Hospital calls firefighters rather than hire more nurses

[alpinism]

St Michael's nurses call emergency dispatchers for help staffing the emergency department

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[Dred Pirate]

I don't think they did this because they wouldn't hire nurses, I mean, we just can't keep any around. Despite paying high bonus, travel pay, and other shift incentives, I mean, even at over $100 an hour for shifts, they go unfilled.

 

[Dr Mantis Toboggan]

St Michael's nurses call emergency dispatchers for help staffing the emergency department

And now that nurse gets to look for another job, probably.

 

[alpinism]

I don't think they did this because they wouldn't hire nurses, I mean, we just can't keep any around. Despite paying high bonus, travel pay, and other shift incentives, I mean, even at over $100 an hour for shifts, they go unfilled.

The hospital in question doesn’t have enough staffing cause they refuse to pay more than 40/hr salaries which isn’t much for that part of the country in Seattle.

 

[emergentmd]

Its supply and demand. They will not fill the spots until Supply matches demand which would only occur with increased pay b/c the jobs are crappy and RNs can get better pay for less work.

The more this happens, the more it will shine light on the situation. Unless hospitals start to increase revenue, increase staff pay, this will continue to happen. Something will have to give. Hospitals go bankrupt, Pt quality of care goes down, or Gov eventually take over healthcare.

Its not that easy as to say, go pay staff more bc if revenue doesn't go up then it closes.

 

[GonnaBeADoc2222]

Regarding revenues, it's hard for me to see what has changed between pre covid 2019 and post covid 2022. Our ED volume is back, all elective surgeries are back, yet my hospital system is still making it seem like we're in a financial crisis.

 

[sylvanthus]

Yaaaa thats my hospital. Our EMR has also been down for over a week. Were straight up winning atm. On the plus side, I have 2 patients in the ICU……

 

[Janders]

Regarding revenues, it's hard for me to see what has changed between pre covid 2019 and post covid 2022. Our ED volume is back, all elective surgeries are back, yet my hospital system is still making it seem like we're in a financial crisis.

Our hospital is pretty open with the finances, and I suspect they are similar around the country.

Income isn’t QUIET back to pre-pandemic levels, but its close when you look at volume of admissions, outpatient/inpatient surgery, outpatient lab/imaging. However LoS of patients is markedly higher, largely driven by inability to get people to SNFs and acute rehabs once done at the hospital, which eats your margins because for a lot of admissions you get $X, not $X/day…

Our ED volume IS back, though LWBS is markedly higher too….

But the issue is the cost of doing business is MUCH higher. The percentage of operating revenue that is eaten by the Salary/Wage/Benefits of employees is very different than pre-pandemic. This is travel nursing 3-4x cost of prior, CT techs costing more, all the US techs being travelers, etc etc.

Its actually hard to see a straightforward way out, you can’t push volume of care much more as we don’t have space/capacity… clearly you need to maximize the potential, do everything possible to improve hospital throughput, leave no OR slots open…

But the simple fact is the cost of providing care in this employment environment is more than what you earn as a hospital in this environment. Either payments need to go up, or cost (of staff mostly…) need to go down, or a massive systemic sea change needs to take place.

Its asking how to run a profitable McDonalds when your workers make $75/hr. Its hard to right size that with volume, especially if your McDonalds is constrained with a single drive through and small parking lot.

I suspect we see some systems/hospitals go belly up and the government steps in, but who knows.

I DO know that insurance companies are making a killing in this environment :-D

 

[GonnaBeADoc2222]

Our hospital is pretty open with the finances, and I suspect they are similar around the country.

Income isn’t QUIET back to pre-pandemic levels, but its close when you look at volume of admissions, outpatient/inpatient surgery, outpatient lab/imaging. However LoS of patients is markedly higher, largely driven by inability to get people to SNFs and acute rehabs once done at the hospital, which eats your margins because for a lot of admissions you get $X, not $X/day…

Our ED volume IS back, though LWBS is markedly higher too….

But the issue is the cost of doing business is MUCH higher. The percentage of operating revenue that is eaten by the Salary/Wage/Benefits of employees is very different than pre-pandemic. This is travel nursing 3-4x cost of prior, CT techs costing more, all the US techs being travelers, etc etc.

Its actually hard to see a straightforward way out, you can’t push volume of care much more as we don’t have space/capacity… clearly you need to maximize the potential, do everything possible to improve hospital throughput, leave no OR slots open…

But the simple fact is the cost of providing care in this employment environment is more than what you earn as a hospital in this environment. Either payments need to go up, or cost (of staff mostly…) need to go down, or a massive systemic sea change needs to take place.

