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?

[icuRNmaggie, BSN, RN]

stew

You need to start by verifying the academic credentials of the people in charge. It is not uncommon to find a few sociopathic individuals in executive positions who have fraudulent credentials and are incapable of managing their way out of a paper bag. These types hire more people like them and in a few years the place is in big trouble. Restructuring means that someone has figured out what they're up to and they want them gone.

Unqualified leadership who spend their days playing golf and computer games behind closed doors, or schmoozing the elderly to donate to the foundation, while oblivious to the daily operations are the root of the problem.

Labor costs are a necessity. Nurse managed closed units are a viable solution as the people in administration haven't got a clue.

I worked in a place where the CEO was a former janitor who bought a doctorate in healthcare admin. online and got the job through family connections. Seriously. They are everywhere in low level hospitals. They keep guys like you in business. Anyone with half a brain can see the magnitude of the scam.

[gswifty]

Very interesting thread. My advice to stew would be two-fold. First, the us versus them mentality you have gotten a first hand dose of here is because nurses are the team and glue that hold hospitals together. Management, consultants and even auxiliary and other support staff including therapists are not the team. They might think they are, especially if their services are billable, but they are not. Many of us 'on the front lines' have seen our benefits being chipped away at for over a decade, so you can be as civil and polite as you please since your position is heavily dependent upon the perception of fiscal efficiency and political correctness, but you will always be on the outside looking in when it comes to commiserating with actual care-givers. Secondly, and this is a very simple point, so you should be able to grasp this...Regarding a systems approach to nursing care, when someone tells you to be in two places at the same time then that system has become untenable. Efficiency reaches a maximum velocity and once this is exceeded than you have a system that is failing. You want to quantify everything in your systems approach and it simply can't be done. Exemplars can not be quantified only observed and admired, and that's why non-nursing personal like yourself will never understand a nurses job. But that's a discussion for another thread.

[firstinfamily, RN]

I had a class in budgeting when taking my Masters, one of the ideas was rental equipment versus buying the latest and greatest. The rental equipment meant the rental company was also responsible for up keep of the equipment. The downside was if the equipment was not performing as needed it could hold up testing in the facility for days. So, not sure how cost saving this truly is. The LTC facility I worked at did a lot of contract services instead of employing others, when the contract service did not perform up to standard their contract was cancelled. When I was being pressed into doing managerial as well as floor nursing, my patients came first, and the managerial stuff was put to the side. However, I was still being held accountable for the managerial stuff, so I did what any prudent nurse would do, I quit!! It costs facilities more money to re-train other nurses, they should seek ways to keep their staff on board and there should be more shared-governance type leadership.

[Lisaannte]

The hospital I work at also cut staffing to the bone! I work my ass off and I don't feel safe either. I can't quit because I need my benefits and the paycheck. Patients are complaints are high. Falls are high! why? Not enough help! Drs admit people who don't need to be admitted! why? Money!!!

Drug seekers are everywhere! Taking away from people who really need the help.

[cdsga]

I've worked in many settings and in many different locales and have found paradoxically that appropriate staffing numbers do not always tell the tale. I have seen limited staffing perform better than when fully staffed why? Maybe because it's a sink or swim issue of everyone having to really work together to get the job done. If staffing mix is not resolved, you will see fast burn out and quick turnover, especially if you don't streamline the workplace to resolve hardship issues, bureaucracy, and unnecessary steps in the nursing role/functions. So many things can be done to make a place of work more efficient, but leadership (I have found) is lacking. People are in fear of using creative solutions without formal consent, while we tout critical thinking skills, we don't give permission to fully use those skills.

It's painful and you must always look to the systems, workflow, adequate ability to take a break, or eat a lunch/dinner in peace; meaning you have to have enough staff to provide relief so that workers can stay focused and alert/less irritable and be able to work together as a team.

Unless an organization really wants to retain staff, they have to look at these issues of workflow, redundancy, support staff, and be serious about it. Not just constantly be on a recruitment journey paying bonuses etc. We have enough satisfaction surveys to show what needs to be done, just do what is necessary. If leadership is lacking, get people who have the right skills for the job. Have a balance of experienced and inexperienced, pay people a good wage, and provide an environment that is safe and well laid out. Listen to the employees who stay, and implement their suggestions within reason. Most times they have the answers, not someone that never works in that environment.

[TU RN, DNP, CRNA]

Why are we laying into this guy? It's an innocent discussion. He hasn't done anything wrong to us, and is simply asking for our opinion.

Stew, does the presence of a nursing union complicate or change the way a consultant handles their job at a given hospital? How exactly does a nursing union affect your job?

[imintrouble, BSN, RN]

Why are we laying into this guy? It's an innocent discussion. He hasn't done anything wrong to us, and is simply asking for our opinion.

Stew, does the presence of a nursing union complicate or change the way a consultant handles their job at a given hospital? How exactly does a nursing union affect your job?

IF the OP is a consultant, he knows exactly what's happening in our hospitals. Then he wants to know how that's working out for us.

I find those questions insulting, from somebody who already knows the answers.

[toomuchbaloney]

Health care consultants = modern business model that adds costs but little value to the health delivery system.

Hospitals pay consultants to tell them what they want to hear because they already KNOW what the experts at the bedside will say and that doesn't meet their corporate needs, IMHO.

[TU RN, DNP, CRNA]

He is an individual, the wave of changes taking place in hospitals and the negative experiences you claim to have had with healthcare consultants are all generalizations. The OP has stated himself that his (third party) recommendations are often disregarded by "the powers that be." What if he is a nurse consultant who advocates for business changes supportive of nursing? After reading the emotionally charged and downright prejudiced remarks you made about him and his duties, HE has more right to be upset than you do. Here you all are trashing this individual for bothering to take your feedback into account simply by posing very neutral, non-offensive inquiries. I wouldn't be surprised if the type of unprofessional and RUDE display you spewed in his direction left a lasting impression on his values, instilling bias AGAINST us nurses, and propagating within another healthcare consultant an attitude ambivalent of the woes of nursing.

[icuRNmaggie, BSN, RN]

[quote name=

Stew, does the presence of a nursing union complicate or change the way a consultant handles their job at a given hospital? How exactly does a nursing union affect your job?[/quote]

If the nurses try to organize, the healthcare consultant trying to reduce labor costs can recommend an a "HR Consultant" which is a euphemism for union buster.

[joanna73, BSN, RN]

And let me guess... The senior manager didn't bother to answer the call light the entire time it had been ringing. Is my guess correct?

$

Of course your guess would be correct.

[stewstew03]

Why are we laying into this guy? It's an innocent discussion. He hasn't done anything wrong to us, and is simply asking for our opinion.

In summary, the reaction seems to be: (1) consultants are lower than pond scum; (2) consultants don't know anything about what nurses experience; (3) consultants don't care enough to ask about what nurses experience; and (4) even if consultants did care to ask, nurses wouldn't say anything because of #1.

Stew, does the presence of a nursing union complicate or change the way a consultant handles their job at a given hospital? How exactly does a nursing union affect your job?

We never get involved with nurse unions because of bargaining agreements. We leave that up to hospital leadership.