Why don't hospitals cut down number of nurses/staff??

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nope80

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Maybe its just my hospital, maybe its just this particular rotation (my first rotation of third year, obgyn) but one thing I have noticed is that there are SO many nurses and nursing staff for the amount of patients/things to do. Our labor and delivery floor has so many nurses that are honestly hanging around with nothing to do; the only thing I can think of is how much this is costing our hospital. Have others noticed this too? On night shift, for example, we have like 10 nurses sitting around the station gossiping, talking, singing, watching american idol videos online or whatever it is, and I'm like why so many? They only have to check on patients every two hours, max hour, so why does every patient need their own personal nurse? We could easily easily cut the number of nurses and other staff in half and things would run the same and at the least be less hectic and chaotic (more room to sit, less talking and fooling around). Has anyone else noticed this or is this just my rotation/hospital?
 
What do you mean evidence for my claims? What type of evidence would I be able to provide over the internet - its just something I have noticed and was kind of surprised given the fact that obviously the cost of healthcare is a big issue.
 
Actually, what they have is an overload of Nurse Administrators. These are people who rarely see patients, but rather review their charts so that the hospital, their employer, stays in compliance with arbitrary and asinine JCAHO standards. That's their contribution to "patient care."

Nursing admin needs to be thinned. Their role and purpose in the grand scheme of things is questionable IMHO
 
I've never been in a hospital that seems to have an overabundance of nurses. Usually quite the contrary.
 
RGMSU said:
I've never been in a hospital that seems to have an overabundance of nurses. Usually quite the contrary.
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Nearly every place I have worked (even in life before medical school), there was a shortage of nurses and other ancillary staff (especially the ancillary staff). When I was a tech on a med/surg floor, it was floor policy not to bring in a second tech until the census was over 30 patients (36 bed ward). My nurse manager, to further save money, would not bring on that second tech unless the shift STARTED with over 30 patients. One person taking vitals (q4), doing q2 turns, with 3-8 total care patients (tube feeds, and the concomitant q2 changing/washing FTW), I/Os, foleys, and any other general assisting tasks for 30+ patients sucks.
 
They would cut payroll if they could; the painful reality (currently, and I do not see it changing) is that they cannot. Too many regulations and they must have excess capacity built into the system in order to be meet the regulatory requirements when they are at full capacity. Every time the opportunity arises they cut hours through the low census mechanism. They hire PRN staff. They do, in general, make an effort to keep payroll from becoming overly bloated.

With the looming cuts in funding, you can bet your bottom dollar that nursing, other clinical positions, as well as admin and ancillary staff will experience wage cuts. That is where the savings will come from, lower wages for labor -- not cutting the number of job slots.
 
I do not believe that nurses or ancillary staff should receive pay cuts. I believe they should receive pay raises actually. I believe if nurses, docs, and everyone associated with the healthcare industry stand united against pay decreases, we can keep it from happening to all of us. After all, we have supply and demand on our side for nurses, physicians, pharmacists, etc. It's not too easy to replace any of us too quickly, and there are already shortages if we all decide we've had enough and won't take anymore. Getting all healthcare providers to be united for once would be quite a trick though. The powers that be take advantage of the fact that we are usually more willing to stab each other in the back than look out for each other. The lack of fight in healthcare workers' spirit disturbs me. Why do we all sit around expecting pay cuts and not resist? Are we all just stupid or what? No other professionals so happily accept pay cuts.
 
There are actually too few nurses where I have recently worked. We have had a hiring freeze at the hospital due to the economy so we can't hire new nurses. It is not a good situation.

I agree there is a lot of administrative work done by nurses, but you can't cut the Nurse administrators before you first eliminate the paperwork that is required of them.
 
Acutally, i have seen plenty of nurse and docs sit around doing nothing. But thats not the issue.

The question is what are these people contributing to the patient and the hospital? The docs i can understand. some of these nurses i have no clue about.

Nurses do a thankless job. Now we can add physicians to that list once this bill passes.
 
Lonestar said:
Acutally, i have seen plenty of nurse and docs sit around doing nothing. But thats not the issue.

The question is what are these people contributing to the patient and the hospital? The docs i can understand. some of these nurses i have no clue about.

Nurses do a thankless job. Now we can add physicians to that list once this bill passes.
Click to expand...

