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?

Specializes in Med/Surg, Academics.
Acute care hospitals are available for people who need inpatient nursing care. They, by and large, pay their nonnursing administrators very handsomely. When they need to cut costs the FIRST place they look is on the side of care delivery and that directly affects nursing and the very reasons that people come to the hospital in the first place. It does and will continue to adversely affect outcomes. Sometimes the remaining nurses can minimize that affect but not always.

Yes! Nursing needs are simple. We want working equipment, we want the layout of our units to be efficient, we want input into "ideas" that affect our work.

Example: I work mostly on a tele floor. When the manager secured four new Dynamaps, we were like kids on Christmas morning! But why are half the in-room BP cuffs broken, and there is only one rolling manual cuff for the entire floor? We have only one Doppler!

However, we got two new blanket warmers when half our patients complain about being too hot. The manager confided in me that it was a fight she lost when a non-nurse manager got the funding for new warmers for every floor. The non nurse had a "brilliant idea," sold it to upper management, but all the nurses thought it was the stupidest idea ever. Even more so that the only place they could put them on one floor was in the nurse's station from which we lost a computer to make room. Four nurses, three seated computers. Go figure.

Another non nurse manager took our supply room on one floor for a "family room." Supplies were then split into three separate locations. Every single nurse was angry. Another example of never asking frontline for a solution...just make our jobs harder!

I hope that you can take our insights to whatever job you're doing right now. Like I said, our needs are simple, but one person's brilliant idea can make our jobs exponentially harder.

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As a patient and big supporter of nurses I have to say:

Why would you be on a message board asking this question when you have no way of knowing if who you are asking is a real nurse or not?

Since you are a consultant wouldn't you know this stuff already?

Why don't you talk to the CEO's, and upper management about cutting their paychecks? So they could hire more nurses and could provide better care. I couldn't even tell you the name of the CEO (I wouldn't want to meet them anyway.) of the hospital I went to, but I remember my nurses.

Hospitals would be run more efficiently if management would listen to their employees and follow their advice rather than pay outside agencies because they work there, they know what needs to be done, many just need enough nurses to properly care for their patients.

I do have to say this is a interesting first post!

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Specializes in Med/Surg, Academics.
"Are some of you so downtrodden at work that you resort to self-aggrandizing on the internet?"

Sometimes! Does that impact your findings?

Would you EVER say something like that to the big boys?

That disrespectful statement was all I needed to hear ...to not assist you with your research.

P.S. When's the last time YOU saved a life?

How did I miss Stewie's post that conjured this response?

Stewie, you still here? Have some freakin' respect, please. In the name of research, follow a couple of us around one day, matching step for step. I hope it could open your eyes, regardless of whether you are with a lazy nurse or a hard-working nurse.

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Specializes in OR, Nursing Professional Development.
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.

This. We had an outside group provide suggestions on how to cut costs in our OR. Not a single member of the team had OR experience. What they suggested went against every shred of common sense (seriously, we need more than two of a single item kept in stock- what if we have two cases and end up dropping one?) and ended up causing a lot of people to leave. Well, they cut costs for sure- about 20% of the staff up and left.

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How did I miss Stewie's post that conjured this response?

Stewie, you still here? Have some freakin' respect, please. In the name of research, follow a couple of us around one day, matching step for step. I hope it could open your eyes, regardless of whether you are with a lazy nurse or a hard-working nurse.

Respect runs in both directions -- is calling me a hack respectful?

A few of you have been respectful - and for that I applaud you.

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"Are some of you so downtrodden at work that you resort to self-aggrandizing on the internet?"

Sometimes! Does that impact your findings?

no

Would you EVER say something like that to the big boys?

depends

That disrespectful statement was all I needed to hear ...to not assist you with your research.

i think i'll be okay

best of luck to you

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Specializes in Med/Surg, Academics.
Respect runs in both directions -- is calling me names respectful?

A few of you have been respectful - and for that I applaud you.

Well, one person called you a name, then you ambiguously referred to "some" of us as downtrodden with questionable coping mechanisms.

The Commuter is much better at telling it like it is without being witchy, but I'll paraphrase her anyway: You are on a nursing site, and many of us don't particularly like consultants who are paid a lot of money or design and implement programs that do nothing but make our work harder.

I have a friend who works for a very large public school system. She told me that consultants are hired to tell them how to go about doing what they want to do, but make it appear that teachers and parents have a say in their decisions. Niiiiiiice.

Consultants, regardless of the industry, are not particularly well-liked by the rank and file.

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Specializes in ICU.

I don't know about everyone else, but I like to see people that possibly have an impact on financial decisions actually seeming interested in how these decisions affect nurses. I don't get what everyone's problem with the OP is. The OP is posting on a nursing forum... Come on guys, how many people that affect our pay do you know that do that? Nurses good at saving lives are not necessarily good at financial things, education, or management - it takes all kinds to run a hospital successfully. Let's face it - hospitals are not entirely made up of bedside nurses. Let's not throw every other job position under the bus just because they aren't us.

