Surviving Modern Healthcare: A Nurse' Toolkit
Dr. Val Gokenbach
The dynamics surrounding the modern healthcare environment is placing incredible pressures on hospitals and other types of healthcare organizations to continue to reduce costs and increase productivity. It appears that many hospitals have focused solely on productivity, forgetting the mission of healthcare organizations to serve those who need our help and to make a difference in the lives of others. The argument of no margin no mission is certainly a reality, but when you look at where cuts are made, it is oftentimes at the point of service where the manpower, especially nurses, is vitally needed.
Several factors contribute to this dilemma. Healthcare reform will definitely reduce payments to hospital and physicians, reducing revenues used to fund organizational operations. Pay for performance, although a positive step to improve quality, will further reduce revenues as hospitals scramble to improve process to meet these targets. Some of these quality targets have no research to substantiate that they will improve quality and ultimately save lives. Technology and the cost of drugs are also facing tough economic times, forcing their costs to rise as well, which will transfer to the increase cost of technology and drugs in the hospitals. All of this will reduce the dollars that hospitals will have to spend on expenses. Being a service industry, the bulk of costs in healthcare reside in salaries, the greatest being within the nursing department.
These economic challenges are acutely felt by the nursing staff at the bedside. Many hospitals and healthcare organizations are laying off staff, freezing hiring and cutting services that increase the workload of the nurse. This increased workload not only causes stress for the nurses, but it can also create an unsafe environment for the patients. The decision to reduce nursing staff and services that affect the bedside are counter-intuitive and actually hurt hospitals more than help. The competition for patients in many demographic areas is fierce, and anything that reduces the level or quality of care at the bedside will increase the patient’s dissatisfaction and encourage them to seek services in other organizations. Less staff increases the chances of adverse events for the patients, increasing the risk of lawsuits and negative public press. All of this goes against the mission of hospitals and healthcare organizations to protect and save lives, but if the administration is looking at the quick fix and forgetting the long-term potential problems, they are setting their organizations up for failure. As an administrator for 35 years, I never understood the hiring freezes in areas where we know we need the staff. This practice results in the use of overtime which increases costs. Another quick fix in many organizations is to lay off ancillary staff such as housekeepers and dietary aides. Guess what? The work still needs to be done, so it ends up the responsibility of the nurse. These tasks that should be done by someone else further pull the nurse away from the vital responsibility of the science of patient care. The answer is radical changes of processes with increased technology to decrease the workload of the staff.
Despite the challenging environment of healthcare, there are things that nurses can do to improve their work and personal life. This series will focus on many topics vital to the needs of nurses, including tips and strategies to put control back into your life, both personally and professionally.