I don't know where you've been, but physicians have been doing a thankless job long before this bill came up. Hah, and I've never seen a physician sitting around doing nothing - except for the ones who work for the government already. Those types see one patient every 30 minutes because that's all they're obligated to see, and it has no impact on their salaries.
 
leemerdo said:
actually, what they have is an overload of nurse administrators. These are people who rarely see patients, but rather review their charts so that the hospital, their employer, stays in compliance with arbitrary and asinine jcaho standards. That's their contribution to "patient care."

nursing admin needs to be thinned. Their role and purpose in the grand scheme of things is questionable imho
Click to expand...

x2
 
More arbitrary and asinine regs are on the way, so get ready.
 
Most hospitals use acuity-based nurse staffing system to calculate the acuity of each patient and that determines the hours of direct nursing care each patient requires. There are several different systems in use in the USA. The emergency dept and OR use different systems.

Every day nurses complete a tool that ask questions about patient mobility, hemodynamic stability and is hemodynamic monitoring in use, is the patient on a ventilator, et cetera. The data is fed into the computer for all patients on a unit and the average acuity suggests what nurse/patient ratio should be for the day. Sometimes the tool is accurate and sometimes not. Part of my job has been to track the trends for staffing and acuity and look for outliers.

I don't know where we rank now but at the time I did my survey our hospital did the sixth largest volume of open heart surgeries. Open heart recovery has the second highest acuity. Burn units are the highest.

My manager asked me to survey all hospitals on the east coast and ask what responsibilities were assigned to nurses and which were completed by physicians. The results of the study showed that our nurses were performing tasks that were performed by physicians in other hospitals. Things like removing mediastinal and pleural chest tubes. removing pacing wires, inserting radial arterial lines, et cetera. My manager presented the survey results to administration and they increased our nurse/patient ratio because our responsibilities exceeded the norm.

Incidentally I read one study that showed when a unit is over staffed more errors are made. Interesting.
 
Inadequate staffing= poor outcomes. That has been supported by numerous studies.

There are units that will occasionally have more "down" time than others. Those are sensitive to rapid census changes such as L&D. From what I remember, a patient in transitional labor automatically becomes a 1:1. A patient can present to triage at any time dilated to 8 or more- so what are you going to do if the only 2 RNs in the unit are saddled with 2 patients each and one suddenly needs an emergent C-section for ominous decels, meccing all over the place? You either staff in anticipation- or you pay mad scrail for some crazy lawsuit action.

Take my last shift, for example. I started out with one ridiculously stable patient. By 0330 or so the house supervisor advised us we'd be getting a mult GSW/trauma admission, but first going to OR. Well, dude still wasn't back by the time my shift was over- so yeah I had time on my hands- what are ya gonna do? Uncommon, indeed. In those instances, I make use of my time by catching up on the bajillion mandatory education exercises that we are required to do- thank you Joint Commission. It is also a good opportunity to get my CEUs done.

While there may be (god forbid) some free time in a nurse's shift, there are just as many, if not more, shifts without going to the bathroom even once (yes in 12 fkn hours) or so much as something to eat other than horking down a sandwich in less than 5 min.

So yeah, you can save a few bucks by not changing your motor oil 'til your engine light comes on, but I don't recommend it.

Oh, and by the way... to put things in perspective... Let's say in wages and benefits, a nurse costs the hospital $100/h (being very generous here). Let's say, this nurse works in my unit which has ratios of 1:1 to 2:1 (and 1:1 is much, much less common). So at a ratio of 2:1, the nursing care for the patient costs 1,200 for 24 hours. Compare that to the rest of the itemized ICU bill, not even including the physicians' bills. Now if you're at a ratio of 4:1 (generally a reasonable med/surg ratio), nursing care costs $600 for 24 hours. That's less than 1 bag of TPN!
 
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It's true that L & D needs to have some built in overstaffing in case of a huge influx of pt's in labor. Also L & D is one of the few areas of the hospital that needs to kiss patient ass. Women choose where they will have their babies, and it can be a huge financial boon to the hospital to have a desirable maternity unit.
 
I hate how nurses these days are largely unwilling to do any basic patient care...any of the dirty stuff. Ever tell a nurse that a patient needs a bedpan and she responds "Oh, well the NA is on break"? She would literally rather the patient **** the bed than give him a bedpan, b/c the NA would have to clean it anyway. So frustrating.

A recent favorite was, I had a patient who was literally shivering in bed and asked me for a blanket. He had already asked the nurse twice. I asked her where the blankets were. She responded "We're out, no more blankets til tomorrow morning." Are you kidding me? So I walked 30 yards to the next unit and grabbed the poor guy a blanket.

Great nurses are invaluable. Bad nurses can make an already bad time for a patient so much more painful.
 