Okay, off soapbox. In relation to the actual topic of conversation, my last job cut benefits by having us accrue PTO at a lower rate multiple times, including right when I was hired. A bunch of people got upset and quit over time, leading to a high rate of turnover on my unit and leading to a very high rate of new grad nurses on the unit with unwilling, overburdened preceptors. These preceptors took one new grad after another and got so tired of precepting that they started lashing out at their orientees, leading to a problem with the organization losing a good fraction of the new grads they hired before the new grads even got out of orientation because of horrible treatment by their preceptors and no alternative preceptors available.

Obviously, this negatively impacted the bottom line and patient care because the experienced nurses were burned out on the constant stream of new people and the new people felt unwelcome and bullied, leading to even higher turnover. Also, this was an intensive care setting where easily 75% of the nursing staff had less than two years of experience, so there was not a good skill mix for patient care. A nurse with more than nine months of nursing experience was basically an experienced nurse and a resource for the other nurses, who probably had less experience than that. Someone with two years' experience was an absolute expert.

I later saw the same organization take away the weekend option position because weekend option nurses were paid at a higher rate. They allowed current weekend option nurses to keep their special pay, but no new staff were hired for weekend option. As the weekend option people left (high turnover there as well), regular staff just had to sign up for more weekend shifts. Weekend option nights had been the most coveted nursing position on the unit because of the higher pay and many of the regular staff had been signing up for exclusively weekend nights in the hopes of one day landing the highly desired weekend option position, so these staff members threw a fit and quit signing up for weekend shifts altogether when the weekend option position was eliminated.

The gap between the weekend option staff and the regular staff got to be ridiculous, with the regular staff showing active animosity towards the weekend option staff because of their increased pay which was now totally unattainable for regular staff, and the weekend option staff in turn snubbed regular staff who were working with them on the weekends. Fewer and fewer people voluntarily signed up for weekends because of the toxic atmosphere as the weekend option nurses started exclusively keeping to themselves and not helping out any of the regular staff. The weekend charges also showed a huge preference to their own - the weekend option staff almost always had two stable, easy patients each - only regular staff covering weekends were open for admissions, only regular staff got the detoxing alcoholics, etc.

We had a six weekend shifts per six week schedule requirement, but a lot of nurses started refusing to sign up for any weekend shifts at all or only signed up for one or two instead of six. In turn, more people's schedules were rearranged by the nurse manager to get the weekends adequately staffed. This increase in people's schedules getting rearranged where they had usually gotten the shifts they had signed up for previously made a lot of people really angry. A lot of people just started calling out for their weekend shifts because they refused to work with the weekend people. This behavior was tolerated because the unit was so short staffed, especially if the person calling out actually had the magic more than two years of experience which practically made him/her a unicorn. Other staff responded to their schedules getting rearranged often by transferring to other departments or leaving the hospital altogether, worsening the oversupply of new grads on the unit and the lack of experienced nurses mentioned above. Not to mention it was a lot more common to be tripled on the weekends because of the staffing problems! So, taking away weekend option pay led to higher nurse/patient ratios, more animosity between the nurses on the unit, higher turnover, and decreased ability to provide quality patient care.

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

EXACTLY, hence the disconnect. Sounds like a wicked cool way to make it SEEM as if they care about changing things for the better, with no intention from day one of actually IMPLEMENTING anything....Awesome gig.

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Specializes in MICU, SICU, CICU.

To stew:

What your agency's fee structure for an individual client, hospital or healthcare system?

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no

depends

i think i'll be okay

best of luck to you

I don't need luck.. thanks. I now work for an insurance company. My nursing skills are bought and paid for by that system. Yippee skipee.. Any useless consultation fees... do not affect my reimbursement.

I do feel deeply for my fellow nurses .. that have to fight for respect in the hospital setting.

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OK, OP here's a thought. Every CEO, CFO, C3PO take half their salary. So instead of make a million, they "make due" with a 500K year. With that extra money, ensure that every unit gets staffed appropriately.

Take a great number of per diems, part timers, yes even weekenders. So that every nurse gets their vacations, days off, heck even lunch. (ie: my dream part time job would be 11-2--or even 6p-9p--so that others can have a lunch).

Have a well paid and well respected CNA staff. Send anyone who wants to the ability to attend college to advance their studies--so the nurse educator (who should be an actual practicing nurse) could have a few on staff for this purpose--as well as nurses who are into precepting (and there are a great deal who like to do this).

Make it so that nurses can move up the ranks--from charge, to manager, to unit manager....

Invest in the nurses. Invest in creating an atmosphere that is conductive to amazing patient care. But don't spit on our heads and call it rain.

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