The surplus hospital beds have created a problem in down sizing. The real challenge is how to get rid of nursing staff painlessly without fear of retribution. Last month we told you how hospitals got rid of doctors. It worked so smoothly that they are using it on nurses.
In a recent merger, where the intent may have been to eliminate the competition and reduce beds and nurses simultaneously, the nurses were asked to “reapply” for their jobs. So if the hospital has 200 RNs and only needs 100, they can just hire the 100 of the 200 applicants they want. They can then offer the RNs lower positions, even an LVN position, reduce the wage to an LVN level and get RN services. One RN instructor was hired at a lower level but given the responsibility of teaching RNs, which was the level at which she was not “qualified” to work.
She actually took care of twelve patients instead of four and performed all the functions she did before. Not only did she do two to three times as much work, but the hospital was able to pay her about six dollars an hour less which is about a thousand dollars less a month.
Did that show up as reduced patient costs? Probably not. Although such information is difficult to obtain, patients come into my office with bills for outpatient laparoscopic procedures totaling in excess of 10,000 dollars.
As physicians, we are held responsible for 80% of the cost of health care because it is our pen that writes the orders. But we incur health care costs without ever being aware of a price manual. Hospitals could provide a price manual. But we are told that doctors would then become selective to the detriment of patient care. This is just a way of preventing what wouldn’t serve their purpose. Is there anyone else on the health care team that is more qualified to make that cost/benefit judgment? Doctors must take charge. Not only would it benefit our patients, it would also benefit our nursing colleagues.
I don’t need to tell you that our profession is under attack from many flanks. Just as we were beginning to comprehend what hospitals, medical boards, Medicare, and others were doing to us, we now have HMOs and MCOs (managed care organizations) to threaten our existence. In Sacramento, hundreds of doctors have been deselected–lost their ability to earn a living. We are all so busy that we are having difficulty keeping up with our colleagues in trouble. We are bringing you the horror stories as they are brought to our attention to open our eyes so that we will be cautious. If you agree, please tell your friends and colleagues to tune in every week to these messages. It’s cheaper to do that on a regular basis than pay for even one hour of attorney fees.
The first thing in survival is to know who is threatening you. After surviving, the next step in reforming health care is to become aware of the nuances in taking care of patients so that we don’t make the matter worse. Stay tuned to these and other messages in the public and professional interest.