Wow, this thread has been very interesting to me. I am a nurse who, fortunately or unfortunately, gets to see both sides of things, the clinical and the administrative. I have worked at the bedside for many years and still can and do in a pinch. Currently I am a unit-based educator and, as such, I am privy to the administrative processes that go into keeping the hospital operational.
The most important staff in ANY hospital are its medical and nursing staff. Administration knows that they are to be protected almost at all costs. An administrator can take on the job of two or three other administrators to their detriment but nurses cannot be asked to do the same without huge costs to the operation.
Most hospitals in my current area have had to make cuts to save costs, not only due to the current economy but also due to the regulatory environment we are currently functioning in. I am sure that most of you know that hospitals do not get paid for the treatment of a UTI, skin wound, pneumonia and other conditions if they are acquired during the hospital stay. DRGs have made it necessary to try to get patients out of the hospital as quickly as possible because there comes a point in a patient's stay when their care is no longer paid for AT ALL because there is a set number of days they are expected to stay r/t those DRGs. In response to this need to cut costs in order to be able to pay the salaries of the medical and nursing staff administration in almost all of our area hospitals has taken huge hits. I currently work for two organizations involving three hospitals. Both organizations have cut salaried staff from 40 hours to either 37.5 or 36 hours per week. In addition, there was not only no decrease in the expectation for work produced but, in fact, many administrators have been let go and their jobs incorporated into the now decreased paid hours of the ones who remain. Directors and managers are now responsible for two or three service areas....an almost impossible task.
As a result there have been NO lay offs or salary cuts for the medical and nursing staff and that is okay with those of us who do not provide the day to day care of the patients, we KNOW that is the priority and we work without pay to make sure that you can do your job.
I agree that there are a lot of requests that come from administration that seem silly- scripting, increasing customer survey scores etc. but they come from an effort to increase revenues so that they can keep their nurses. Hospitals are starting to look at successful businesses for solutions to our issues. What is it that they do that makes their "customers" happy? Like it or not we do have customers. Patients, non-hospital employed physicians, outside vendors etc. These are all people who can take their business elsewhere. Hospitals do have to make money in order to pay salaries and the largest hit they take is nursing salaries, appropriately so. Hospitals are now required to post their pt. satisfaction scores as well as their rates on those "acquired in the hospital" infections so that patients can choose where they want to go for their care (and yes, many people do have options).
So, in this current environment what you may not see is all the effort that is going into trying to increase outpatient services and other service lines that actually bring in money as opposed to inpatient care where we often lose money.
That leaves administration in the difficult position of having little time to do anything but try to come up with quick fixes for inpatient issues.
As nurses we have a lot more power than we recognize. If a group of you who truly care about what happens on your units took some time to get together and try to come up with some real solutions to your issues that you can present to administration I can't help but think they would at least listen if not respond. The hard thing for an administrator is when people come with complaints but don't offer solutions expecting that overwhelmed administrator to come up with the solution themselves.
I am not an administrator per se but I am one of those people who has had hours cut, more expectations piled on and people come to me with issues expecting me to solve them. I love it when someone comes to me with workable solutions, I stand on my head to try to help make those solutions happen!
Now I think I can predict what the reaction will be to my comment above...."how can we take time to get together to come up with solutions, we are already swamped". The truth is we are ALL swamped, just in different ways and if we are ever to get out of that situation we need to solve our own problems and not just complain. I know that many of you are trying to do just that, we just need MORE of you to help us get out of this rut. There is power in numbers. Unfortunately money is needed for many of the solutions but we just need to keep that in mind as we propose those solutions. What will solve our problems that will be cost-effective, allow us to provide the best evidence-based care and make our patients happy at the same time? We need to put our thinking caps on and provide solutions to administration that will truly work for nurses and patients alike.
Sorry for the soap box, being in the middle is a tough place to be, I value the points that both sides are trying to make, we just need to all get together and find some common ground. (And yes, sometimes I DO wear rose-colored glasses)
Thanks for listening!!