Nurse Staffing Costs

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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 Critical Care, ED, Cath lab, CTPAC,Trauma.

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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.

Excellent post, thank you!

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To stew:

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

Oh, sure icuRNmaggie -- let me just go ahead post that on the interwebs...

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Excellent post, thank you!

So happy you have a response you need towards fulfilling YOUR job requirements.

Again, please expound as to how your job ....works towards the goal of improved health care.

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So happy you have a response you need towards fulfilling YOUR job requirements.

Again, please expound as to how your job ....works towards the goal of improved health care.

I thought you had moved on, but you seem to be taking this personally -- why not start a new thread rather than hijack this one?

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Specializes in Critical Care.

I think healthcare consulting groups can potentially be very helpful to nursing and patient care, but as you may have noticed, that's not the experience many nurses have.

I've worked at two facilities when consulting groups came through, at one I was part of a group responsible for evaluating the recommendations. With adequate knowledge of care delivery as well as a focus on good patient care, consulting groups can be the allies of patients and nurses, without those two attributes they produce the sort of attitudes you've seen in this thread.

One of the most important things consulting groups need to do in order to do more good than harm is to have the appropriate knowledge of what they're basing their recommendations on. For instance, when making recommendations concerning labor utilization you have to have some sort of reliable information on the amount of time certain tasks take and how that matches up with the available labor hours. What I've found in the past is that there is often a lack of understanding of these variables yet that doesn't stop them from making recommendations without any supporting data.

Another issue is making recommendations that they have not researched well, if at all, an example was that at one facility a group recommended switching to all 8 hour shifts, based on a rationale that was easily disproved.

Despite the potential for doing good, I can't think of a single recommendation at either facility that is still followed, all of which failed immediately or over a period of time eventually fizzled out.

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I thought you had moved on, but you seem to be taking this personally -- why not start a new thread rather than hijack this one?

Please respond to my question.. before you accuse me of hijacking.

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Please respond to my question.. before you accuse me of hijacking.

start a new thread

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I think it's awesome that you've come to get ideas from people you know probably have good ideas. I've been a nurse for about 2 seconds, so I have no good ideas for you. Just wanted you to know I appreciate your effort.

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Frankly your question is insulting and inappropriate. You listed your occupation as being a health care consultant. What exactly is it that you do?

If you want to increase your 2 % operating margin, decrease those absurd CEO and CFO salaries.

Do you really think that anyone in nursing is interested in helping you figure out how to take away more of our benefits and reduce our pitiful salaries that have not increased in a decade?

Devise a way to bill for nursing services instead of rolling us into the room rate like housekeeping dietary and a roll of toilet paper.

Devise a way for nurses to generate income.

I am not a staffing cost. I am one of the main reasons that people come to this facility.

AMEN!

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Specializes in OB.

Stew - Two points I'd like to make here: First, you have come into our "home" here. It behooves you to treat our family members (even the somewhat snarky ones) with a measure of respect.

Second - in regards to the financial picture: You get what you pay for. While it may seem counter-intuitive to pay more to front line staff and increase their benefits, the end result will be quality employees, less turnover, less "sick call" and people dedicated to helping the institution succeed.

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Specializes in geriatrics.

We have been reducing hours and eliminating positions. Last week, one of the senior managers came to the unit and asked why a call bell was ringing repeatedly.

Seriously?? What would you expect with a ratio of 1:9?

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