Nurse: Hospital cost-cutting hurts care
Sunday's column was on the complaints being made by hospitals because they're getting a guaranteed revenue increase at a time when many businesses are seeing revenue and price plunges.
The upshot was: They haven't done enough to cut costs and should stop complaining. Got lots of responses, including this good one from a registered nurse. Agree with many of her points, but there are many ways hospitals can cut costs without cutting back on nurses and quality of care: Close and consolidate hospitals; cut management padding; stop spending millions to subsidize doctors -- and that's just in overhead. Hospitals and doctors also prescribe and perform far too many unnecessary procedures.
Jay: I read your article in the Balt. Sun printed on 7/18 with some skepticism. The article drew my attention as I am a Registered Nurse who celebrated 29 years of nursing this last June. I was a nurse before Managed Care came on the scene. You need to interview the working people who are involved in acute care. Although most of my nursing experience has been in acute care, I left that environment in 2008 and vowed to never return. Any professional who has been in the acute care environment within the last 10 years will inform you that cutting costs is much easier said than done.
As someone who has admitted patients from the ER, I can tell you that people are not coming into the healthcare environment as soon as they need to. Many of our fellow Maryland residents either cannot afford or do not have access to a Primary Care Physician and therefore are not followed-up on a routine basis and use the ER for simple ear infections, a small laceration, something that many times could have been treated in an urgency center or in a Physician's office. That cost gets passed on to all of us. Patients who have chronic illnesses are coming in sicker, they are either never taught how to maintain their chronic illness or they wait too long to seek medical attention therefore, being more ill than is necessary and taking more intense medical care for a longer duration. Managed Care created a market for the insurance companies and helped to curtail Physician costs by preventing the Physicians from testing their patients from head to toe. Someone who came in for abdominal pain could have been checked for heart issues etc. Now, when a patient comes in through the ER and is admitted, they are given a diagnosis and categorized within that diagnosis to receive certain tests, treatments etc. What happens when a patient does not fit the box???? Many times an unrelated symptom may occur which extends the patient's stay and thus medical cost. The "box" helps hospitals obtain reimbursements, it also prevents additional, unrelated testing etc. Technology has indeed helped make medical treatments more streamline, but it comes at a price. A nurse is now tethered to a computer as well as caring for patients at the bedside. Yes, the bedside!!!! Nurses still see patients at the bedside, and if you have not seen your nurse for an hour or more it is because she or he has been seeing the other 8-10 patients they must take care of due to staffing cuts. The technology available today cannot tell if a dressing is saturated, if a patient is choking, if someone needs a urinal. It still takes a pair of human eyes and the skills to interpret symptoms and put it all together. Yes, I do believe the management positions are top-heavy, but eventually those of us at the bedside seek higher positions and if management keeps cutting staffing both managerial and clinical there will be no one available to care for the patients!!!! Taking care of people, is not like running any other business; people die. Everyone cares about the Maryland economy, we have to feed our families too!!! Cutting staffing and wanting cheaper, better healthcare does not work. Believe me, I have seen how healthcare has disintegrated since patients are no longer the focus and reimbursement rules. Hug a nurse today!!!