Its asking how to run a profitable McDonalds when your workers make $75/hr. Its hard to right size that with volume, especially if your McDonalds is constrained with a single drive through and small parking lot.

I suspect we see some systems/hospitals go belly up and the government steps in, but who knows.

I DO know that insurance companies are making a killing in this environment :-D

Sounds almost exactly like my system.

Easy way to fix travel nursing nonsense: legislate or make it accepted countrywide culture that hospitals do not hire travelers that live less than x miles away from the hospital. My system is literally trading nurses with the next hospital over.

 

[Mad Jack]

Regarding revenues, it's hard for me to see what has changed between pre covid 2019 and post covid 2022. Our ED volume is back, all elective surgeries are back, yet my hospital system is still making it seem like we're in a financial crisis.

It's the inability to hire local nurses and staff because travel positions pay better, so they have to hire travelers since there is no local supply, thus creating an endless cycle of excess spending

 

[NYEMMED]

Regarding revenues, it's hard for me to see what has changed between pre covid 2019 and post covid 2022. Our ED volume is back, all elective surgeries are back, yet my hospital system is still making it seem like we're in a financial crisis.

There are multiple parts to this.

Travel nurses cost much more. Supplies cost more now with inflation. Volume is still slightly lower. Hospitals cannot increase their charges.

This all leads to revenue decline.

Actually right now nationwide there are only a handful of hospital systems making any profit, vast majority are having huge losses

 

[NYEMMED]

The state department of health the TJC are about to swarm this facility… can almost assume that nurse will be fired as well.

 

[southerndoc]

The state department of health the TJC are about to swarm this facility… can almost assume that nurse will be fired as well.

I'm sure if that nurse is fired, there will be litigation that will ensure that nurse has a comfortable lifestyle ahead of her.

 

[Dred Pirate]

Sounds almost exactly like my system.

Easy way to fix travel nursing nonsense: legislate or make it accepted countrywide culture that hospitals do not hire travelers that live less than x miles away from the hospital. My system is literally trading nurses with the next hospital over.

I know so many nurses who have gotten around this rule but using a family member or friend as their home address if said person lives out of state or 50 miles away (or whatever the rule is). Then they live at home and travel to a hospital in our same city.

 

[Dred Pirate]

Actually right now nationwide there are only a handful of hospital systems making any profit, vast majority are having huge losses

My wife works for of those large private fancy university hospital system - she has gotten a 25% raise over the past 18 months - none of which is merit based - this is system wide push to match inflation and keep their employees for leaving for other places. No that being said the university has over a $10 + billion endowment - so I don't think they are hurting for money, but they seem to play by a different set of rules than most hospitals in the country.

 

[AlmostAnMD]

Yaaaa thats my hospital. Our EMR has also been down for over a week. Were straight up winning atm. On the plus side, I have 2 patients in the ICU……

2 patients that you KNOW about. Your EMR is down, might want to do a manual check

 

[RustedFox]

There are multiple parts to this.

Travel nurses cost much more. Supplies cost more now with inflation. Volume is still slightly lower. Hospitals cannot increase their charges.

This all leads to revenue decline.

Actually right now nationwide there are only a handful of hospital systems making any profit, vast majority are having huge losses

Sounds like we need less administrators.
Fire a few.
Frees up salary, benefits, quarterly bonuses.
All sorts of benefits here.

 

[RustedFox]

Sounds almost exactly like my system.

Easy way to fix travel nursing nonsense: legislate or make it accepted countrywide culture that hospitals do not hire travelers that live less than x miles away from the hospital. My system is literally trading nurses with the next hospital over.

I cant get behind this.
I drive almost 45 minutes one way to my gig, passing 3 hospitals on the way there.

Why?
Because eff THOSE places.
Why are RNs different?

 

[HemeOncHopeful19]

I cant get behind this.
I drive almost 45 minutes one way to my gig, passing 3 hospitals on the way there.

Why?
Because eff THOSE places.
Why are RNs different?

Yeah the real answer is get rid of non-competes and credentialing delays that keep us from doing the same thing.

 

[RustedFox]

Yeah the real answer is get rid of non-competes and credentialing delays that keep us from doing the same thing.

Now that I'm more awake, it's 4 hospitals and 1 FSER that I drive past.