My first two years of nursing I worked on a telemetry unit and I was teamed with an LPN and a nsg asst. I really thought I was going to smack the living **** out of the nsg asst one day. I had a patient with several coronary blockages who was going for CABG when they could get him on the schedule. He would have angina with light exertion so I told the nsg asst that I did not want her to set his bath up because I would hand bathe him. An hour or so later his call light comes on and I go to his room and she had set his bath up and he was trying to bathe himself and he was having angina. I have never been more angry as a nurse than I was at that moment. She is lucky I did not stomp her worthless @ss into the ground that day.
 
I think it is the hospital/unit you are in. I am from Buffalo, NY and the nurse-patient ratio here is ridiculous (9-12 patients) per nurse. I'm a nursing student but I'm interested in what student doctors have to say since I will be working with them.
I know this problem does exist in some places and sitting around gossiping ought to get someone fired. That is definitely a waste.
 
In my area (Buffalo, NY) we have an overabundance of nurses in the market and so many staffing cuts, nurses averaging 8-12 patients per shift. The other problem is that nurses have unions in every hospital in the city (except one) and crappy nurses don't get fired. Some have attitudes and do refuse to do basic tasks. The level of education attained requires a nurse to focus on signs and symptoms of illnesses, medication side effects, complications that arise for patients, etc. I think that simply bringing a bedpan to a patient is a great opportunity to have a look at that patient and check their IV, etc. Nurses are not "above" these kinds of tasks. We couldn't do our jobs without the aides that support us either.
 
Did you explain why you didn't want the NA to set up the bath? Sometimes we forget that when it is really important.
 
That actually happened to my Dad when he was in a hospital once. I wanted to smack that nurse.
 
Wlweaver said:
The other problem is that nurses have unions in every hospital in the city (except one) and crappy nurses don't get fired. Some have attitudes and do refuse to do basic tasks.
Click to expand...

I've spoken to several of my med school classmates who did rotations in NY & experienced the idiocy of the nursing unions. My friend said he actually saw a nurse tell an attending that she wasn't going to take blood on a patient because "I have my union rights".
 
LeemerDO said:
Actually, what they have is an overload of Nurse Administrators. These are people who rarely see patients, but rather review their charts so that the hospital, their employer, stays in compliance with arbitrary and asinine JCAHO standards. That's their contribution to "patient care."

Nursing admin needs to be thinned. Their role and purpose in the grand scheme of things is questionable IMHO
Click to expand...

+3

Certain units and hospitals do have more "just in case" nurses hanging around to meet nurse to patient ratios, but you can't generalize it to every unit and hospital system. There are state and nursing union rules about the ratios and so it varies from hospital to hospital.

Sometimes I shudder to think of all the nurses that are paid (albeit a slightly lower wage) to sit at home on call just in case patient census goes up and they need more nurses; how much money it must cost the system....
 
Frozen said:
+3

Certain units and hospitals do have more "just in case" nurses hanging around to meet nurse to patient ratios, but you can't generalize it to every unit and hospital system. There are state and nursing union rules about the ratios and so it varies from hospital to hospital.

Sometimes I shudder to think of all the nurses that are paid (albeit a slightly lower wage) to sit at home on call just in case patient census goes up and they need more nurses; how much money it must cost the system....
Click to expand...

I'm curious to know why you think the hospital is bleeding money keeping nurses "on call".

You won't find any nurses in the hospital hanging out "on the clock" just in case the census changes. If your unit has available beds, you will have nurses that are "open for admit" meaning that they are taking care of patients already but are available to take an admission. And no you don't staff for every single available bed in your unit, but you do take into account the number of admissions you can reasonably expect, as well as the transfers/discharges that you expect. These operations are designed to afford flexibility. It doesn't always work perfectly.

There are very few instances/departments in which a nurse would need to be "on call" That would be OR, cathlab, maybe L&D. And from what I've heard, the pay isn't as good as you think (i.e. nowhere near "albeit a slightly lower wage").

I work in a neuro ICU and a trauma ICU (one staff pool staffs both). It's pretty sensitive to census shifts. None of us is ever on call. If the census is low, we either get floated to the cardiopulmonary ICU or one of the stepdown units or we get cancelled. If we are short staffed on a shift, the staffing office and the charge nurse start making phone calls trying to get someone to come in on their day off. And no, there is no bonus, no incentive beyond regular wages for coming in extra (unless it puts you over 40 h/wk).

