Calif: Hospital Boom

-jt · Dec 9, 2002

sure theyre adding more beds -- now that they may not have to hire hire RNs to staff them.

NMAguiar · Dec 9, 2002

Every one on this discussion knows I read A LOT of newspapers, and have read everything negative about Mercy and Catholic Healthcare West -- that is, when the stories aren't about Tenet.

But I'm doing my RN clinical rotations at a Catholic Healthcare facility in Woodland, about 30 miles outside Sacramento. It's a lovely place to work and is known for EXCEEDING ... yes, that's right ... EXCEEDING the proposed state mandated nursing ratios.

I could tell something was right from the beginning -- the staff carries largely positive attitudes! Yeah, they ***** and moan occasionally, as is every American worker's right. But generally they're happy and carry a great deal of seniority.

Is this normal for Catholic Healthcare, or an exception? :confused:

Home Health Columnist / Guide · Dec 9, 2002

Must be "Values in Practice" ---- our new Catholic Healthcare East (CHE) health care excellence initiative in practice.

obeyacts2 · Dec 9, 2002

The valley south of Sacramento is getting a boom too. We have two hospitals in our town and both are expanding- one is adding a seven story tower! And this last week Kaiser announced it was going to build a hospital from the ground up, and needed 500 RNS.

Laura Modesto CA

-jt · Dec 9, 2002

I just dont get it. California Hospital Assoc says they have the second worst bedside RN shortage in the nation & cant attract enough RNs to work for them now. Then they go ahead and build towers full of new pt beds. So who do they think is going to be there to care for all these new pts in all these new towers?

The for-profit hospitals in California reported record-breaking profits last year -- millions upon millions that went to their investors -- while they forced their RNs out on strike to avoid having to spend an extra dime on them. They have millions to invest in new construction but they have "no money" to improve working conditions for RNs. And they wonder why they cant "find" nurses to work for them? It seems they dont even care about that since they are doing all this building already knowing they wont have RNs to staff them. And are doing nothing to try to draw them back but everything they can think of to drive more of them away.

Whats wrong with this picture?

2banurse · Dec 9, 2002

-jt, I was thinking the same thing when I first saw this post. You just put it in just the right words.

Kris

NMAguiar · Dec 9, 2002

JT's post could be titled "When Ratios Collide." Imagine as California hospitals begin trying to meet mandated nurse ratios, and there aren't enough RNs to go around.

Can you say "floor closure?"

Dr. Kate, BSN, RN · Dec 9, 2002

Under a 1994 state law, all California acute-care hospitals are required to retrofit, rebuild or close any non-compliant inpatient facility by 2008. Even more stringent seismic standards will be required by 2030. According to a recent report by the California Office of Statewide Planning and Development (OSHPD), 78 percent of hospitals in the state have at least one building that, unaltered, would be forced to close by 2008. At a time when more than 60 percent of California hospitals are reporting negative operating margins, according to the California Healthcare Association, the cost to comply with the unfunded mandate is roughly $24 billion.

While there is discussion and a high probability that the dates for compliance will be extended, this legislation is a reality in California. Some hospitals are using it as an opportunity to update and expand their facilities.

It usually seems to take a major disaster to get a new hospital building. There are 10 hospitals in my little corner of the world. Prior to this legislation, the newest one was built about 10 years ago. One has recently been completed, one is in progress, one was completely retrofitted after the 1994 earthquake (it fell down in 1971 and was rebuilt then), the rest are trying to figure out how they're going to make it happen.

Earthquake retrofitting is as and often more expensive than rebuilding. And it takes just about as long.

I was working the night of the 1994 quake. We were lucky. The generators came on (though one failed later and we borrowed from Disney), no major equipment went to ground, the only water leak was in nursery and NICU. None of the babes were vented,\ and they were the only patients transferred 1st to the ER and then to another hospital. I for one think that retrofitting or building a new hospital is a prudent move and one that as both a hospital based nurse and a consumer I appreciate. It's a cost that benefits everyone.

oramar · Dec 9, 2002

I followed a link over on CNA website. It took me to a site all about Tenet. It showed a comparison between a CEO who gets a pension of nearly $200,000 a year and a 29 year veteran nurse who gets a few thousand. It made me sad and sick.

sjoe · Dec 9, 2002

"Imagine as California hospitals begin trying to meet mandated nurse ratios, and there aren't enough RNs to go around"

But worldwide, there ARE enough nurses willing to work in today's hospital conditions.

