In small communities it doesn't take long for info to become public knowledge, but I haven't really heard too much rumble about health care and jobs in our community. Some might snicker at the fact that even health care professionals (once thought to be safe in hard economic times)are at risk. But what worries me more is the risk to the members of our community who become patients. We all know that nurses work hard to protect us even in hard times, but at what point will their efforts not hold up to the cuts being made? They all have a sense of moral responsibility to help those in our community and will work long and hard to protect their patients, but at what point in Holy Rosary's taking advantage of the nurse's sense of responsibility will the nurses break? They have families to feed and care for too, the hospital can't expect them to work 1/2 their hours or less and perform 25-100% more work and responsibility while they are there. How is each patient going to feel when they essentially are getting 50% less time for care than what they should have. It just isn't safe for the nurse or the patients. It's not unheard of, it's being done in hospitals around the country where there is no one to keep it from happening, but does it make it OK or right? No.

There is no 'safe' job. The reality of this economy dictates that we have to make changes in the way we do things, as well is in our expectations. Often we turn to the overworked nurse as an example. It makes for a plaintive cry, but the accuracy is something else. The average income for an RN in Montana $47,996. Across the US it is $56,242. This is hardly a drop in the bucket for a two-year degree.

When we, as a society, value healthcare- particularly preventive care- the strain on our healthcare system will be relieved. While we continue to focus on treating emergent symptoms, and hospitalize people, only to release them within a couple days without true ongoing care to prevent yet another inpatient stay, we will continue to strain these systems. People unable to afford the doctor's appointments that will keep them healthy place a huge burden on the healthcare system when they are in crisis. The $100 bill they couldn't afford the week before becomes a multi-thousand dollar bill they still can't afford. That cost must be absorbed elsewhere.

Instead of focusing on the poor beliegured nurse, or the neglected patient, let's focus on the system. When we fix that, the rest will be self-correcting.

jab stated
"The average income for an RN in Montana $47,996. Across the US it is $56,242. This is hardly a drop in the bucket for a two-year degree."

A LPN is a 2 year degree. A RN is a 4 year degree.

http://milescc.edu/Degree...h/Nursing/

This is a 4 semester program allowing one to apply to become eligible for an RN.

I believe you are thinking of a BSN, which does require a 4 year degree.

There is apparent discrepencies in what the industry considers as educational requirements for your RN.

I found several sources supporting what I stated and several indicating a 2-3 year associates program is also eligible.

With clinicals included I don't think a RN is really getting paid strictly off the merits of a 2 year degree. I've also been told the exam that is needed to get certified as a RN is ridiculously difficult to pass without the extended benefit of 2 years of additional learning. Possible, but extremely difficult. Most candidates spend 6-8 months preparing. This is consistent with what I've found looking around at this information.

Either way it is a great job considering the educational requirements.

Your right, to fix health care as a whole and really focus on preventive health care sure would fix a lot of problems, but do you really foresee this happening anytime soon? In the meantime let's not risk the safety of the patients. We can blame people for not following up or having regular check-up as they are encouraged, but even people who can afford these things or have insurance to cover these bills still do not do so. We can plan on being as pro-active as we can, but no matter what, there will be many times when we will have to be re-active. In these cases, do you want enough trained professionals to help you? What is there to keep nurses in their jobs if not the benefits (including enjoying their profession and money). If they are going to be making 1/2 of what they have been and be forced to work under unhealthy, unsafe, and unhappy conditions, what keeps them in that profession? Why not pick a profession in which peoples lives aren't in your hands and have the same benefits?

RNs can be either 2 year (associate degree - ADN) or 4 year (bachelor degree - BSN). Both take the same Nursing Licensure Exam and have to meet the same continuing education requirements. Licensed Vocational Nurses (LVN) or Licensed Practical Nurses (LPN) (again varies by state) are 1-2 year programs and they take an exam also. Generally for pay, someone with a bachelor's degree will make more than an associate degree. The ADN program is focused on technical skills and clinicals. The BSN program focuses on theory (nursing theory, change theory, organizational theory, etc.), evidence based research, sciences (biology, microbiology, pathophysiology, etc. along with the technical and clinical.