The one hospital is so bad that all of us at CurrentJob keep getting phone calls to join the new ER group that they're trying to cobble together and the answer is a universal "no".

 

[Ho0v-man]

I feel like this all could’ve been avoided in 2020 if our fearless leaders would’ve just paid their staff nurses to stay.

 

[namethatsmell]

I feel like this all could’ve been avoided in 2020 if our fearless leaders would’ve just paid their staff nurses to stay.

Travel nurse game was already well underway, but I agree their major slap in the face to health care staff (ie furloughs and layoffs) early in the pandemic was fuel on the fire

 

[namethatsmell]

The only hospitals I hear about that don't have massive nursing shortages are some municipal/governmental shops, Kaiser, state-supported academic health systems, and maybe the rare non-profit hospital.

And what do they all have in common? Golden handcuffs. Ie benefits that are now rare in health care-- heavily-subsidized good health insurance, tuition benefits for their kids, FSAs, medicolegal shielding by their employer, PTO that goes up over time...and, of course, legitimate retirement benefits and/or formal pensions. And a sense of job security provided they do their job. Once people get a taste of these things, they can be awfully hard to walk away. It's also no coincidence that places that chose to offer all these benes typically treat their people better than the average shop in town.

The rub is that for the last several decades, most health corps could've cared less about offering these things to their employees. And they are now financially incapable or unwilling to offer them now...naively thinking that their staffing situations will eventually get better. Wellllll that seems increasingly difficult to believe.

It only takes one health system in a big metro offer stuff like this to attract and retain staff and talent before all the others health system feel the pressure to fall in line to stay competitive...

 

[RustedFox]

The only hospitals I hear about that don't have massive nursing shortages are some municipal/governmental shops, Kaiser, state-supported academic health systems, and maybe the rare non-profit hospital.

And what do they all have in common? Golden handcuffs. Ie benefits that are now rare in health care-- heavily-subsidized good health insurance, tuition benefits for their kids, FSAs, medicolegal shielding by their employer, PTO that goes up over time...and, of course, legitimate retirement benefits and/or formal pensions. And a sense of job security provided they do their job. Once people get a taste of these things, they can be awfully hard to walk away. It's also no coincidence that places that chose to offer all these benes typically treat their people better than the average shop in town.

The rub is that for the last several decades, most health corps could've cared less about offering these things to their employees. And they are now financially incapable or unwilling to offer them now...naively thinking that their staffing situations will eventually get better. Wellllll that seems increasingly difficult to believe.

It only takes one health system in a big metro offer stuff like this to attract and retain staff and talent before all the others health system feel the pressure to fall in line to stay competitive...

Not the spirit of the term "golden handcuffs" (I think? ... I'm really, really getting tired now), but you're absolutely correct.

This sounds like the hospital system being a "Good Guy Greg".

 

[sylvanthus]

Epic may be up in a week, hopefully we can get back up and running before everyone ragequits.

 

[sylvanthus]

Prob just pissed off admin but F it. An outside hospital wanted to transfer a pt to
my barely functional hospital because their cardiologist is here.( post arrest) I made sure family was fully aware we have no EMR and are barely functional. They still want to transfer. Whelp they better not bitch if and when theres a bad outcome. Cant believe were taking transfers at the moment. Nm its revenue, of course we are.

Cards isnt even gonna do dick until they are “extubated and have an appropirate mental status” or whatevs. Ahh well F it outta my hands.

 

[turkeyjerky]

Prob just pissed off admin but F it. An outside hospital wanted to transfer a pt to
my barely functional hospital because their cardiologist is here.( post arrest) I made sure family was fully aware we have no EMR and are barely functional. They still want to transfer. Whelp they better not bitch if and when theres a bad outcome. Cant believe were taking transfers at the moment. Nm its revenue, of course we are.

Cards isnt even gonna do dick until they are “extubated and have an appropirate mental status” or whatevs. Ahh well F it outta my hands.

That sounds like the most ridiculous transfer ever (and I’m typically a big proponent of xfering for continuity of care). I can only imagine what a pain the ass that family must be. Maybe a post arrest Lvad pt should get transferred, but failing that…

 

[FiremedicMike]

Sounds almost exactly like my system.

Easy way to fix travel nursing nonsense: legislate or make it accepted countrywide culture that hospitals do not hire travelers that live less than x miles away from the hospital. My system is literally trading nurses with the next hospital over.