Much as the computer industry put pressure (successfully) on Congress to increase the number of available working visas for computer engineers in the 1990s, hospitals will use this increased "need" to make the same argument.

Or, then again, I may be wrong and US hospitals will "see the light" with all these vacant beds, and take major steps toward making their environments sufficiently patient- and nurse-friendly that the 500,000 of us who are RNs and NOT working in the field will be delighted to return.

Of course, pigs may fly.

-jt · Dec 10, 2002

ok..... new replacements for old dangerous buildings I can understand --- you just move the staff over to the new address - but to ADD new buildings with more beds while resisting doing anything to attract the professional staff you will need for those additional pts (and even actively driving them away) just doesnt make sense. Unless thats the goal to begin with.

Great business strategy -- increase business and revenue by bringing in more pts, at the same time you cut overhead costs by replacing RNs with other less expensive personnel. A decade ago, this attempt met with public outrage. But hospitals have been looking for a way to do that ever since. . Now they have the perfect excuse to convince the public that replacing RNs with other personnel is necessary for their health. Like its either that or nobody to care for them in the hospital. Get states to pass laws allowing it and the bedside RN shortage becomes irrelevant.... get the federal govt to pass the bill they currently have there that will allow for an UNLIMITED number of foreign recruits & will lower the standard of their credentialling & we can all just whistle Dixie before theyll pay any attention to us again.

Heres a scenario:

Once they have all those new beds built & filled while deliberately doing nothing to make the workplace improvements that RNs need to come back to the bedside, it will be that many more pts they wont be able to "find" nurses for (albeit they arent really trying all that hard if they forcing them out on strike over recruitment/retention incentives and pt safety issues as we speak). But the "lack" of bedside RNs will be a "crisis" and the public/legislators will be told something MUST be done to provide care without more RNs or units & ERs will close because "there just arent any RNs to be had". Then there will be a big push get the state to expand the scope of less costly UAPs. Just as they are already pushing hard now to get the state to allow them to fill the new nurse staffing ratios with less costly LPNs instead of all RNs -- so they can save money (while reporting record-breaking profits for their investors).

They have the perfect excuse - "the nursing shortage". The public will accept having more UAPs & others doing more because they are hearing "there are no RNs" - and not "there are no RNs who will work for what we want to throw at them". Legislators will accept replacing an RN with other personnel because they will be told "floors will close" &" pts wont get the care they need" if they dont do so. Hell, they are already being told that right now in California to justify why LPNs should be allowed to replace RNs in the states mandated staffing ratios - "There are not enough RNs to fill the ratios" so we must use less expensive LPNs. (God forbid we spend some money to fix the things that are keeping the RNs away). Actually, there are enough RNs- but nobody wants to do anything that might make them come back to work 'cause then theyd have to pay them their higher salary.

It just happened in Nevada - the hospitals refused to hire available ER RNs because they didnt want to spend the money & then went to the state & convinced them they needed to create a new category of less costly ER UAP to fill in the gap because they "didnt have enough" ER RNs. Despite the fact that the Nevada Nurses Assoc proved there WERE more than enough ER RNs available to work - the hospitals just were refusing to hire them & then claiming they had a "shortage" of ER RNs! Instead of telling the hospitals to prioritize & pay for what they needed (RNs), the state allowed them to turn RNs away & create the inexpensive ER UAP to take their place. In Tennesse, they just passed a law allowing school secretaries to do accuchecks on school children and ADMINISTER INSULIN & glucagon to kids because "there are no RNs" - except that the Tennesse Nurses Association showed there were PLENTY of RNs who wanted school nurse jobs - the school districts just didnt want to hire & pay them. There was no shortage of RNs who wanted to be school nurses. There was only a shortage of school districts who wanted to give jobs to RNs. But they used the excuse of the "nursing shortage" to get a law passed that will hand off an RN function to unlicensed office personnel & allow the schools to not have to hire and pay for RNs at all.

None of their agenda in any of this has a thing to do with patients or pt care or any nurse "shortage" --- its all about big business seeing an opportunity to serve itself, & hand over fist profit margins.