your doctor rounds on you for five minutes a day. All 24/7 monitoring of your condition is done by a nurse. Essentially, the doc's picture of your status is retrograde. What happens in the future 24 hours--until the doc rounds again--is dependent on the skill and workload of the nurse, and what he/she tells the doc.

Do you want the nurse who is over ratio? Do you want the nurse who should be on a much-needed vacation, but that vacation was denied? Do you want the nurse who is sick, but who was threatened with a write up because of short staffing that administration has known about for that shift for a month?

I think not. You want the nurse at the top of her game.

In a former life, I was a marketing manager. My mantra was, "All work is a process." I concentrated on process improvement. What this involved was mapping current processes that were troublesome as identified by the frontline responsible for them, pinpointing inefficiencies, and smoothing out the process. End result:better outcomes, happier frontlines.

People don't need to be streamlined; processes do. Food for thought.

[dudette10, MSN, RN]

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.

Thanks for being transparent about the truth. Execs are paid big bucks to be ineffective or cowards.

[dudette10, MSN, RN]

I don't "need information." Perhaps I'm a glutton for punishment, but it is helpful to read the constructive comments that many are posting. I suppose I could have disguised myself and said I was a nurse, or a student, but I didn't. I've been completely honest and transparent.

As an aside - my work focuses solely on compensation (not productivity). And, as I said in a previous post, sometimes the recommendation put forth is to increase the total rewards package for one or more groups. There have also been times (as you alluded to) when we've observed rates that are above market, but don't recommend reducing the rate because any costs recovered would be offset by increased turnover and poor employee engagement (and ultimately causing patient care to suffer).

How can consultant work focus only on compensation, but not productivity? The two don't live in independently of each other!!

[RNsRWe, ASN, RN]

Thanks RNsRWe -- just curious... the hospital that cut staff - they didn't consider other alternatives first? Other options might include -- reduce premium pay rates, reduce on-call utilization, etc.

I can't be sure what they ACTUALLY did, as I was not high enough up the food chain to be 'in the know'. They usually just TOLD us what they did (whether or not it was done).

I frequently worked shortstaffed, being told it was So and So's fault because she called out sick. And that the Staffing supervisior had called everyone and their cousin in an effort to replace the sick nurse, but no one (NO ONE) was available. Only to find out that not only was it not true that "everyone" was called, the very people who worked our UNIT were not called to cover! In other words, if a nurse was out sick, they had no intention of getting a replacement and paying not only the sick nurse's sick day pay but also someone else to cover---and potentially at a premium rate.

So, the answer quite simply was to always work short whenever there was a callout, OR every time someone was on vacation OR it was a holiday and the per-diem assigned bagged it.

The story given to the masses was that the shortage of staff was OUR faults, not the Staffing office. After all, if people take their holidays, and vacation time and (gasp!!) use a sick day, the rest of us should just expect to work with that many less people.

Ridiculous. And there ARE those who will vote with their feet

[dudette10, MSN, RN]

Oh, yes. ^^^

Staffing offices are known for not doing a darn thing about understaffing, no matter how far in advance they are aware of it. A unit I work on was staffed three short a month in advance. Guess what? The unit worked three short that day.