I think that’s already in place, and the distance is a shockingly low 50 miles. In my state, we have nurses from one city traveling to the next closest city for travel pay, and the nurses in that city are “traveling” back to the original city.

 

[alpinism]

The only hospitals I hear about that don't have massive nursing shortages are some municipal/governmental shops, Kaiser, state-supported academic health systems, and maybe the rare non-profit hospital.

And what do they all have in common? Golden handcuffs. Ie benefits that are now rare in health care-- heavily-subsidized good health insurance, tuition benefits for their kids, FSAs, medicolegal shielding by their employer, PTO that goes up over time...and, of course, legitimate retirement benefits and/or formal pensions. And a sense of job security provided they do their job. Once people get a taste of these things, they can be awfully hard to walk away. It's also no coincidence that places that chose to offer all these benes typically treat their people better than the average shop in town.

The rub is that for the last several decades, most health corps could've cared less about offering these things to their employees. And they are now financially incapable or unwilling to offer them now...naively thinking that their staffing situations will eventually get better. Wellllll that seems increasingly difficult to believe.

It only takes one health system in a big metro offer stuff like this to attract and retain staff and talent before all the others health system feel the pressure to fall in line to stay competitive...

The fundamental problem with most healthcare systems is they continue to view healthcare workers as nothing but interchangeable widgets that work in a factory assembly line making products for their customers. When you have experienced charge nurses who've been there for ten years making significantly less than newly graduated nurses who've been there for ten days you'd be a fool not to leave and became a travel nurse.

 

[collegestud2013]

The fundamental problem with most healthcare systems is they continue to view healthcare workers as nothing but interchangeable widgets that work in a factory assembly line making products for their customers. When you have experienced charge nurses who've been there for ten years making significantly less than newly graduated nurses who've been there for ten days you'd be a fool not to leave and became a travel nurse.

Travel nursing is going away fast across the board. It was a short-term staffing solution during the pandemic when the patient census in hospitals surged and hospitals needed urgent coverage, but the economics of it make no sense in the long run. Paying >$100/hr to onboard an new RN (that probably doesn't know your hospital system and is only there to cover a small amount of shifts) doesn't make financial sense when you can probably retain your current fulltime staff (who already know your system) by just paying them a bit more. More (but not all) hospitals are just realizing that it's much more cost effective in the long run to reduce turnover of full time staff even if you have to pay them a bit more upfront.

 

[Fpg1245]

Travel nursing is going away fast across the board. It was a short-term staffing solution during the pandemic when the patient census in hospitals surged and hospitals needed urgent coverage, but the economics of it make no sense in the long run. Paying >$100/hr to onboard an new RN (that probably doesn't know your hospital system and is only there to cover a small amount of shifts) doesn't make financial sense when you can probably retain your current fulltime staff (who already know your system) by just paying them a bit more. More (but not all) hospitals are just realizing that it's much more cost effective in the long run to reduce turnover of full time staff even if you have to pay them a bit more upfront.

Long term thinking isn’t in the admins thought process. Honestly they don’t see the value treating employees any better and won’t see the consequences of that until it’s too late.

 

[RustedFox]

Long term thinking isn’t in the admins thought process. Honestly they don’t see the value treating employees any better and won’t see the consequences of that until it’s too late.

Hospital admins and MBA-Bro types have to be some of the most ostriched people there are. I had to play golf with one a few times (*had* to; i.e. - there was no way out if it) and the things that he said really made me wonder if he even lived on this planet.

 

[Fpg1245]

Hospital admins and MBA-Bro types have to be some of the most ostriched people there are. I had to play golf with one a few times (*had* to; i.e. - there was no way out if it) and the things that he said really made me wonder if he even lived on this planet.

Do tell. Hopefully the details don’t out you

 

[RustedFox]

Do tell. Hopefully the details don’t out you

It was years ago. I have no recollection of any specifics other than the guy had an awful swing, and used business buzzwords the entire time.

Like, bro... hit your shot. We don't need the analysis. You're gonna miss the green in regulation anyways so STFU about it.

 

[Janders]

Travel nursing is going away fast across the board. It was a short-term staffing solution during the pandemic when the patient census in hospitals surged and hospitals needed urgent coverage, but the economics of it make no sense in the long run. Paying >$100/hr to onboard an new RN (that probably doesn't know your hospital system and is only there to cover a small amount of shifts) doesn't make financial sense when you can probably retain your current fulltime staff (who already know your system) by just paying them a bit more. More (but not all) hospitals are just realizing that it's much more cost effective in the long run to reduce turnover of full time staff even if you have to pay them a bit more upfront.