If you care about patient care standards/safety/quality, it would make you shudder to think that you could have several traumas, STEMIs, women in transitional labor and find yourself without enough nurses for these patients. Being understaffed is not a valid excuse for substandard care and resulting poor outcomes.

Apparently there are important financial implications when the hospital is on "diversion" (which admittedly I don't know the details) such that the powers that be do what they can to avoid the necessity of being on diversion.

Since nurse-patient ratios seem to be a topic that you're very concerned about (an assumption on my part since you took the time to post and the visceral reaction you described (i.e. shudder)), there is plenty of literature that addresses the relationship between ratios and patient mortality, length of stay, nosocomial infection, costs, etc. Since you so freely express your opinion on nursing staffing levels, I'm curious to know what data supports it.
 
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You know, one of my favorite book series is the Charles O'Brian "Jack Aubrey and Dr. Martinian" series (you might remember "Master and Commander").

One of the things that made Capt. Jack Aubrey such a phenomenal captain was a period of time in which he was "turned before the mast" as a midshipman and made a common jack (just your average shiphand). Working with them, bedding with them, and eating with them gave him a unique perspective of their life, and due to that, understood them much better then his enlightened and educated collegues.

Perhaps this is needed by those that are working as doctors, but never lived the life of a nurse. I worked with nurses for 3 years while stationed at a Naval Hospital. Their job is thankless, yes, but you could never really understand the absurdity of your statement until you spent some time in their shoes.

I would ask you remember the golden adage of hospital care: "Doctors treat, Nurses heal."
 
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The right Path said:
I'm curious to know why you think the hospital is bleeding money keeping nurses "on call".

You won't find any nurses in the hospital hanging out "on the clock" just in case the census changBeing understaffed is not a valid excuse for substandard care and resulting poor outcomes...
Since nurse-patient ratios seem to be a topic that you're very concerned about (an assumption on my part since you took the time to post and the visceral reaction you described (i.e. shudder)), there is plenty of literature that addresses the relationship between ratios and patient mortality, length of stay, nosocomial infection, costs, etc. Since you so freely express your opinion on nursing staffing levels, I'm curious to know what data supports it.
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Speaking of visceral responses...

Saying something is incredibly expensive does not equate to saying it is not necessary.
I shudder at the cost of medicare, but it's still necessary.

Yes RN/pt ratios are very important, I never said otherwise. In fact I mentioned that there are RN's on call and RN/pt are often slightly above minimum just in case they are needed. I didn't say this was bad, just that it costs the system money.

Are you saying that at your hospital your RN/pt is always perfect, never higher than it needs to be? Because I have yet to rotate at a hospital that that is the case.
 
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I didn't exactly have a physiological response to this thread. Being a nurse, however, I do care about how my profession is represented (by folks that haven't worked a day as a nurse, no less).

Perfect staffing? Lololol! And no I didn't say that staffing is never higher than it needs to be. When we are "over", staffing gives voluntary cancellations to the nurses that request them, then they go down the line calling nurses and cancelling them for at least part of their shift (all of their shift) if the census doesn't change. And yes, we actually shift around assignments and send nurses home if the census drops enough and we aren't getting admissions.

We are more likely to run on the short side than the over side. And I'm not going to make any further public commentary on how I feel our staffing is handled. I can assure you, however, that administration pays very close attention to staffing and the bottom line, and they would not tolerate overly generous staffing. Not where I work, and I bet that's the case across the board.

And if you're really worried about waste of resources in healthcare, nurse staffing is not where it's at.


Frozen said:
Speaking of visceral responses...

Saying something is incredibly expensive does not equate to saying it is not necessary.
I shudder at the cost of medicare, but it's still necessary.

Yes RN/pt ratios are very important, I never said otherwise. In fact I mentioned that there are RN's on call and RN/pt are often slightly above minimum just in case they are needed. I didn't say this was bad, just that it costs the system money.

Are you saying that at your hospital your RN/pt is always perfect, never higher than it needs to be? Because I have yet to rotate at a hospital that that is the case.
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FWIW, I used to have to take call in the unit. I got $1 an hour for being on call, which stopped and converted to my regular hourly wage when I arrived. I didn't even get the extra $1 for the whole 12 hours! I refused to take call at all there at the end. I told them I'd either work or stay home, but none of this call business. AFAIK, I'm the only one that ever got away with that, lol.

Even when I was the house super in union hospitals, I never saw egregious over staffing. Never. I do remember thinking that the L&D nurse without patients ought to have been out on the units helping where they were so terribly short staffed, but that just isn't how it's done.
 
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