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    Sunday, June 27, 2004

    Strike Over? The hospital and nurses have reached a tentative agreement. Details aren't available, but it sounds as if the nurses got pretty much what they wanted - "raises and other improvements." Now we'll have to wait and see what services the hospital will have to cut to pay for them. Fewer new hires? Probably. Which means that there will be more reliance on nurses' aides and poorer patient care.

    UPDATE: Nurse Alwin at Code: the WebSocket says I'm wrong:

    I know that' the conventional wisdom is that with wage and benefit increases come poorer care and more aides. However, my experience has been just the opposite at my House of Pain.

    With a better wage and benefit package we were able to attract more RN's to apply and be pickier about whom we hired. As attrition took it's usual toll, we retained more of the 'solid' nurses and were able to lose the ones that flitted from hospital to hospital looking for Nirvana. It was a real issue, with 5 major and numerous smaller community hospitals competing for bodies in the Portland metro area.

    What are your nursing vacancy rates ? It could well be that you are using nursing aides because you can't hire enough RNs and they are filling slots to put bodies at the bedside. We run an almost completely RN staff at our joint, in a part of the country that has some of the lowest Medicare reimbursement rates due to competition from the Kaiser Permanente HMO network (which has been in the area
    since WWII). With some of the highest benefit/pay packages in the area we are turning out some of the highest budget surpluses, patient, and physician satisfaction numbers in the area.

    It could get better now, rather than worse. I'll be interested in hearing how things resolve; it usually takes about a year for feathers to settle locally before any real team-building re-occurs.

    I'm not sure what the philosophy is behind the over-reliance on nurses' aides in the hospital. But, having once been in a practice owned by them, I suspect it's because the administration believes its a cost-saver. They were very gung-ho on hiring physician's assistants and nurse practitioners in the doctor's offices they owned so that the doctors could "see more patients" at lower costs to the hospital. Of course, the doctors don't really see the patients, the physician-extenders do. They made it clear that they would rather do this than hire new doctors. I suspect that the same thing applies with the nurses' aides. But the problem with that approach, at least in the hospital setting, is that the nurse doesn't get to know the patient at all and the nurse's aides don't necessarily have the knowledge to know when something isn't right with the patient. We'll see how things go, but I'm not optimistic.

    posted by Sydney on 6/27/2004 08:22:00 AM 0 comments


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