What full time nurses? We’re majority traveler, minority per diem / part time, a few full time holdouts. Same at all the ERs around here. How does the Csuite get off the moving treadmill of paying waves of travelers Mega-bucks? If we say to the FT people we’ll give you a 20% raise and retention bonus for 2 years… we still need a ton of travelers! It seems to be a rather long term project to slowly rebuild a majority FT nursing workforce, slowly attracting nearby workers from their incredibly lucrative travel gigs.

If one hospital decides to just stop hiring travelers… well they won’t have any nurses and they will go down in flames.

If all the regional hospitalist collude and stop hiring travelers at once… it’ll be a clinical **** show going into flu season, and can you imagine the headlines!

We all love giving hospital Csuites lots of crap, but there is not an easy way out of the current nursing/CT tech/ US Tech 80% travelers game. I agree the best approach is to give excellent full time wages with nice benefits to grow a stable long term team… but much easier said than done, especially when your current budget is losing millions per year.

 

[RustedFox]

What full time nurses? We’re majority traveler, minority per diem / part time, a few full time holdouts. Same at all the ERs around here. How does the Csuite get off the moving treadmill of paying waves of travelers Mega-bucks? If we say to the FT people we’ll give you a 20% raise and retention bonus for 2 years… we still need a ton of travelers! It seems to be a rather long term project to slowly rebuild a majority FT nursing workforce, slowly attracting nearby workers from their incredibly lucrative travel gigs.

If one hospital decides to just stop hiring travelers… well they won’t have any nurses and they will go down in flames.

If all the regional hospitalist collude and stop hiring travelers at once… it’ll be a clinical **** show going into flu season, and can you imagine the headlines!

We all love giving hospital Csuites lots of crap, but there is not an easy way out of the current nursing/CT tech/ US Tech 80% travelers game. I agree the best approach is to give excellent full time wages with nice benefits to grow a stable long term team… but much easier said than done, especially when your current budget is losing millions per year.

See my above post about where to find millions per year.

 

[FiremedicMike]

Travel nursing is going away fast across the board. It was a short-term staffing solution during the pandemic when the patient census in hospitals surged and hospitals needed urgent coverage, but the economics of it make no sense in the long run. Paying >$100/hr to onboard an new RN (that probably doesn't know your hospital system and is only there to cover a small amount of shifts) doesn't make financial sense when you can probably retain your current fulltime staff (who already know your system) by just paying them a bit more. More (but not all) hospitals are just realizing that it's much more cost effective in the long run to reduce turnover of full time staff even if you have to pay them a bit more upfront.

Travel nursing has been around since I was a baby ER tech back in 1999, it just wasn't anywhere near as popular.

But I agree, if FiremanMike was running the hospital world, pay the staff RNs $20 more an hour. They'd be more likely to stick around instead of driving two hours per day and the hospital would save a ton compared to what they're paying the travelers.

 

[GonnaBeADoc2222]

What full time nurses? We’re majority traveler, minority per diem / part time, a few full time holdouts. Same at all the ERs around here. How does the Csuite get off the moving treadmill of paying waves of travelers Mega-bucks? If we say to the FT people we’ll give you a 20% raise and retention bonus for 2 years… we still need a ton of travelers! It seems to be a rather long term project to slowly rebuild a majority FT nursing workforce, slowly attracting nearby workers from their incredibly lucrative travel gigs.

If one hospital decides to just stop hiring travelers… well they won’t have any nurses and they will go down in flames.

If all the regional hospitalist collude and stop hiring travelers at once… it’ll be a clinical **** show going into flu season, and can you imagine the headlines!

We all love giving hospital Csuites lots of crap, but there is not an easy way out of the current nursing/CT tech/ US Tech 80% travelers game. I agree the best approach is to give excellent full time wages with nice benefits to grow a stable long term team… but much easier said than done, especially when your current budget is losing millions per year.

They way to stop it was to not let it happen to begin with.

They rely on self report of address to determine "eligibility" for travel assignments. This led to people who literally live 10 mi away, putting their gammy's north carolina address in.

They should have formally screened these people to see where they actually lived.

These travel rates are now one of my system's largest expenses, and likely is the reason why I haven't had a raise since COVID.

 

[Janders]

See my above post about where to find millions per year.

You could remove the entire C suite of my hospital and not come close to covering the cost of travel nurses, so I need more cuts than that!