Nurses and the Bottom Line

An interesting article popped into my email today. It's titled The New Rainmakers, and discusses the role of nurses in hospital budgets.

Nurses cost money. In fact, their salaries are perhaps the biggest staffing cost a hospital must absorb. Over the past few decades, though few chief executive officers like to admit it, those costs have caused many hospitals to encourage their nursing managers to try to do more with less--less nurses per patient, that is.

Staffing is the biggest cost center for all providers of care to seniors, whether hospital, nursing home or assisted living communities. When financial times are tough - and even when they're not - cutting these costs directly affects the bottom line. When revenue slips, usually related to a lower census or occupancy, the biggest area to cut is staff wages - and that means staff hours.

With increasing emphasis being placed on quality and patient satisfaction by health plans and consumers alike, hospitals are realizing that reimbursement increasingly depends on how well nurses do their jobs, making nurses, as a new PricewaterhouseCoopers report says, the "rainmakers" of the hospital.

In my own local newspaper, printed tables display the patient satisfaction scores at all of our local hospitals side by side. Many of us have a choice in medical providers, and viewing these scores will undoubtedly help us choose a provider.

And yet, says Janet Hinchcliff, author of What Works: Healing the Healthcare Staffing Shortage,

"I'm not sure they [hospital administrators] realize the interconnections. This is going to be a big deal for them," she says. "Quality and patient satisfaction scores will show that a great deal of how a hospital is perceived has to do with the nursing staff. So they're a revenue contributor from a payment side, but also in terms of the fact that people are going to those hospitals because the nurses are really good."

What happens when a hospital chooses to spend just a little more in staff wages?

What about training expenditures, especially in the areas of leadership, customer relations and communication?

Repeated studies have shown that adequate levels of staffing and above average training investments DO have a significant return in the longevity of staff and, consequently in customer satisfaction.

Says Lilee Gelinas, another hospital executive (vice-president and chief nursing officer with VHA Inc.)

Nurse turnover among those with three years or less experience at some hospitals is 45 percent to 55 percent. "We can't hold on to the new kids coming out of school. Retention is tied to stability in the patient care environment, it's tied to nursing excellence, and it's tied to patient care excellence."

Excellence in care is apparently a language that the top management level didn't understand. But when the excellence of care and the happiness of patients reflects directly on the bottom line dollars, that's starting to speak their language.

It's a Baby Boomer Theme - Caring for Aging Parents

We were at an end-of-summer garden party last weekend. The day was unexpectedly warm and sunny, and we arrived to the beautiful creek-side yard of our friends Lane and Maureen. Many of the people there were friends we had known for decades.

As we mingled and caught up with old friends, we shared what had occupied our time this past summer.

"We didn't go anywhere this summer. We were busy all summer selling my mom's house and helping her move into a small house just a mile away from our home," said Bridgett. "I go over to her house every day just to visit, and most evenings we'll either cook dinner or barbecue at her house so we can eat together. It's been a challenge, but it's rewarding seeing my mom so much happier, and closer to us so we can help more."

"We had to move my mom into a new care home this summer," said Linda. "Her Alzheimer's has been getting worse and worse, and then we were told we had to move her. It took all summer to find a place, get her settled in and hope for the best."

As we worked our way around the party, we noted that every one of us were dealing with similar problems: aging parents who needed our help, work and careers - or making the transition to retirement, which is also a challenge for many, and our own children.

We're not alone. 13 million baby boomers throughout the US - just like us - are all facing the need to care for their elderly parents. Some are worrying long distance, feeling the need to travel as often as possible to arrange care. Some move parents into their own homes, resulting in caregiving close at hand, but often increasing family tensions at the same time.

Health care and financial challenges (how will we pay for all the services we need) are increasingly common topics of dinner tables and garden parties.

For us and our friends, it was eye-opening to hear how many of us are experiencing a different life-style than we planned for this stage of our lives. How many of us are finding that time is our most valuable asset, just when we thought maybe life would slow down a bit, and we could enjoy it a little more.

We're just starting down the path of challenges, too. We'll need all the mutual support, all the resources and all the ingenuity we can dig up to support our own families - and each other - as we face coming caregiving crises.

In the meantime, we'll enjoy these last days of summer, and we'll value knowing that we're not alone in this drama. And maybe that will make it a little bit easier to keep moving on, searching for solutions that fit just right for our families.

Compassion Fatigue for a Reason - and why it hurts you

You may never heard of a condition that you might have. It's called by some Compassion Fatigue, and it refers to that point in time when stress, fatigue and tension start overtaking compassion and caring.

It's a feeling common to caregivers of individuals with Alzheimer's disease, many of whom suffer more physical and emotional ailments than the people in their care.

It's becoming increasingly common with professional caregivers, too. These are the home care workers, the nursing assistants and the assisted living caregivers who work for the love of the job and their clients - not the money.


In times of economic downturn, these are the folks who get hurt the most.

Many of them have no company-paid health insurance. Their real wages, in terms of buying power has actually decreased, according to PHI.

This decline in wages is even more distressing when you compare caregivers' wages to wages earned in other occupations.



It's no wonder that many of these hardworking individuals are being stretched even tighter in these challenging economic times.



PHI lists the 9 Elements of a Quality Job. It's their mission to advocate for direct care workers to achieve these elements:

1. Family sustaining wages (we're not moving in the right direction on this one yet).

2. Affordable health insurance (in my state - Oregon, there are 612,000 people without insurance. In tough economic times, this number increases dramatically).

3. Full-time hours (many caregivers work irregular, part time shifts. It's tough for many, especially home care workers, to cobble together the equivalent of full time work).

4. Excellent training (my area of passion; a pivotal area of determining the quality of care that will be delivered).

5. Participation in decisions (empowering employees means greater job satisfaction. It means the good ones might just stay).

6. Career advancement (an opportunity through training to advance through a "career ladder" to increased opportunity and pay).

7. Linkages to services (removing barriers to work for some who would be great caregivers but need support to get started).

8. Supervisors who set clear expectation and encourage and support as well (leadership is one of the greatest needs in health care today).

9. Owners and managers who are willing to truly implement a system of quality improvement.

These 9 element break down into three main areas: Compensation, Opportunity and Support.

Without these elements, those individuals who provide care to my mom and yours will suffer enough compassion fatigue to possibly lose them from the caregiving workforce.

And that will hurt me. And you. And our elderly loved ones.

It's time for all of us to better understand this challenge and continue to advocate for relief for these very valuable, very caring individuals.