Please explain how union hospitals do it.

allnurses Guide · Apr 30, 2015

Well if you are following the news you will find Kaiser Nurses in Los Angeles, CA are currently on strike. They have a very strong Union and no one who wants to work for Kaiser will cross that picket line.

True Califonia has some of the highest nurse salaries in the country but the cost of living is 3 times higher than some other states especially those in the middle US. I don't currently work in a union shop so my situation is different.

Hppy

momof3lv · Apr 30, 2015

Because California is going broke and things will probably have to change soon.

Home Health Columnist / Guide · Apr 30, 2015

Moved to Collective Bargaining / Nursing Union forum... many discussions here that might interest you.

Libby1987 · May 1, 2015

I'm not understanding. I mean how does kaiser stay so solvent while paying higher wages and complying with mandated ratios?

And when I say higher wages, I mean compared to other California hospital systems. I didn't mean to make a COL comparison.

allnurses Guide · May 1, 2015

A lot of this has to do with Kaiser being a private health system. All of the patients with a very small exception are insured by Kaiser so they don't spend a lot of time and effort chasing down people who can't or won't pay their medical bills. Kaiser was origally set up to offer health services to employee's of Kaiser Steel Manufacturing. They do tons of clinical research and prettyy much have managed care down to a science. Infact they are the model other managed care health systems are built on. When you are a member of Kaiser they do all your lab work, sell you your prescriptions etc..... Some say they give less than adequate care but I have been with them for several years and been hospitalized 3 times and found the care excellent.

Hppy

Libby1987 · May 2, 2015

A lot of this has to do with Kaiser being a private health system. All of the patients with a very small exception are insured by Kaiser so they don't spend a lot of time and effort chasing down people who can't or won't pay their medical bills. Kaiser was origally set up to offer health services to employee's of Kaiser Steel Manufacturing. They do tons of clinical research and prettyy much have managed care down to a science. Infact they are the model other managed care health systems are built on. When you are a member of Kaiser they do all your lab work, sell you your prescriptions etc..... Some say they give less than adequate care but I have been with them for several years and been hospitalized 3 times and found the care excellent.
Hppy

Agree, I think their reputation has greatly improved. I've heard stories, mostly in the past, but personal experience has been good.

MatrixRn · May 2, 2015

I think it is a matter of if there is a will there is a way. Companies will do what they must do to survive. If Kaiser wants to be in the CALI market they need to abide by the ratio rules.

They are a private company and will need to offset that cost. As with other companies who have facilities in multi states they allow the other facilities that do not cost as much to run...ie no ratio standards...run with a touch less staff, and get less pay ie. pay the market value for that region.

allnurses Guide · May 2, 2015

Kaiser is not losing money:

Fitch Affirms Kaiser's IFS Ratings at 'A+'; Outlook Stable - MarketWatch

With decreased CMS compensation for readmission within 30 days, ventilator associated pneumonia, bloodstream and other nosocomial infections, and other complications safe staffing ratios save lives and are cost effective:

An observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions
BMJ Quality and Safety in Healthcare online May 2013
Adding just one child to a hospital's average staffing ratio increased the likelihood of a medical pediatric patient's readmission within 30 days by 11%, while the odds of readmission for surgical pediatric patients rose by nearly 50%.
Nurse Staffing and NICU Infection Rates
JAMA Pediatrics: Published online March 18, 2013
There are substantial shortfalls in nurse staffing in US neonatal intensive care units (NICUs) relative to national guidelines. These are associated with higher rates of nosocomial infections among infants with very low birth weights.
Hospital Nursing and 30-Day Readmissions Among Medicare Patients With Heart Failure, Acute Myocardial Infarction, and Pneumonia
Medical Care: January 2013
Improving nurses' work environments and staffing may be effective interventions for preventing readmissions. Each additional patient per nurse was associated with the risk of within 30 days of readmission for heart failure (7%), myocardial infarction (9%), and pneumonia (6%). In all scenarios, the probability of patient readmission was reduced when nurse workloads were lower and nurse work environments were better.â€
State-Mandated Nurse Staffing Levels Lead to Lower Patient Mortality and Higher Nurse Satisfaction
Agency for Healthcare Research and Quality, September 26, 2012
The California safe staffing law has increased nurse staffing levels and created more reasonable workloads for nurses in California hospitals, leading to fewer patient deaths and higher levels of job satisfaction than in other states without mandated staffing ratios. Despite initial concerns from opponents, the skill mix of nurses used by California hospitals has not declined since implementation of the mandated ratios.
Nurse Staffing and Inpatient Hospital Mortality
New England Journal of Medicine, March 17, 2011
"Studies involving RN staffing have shown that when the nursing workload is high, nurses' surveillance of patients is impaired, and the risk of adverse events increases." "â€¦ We found that the risk of death increased with increasing exposure to shifts in which RN hours were 8 hours or more below target staffing levels or there was high turnover. We estimate that the risk of death increased by 2% for each below-target shift and 4% for each high-turnover shift to which a patient was exposed."
Implications of the California Nurse Staffing Mandate for Other States
Health Services Research, August 2010
The researchers surveyed 22,336 RNs in California and two comparable states, Pennsylvania and New Jersey, with striking results, including: if they matched California state-mandated ratios in medical and surgical units, New Jersey hospitals would have 13.9 percent fewer patient deaths and Pennsylvania 10.6 percent fewer deaths. Because all hospitalized patients are likely to benefit from improved nurse staffing, not just general surgery patients, the potential number of lives that could be saved by improving nurse staffing in hospitals nationally is likely to be many thousands a year,â€ according to Linda Aiken, the study's lead author. California RNs report having significantly more time to spend with patients, and their hospitals are far more likely to have enough RNs on staff to provide quality patient care. Fewer California RNs say their workload caused them to miss changes in patient conditions than New Jersey or Pennsylvania RNs
Overcrowding and Understaffing in Modern Health-care Systems: Key Determinants in Meticillin-resistant Staphylococcus Aureus Transmission
Lancet Infectious Disease, July 2008
This study finds that understaffing of nurses is a key factor in the spread of methicillin-resistant Staphylococcus aureus (MRSA), the most dangerous type of hospital-acquired infection. The authors note that common attempts to prevent or contain MRSA and other types of infections such as requirements for regular and repeated hand washing by nurses are compromised when nursing staff are overburdened with too many patients.
Survival From In-Hospital Cardiac Arrest During Nights and Weekends
JAMA, February 20, 2008
A national study on the rate of death from cardiac arrest in hospitals found that the risk of death from cardiac arrest in the hospital is nearly 20 percent higher on the night shift. The authors highlight understaffing during the night shift as a potential explanation for the death rate. Most hospitals decrease their inpatient unit nurse-patient ratios at nightâ€¦ Lower nurse-patient ratios have been associated with an increased risk of shock and cardiac arrest,â€ the authors stated.
Staffing Level: a Determinant of Late-Onset Ventilator-Associated Pneumonia
Critical Care, July 19, 2007
Understaffing of registered nurses in hospital intensive care units increases the risk of serious infections for patients; specifically late-onset ventilator-associated pneumonia, a preventable and potential deadly complication that can add thousands of dollars to the cost of care for hospital patients. Curtailing nurse staffing levels can lead to suboptimal care, which can raise costs far above the expense of employing more nurses
Nurse Working Conditions and Patient Safety Outcomes
Medical Care,Journal of the American Public Health Association, June 2007
A review of outcomes for more than 15,000 patients in 51 U.S. hospital ICUs showed that those with higher nurse staffing levels had a lower incidence of infections, such as central line associated bloodstream infections, a common cause of death in intensive care settings. The study found that patients cared for in hospitals with higher staffing levels were 68 percent less likely to acquire an infection. Other measures such as ventilator-associated pneumonia and skin ulcers were also reduced in units with high staffing levels. Patients were also less likely to die within 30 days in these higher-staffed units.
Hospital Nurse Staffing and Quality of Patient Care
Evidence Report/Technology Assessment for Agency for Healthcare Research and Quality, May 2007
A comprehensive analysis of all the scientific evidence linking RN staffing to patient care outcomes found consistent evidence that an increase in RN-to-patient ratios was associated with a reduction in hospital-related mortality, failure to rescue, and other nurse sensitive outcomes, as well as reduced length of stay.
Quality of Care for the Treatment of Acute Medical Conditions in U.S. Hospitals
Archives of Internal Medicine, Dec 2006
A national study of the quality of care for patients hospitalized for heart attacks, congestive heart failure and pneumonia found that patients are more likely to receive high quality care in hospitals with higher registered nurse staffing ratios.
Longitudinal Analysis of Nurse Staffing and Patient Outcomes - More About Failure to Rescue
Journal of Nursing Administration, Jan. 2006
Increasing RN staffing increased patient satisfaction with pain management and physical care; while having more non-RN care "is related to decreased ability to rescue patients from medication errors."
Correlation Between Annual Volume of Cystectomy, Professional Staffing, and Outcomes - A Statewide, Population-Based Study
Cancer, Sept. 2005
Patients undergoing common types of cancer surgery are safer in hospitals with higher RN-to-patient ratios. High RN-to-patient ratios were found to reduce the mortality rate by greater than 50% and smaller community hospitals that implement high RN ratios can provide a level of safety and quality of care for cancer patients on a par with much larger urban medical centers that specialize in performing similar types of surgery.
Is More Better? The Relationship Between Nurse Staffing and the Quality of Nursing Care in Hospital
Medical Care, February 2004
Survey of 8,000 RNs in Pennsylvania hospitals found workload and understaffing contributed to medical errors, patient falls and a number of important nursing tasks left undone at the end of every shift.
The Effects of Nurse Staffing on Adverse Events, Morbidity, Mortality, and Medical Costs
Nursing Research, March/April 2003
Increasing nurse staffing by just one hour per patient day resulted in a 9% reduction in the incidence of hospital-acquired pneumonia. The cost of treating hospital-acquired pneumonia was up to $28,000 per patient. Patients who had pneumonia, wound infection or sepsis had a greater probability of death during hospitalization.
Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction
Journal of the American Medical Association, Oct. 22, 2002

allnurses Guide · May 2, 2015

Four years ago California was in debt $26 billion and the unemployment rate was 12.1 percent. Now, the state budget is balanced. With more than 1.3 million new jobs created in just four years the unemployment rate has dropped to 7.2 percent.

The Legislature cut spending, and the people for voting for temporary taxes.

Office of Governor Edmund G. Brown Jr. - Newsroom

People are still coming to California:

California's population grows modestly

caliotter3 · May 2, 2015

Many years ago, where I used to live, I noticed the Kaiser job postings on the EDD website consisted of listing after listing after listing of "20 hours a week or less" positions with no benefits. I was informed at that time by someone with an acquaintance in a Kaiser HR position, that trips were made overseas by Kaiser reps to obtain nursing personnel eager to work at these "20 hours or less" positions. At that time I made the decision that Kaiser did not interest me for employment opportunities. That was how they did it then. I suppose consequences of those policies have persisted.

MatrixRn · May 4, 2015

Many years ago, where I used to live, I noticed the Kaiser job postings on the EDD website consisted of listing after listing after listing of "20 hours a week or less" positions with no benefits. I was informed at that time by someone with an acquaintance in a Kaiser HR position, that trips were made overseas by Kaiser reps to obtain nursing personnel eager to work at these "20 hours or less" positions. At that time I made the decision that Kaiser did not interest me for employment opportunities. That was how they did it then. I suppose consequences of those policies have persisted.

I am unclear of what you mean by 'consequences of those policies have persisted.'

There are many nurses who are only looking for per Diem work. 20 hours a week could be a dream job for some people.

Also as an aside, when I lived back East they often would contract with the Philippines for nurses, as there were not enough American nurses willing to go into the inner cities. Inner city dwellers need care too.