In central TX I'm signing off on salaries of $50-60K for med-surg and $70-80K for specialty areas (L&D, ER, ICU). We are near the low end of the local market. I base the salary on experience, education and national specialty certifications. Salaries vary based on supply and demand. Certain specialties are harder to get than others, so we pay more for them than the easy to fill positions.

When I became a nurse 21 years ago, there was a shortage. There has been a peak and trough cycle since then. We're currently again in a shortage - not necessarily just because of low pay - but because nursing programs can't expand to meet the demand, the age of working nurses is higher and they are retiring, long hours, demanding jobs, etc. also play into it. There is no single reason. Certainly patients deserve safe, responsive care. It's difficult to measure nursing care in terms of dollar value which is what the bean counters look for in making their budget decisions.

How can we reduce the cost of health care without affecting every level of service? We all are facing great challenges to do more with less. What are the solutions?

Bruce? Get rid of the overhead and profit. Reduce, or streamline the management before you start cutting the providers.

.....back when I was a kid......my doctor worked out of a small office with one or two nurses that also doubled as receptionists, records keepers, and house keepers (they did the cleaning). He handled the billing and book keeping. There was a large area of town called Pill Hill because it was where the doctor's offices and pharmacies were. The hospital didn't have fleets of management and administrators, it had a director, a book keeper, some maintenance and housekeeping staff, and a hoard of nurses keeping the place running.

Health care has transformed from a profession to a business and there are too many fingers in the pie. That goes for administration, insurance, equipment manufacturers and distributors, pharmaceutical manufacturers/suppliers/distributors/reps/corporate pharmacies, etc.

Another step in the right direction would be to stop building palatial structures to house the industry- the patient pays for it and I for one don't give a damn what the outside of a hospital looks like when I'm headed into the E.R. for stitches.

You are hitting exactly on my next point. Here's a thought... perhaps we should stop paying the CEO (in a small town I might add) $350,000/yr!! That is about double what the hospital's highest earning physician makes from what I understand. (I hear there is a place to find the top earners and their salaries, but I'm having a hard time finding it) Also, how does a marketing/foundation director in a small town earn >$100,000/yr? Physicians are truly saving lives and helping people every day and put their careers on the line just by doing their job (everyone is so sue happy and fail to understand that there will always be unforeseeable events).
All the community sees about this hospital is the upper-ups getting "fat-n-happy" off patients money. Sure they got a new MRI machine (for the low price of $100,000 to >$1 million), didn't the old one work just fine? Not to mention, when you go to Billings to see your specialist they are going to want you to have one done there, so what was the point in wasting your money to get one done here? Suppose the ER remodel could have waited so people won't lose their jobs, but no...that's from a different budget. Oh ya, how about the 6th, I think it is, remodel of the clinic? You don't have any patients or employees, but we have one pretty hospital. Maybe it can make money if we put it in a TV series. It is nice to have a pretty hospital, but is this the time for it and is it necessary NOW?

I agree. Way to much spent on form not function. Unfortunatly managment is always the last place to take a cut. The claim for all the support personal is the complexity of insurance and Medicare/Medicaid billing/regulations. Solution? Dump the insurance providors and streamline the [email protected]'s! OMG! Sounds like 'national health care!'

Why is everyone arguing about the Nurses, when 90% of the care is provided by the CNA's, who are not mentioned? It seems that people tend to forget about the backbone of care facilities..The Nures are a Godsend, as they provide the treatments ordered by the Dr's, but the real work in the health care/patient care is provided by the overworked under paid CNA's. It does not take a two or four year degree to care for people, that still comes from the heart.

i would like to say a few things too. James, you were right about the CNA's. they are over worked and so underpaid and thanked. please don't forget us respiratory therapists who are the unrecognized and unthanked too.
the other thing i would add also is that we are underpaid and at risk with our jobs. the average RT in this country makes $45,000 right out of school. with experience here in Montana you are lucky to make $30,000/yr.
i agree with some of you others about most things you posted.

As you can see, everyone is 'defending their own turf' This is what makes correcting this such a problem.

It stopped being about patient care a long time ago. It's all about money now, more specifically, administrative money. It seems that when times get tough it's almost always the low end of the totem poll that takes up the slack. It's very rare that administration looses a dime or a wink of sleep over it.

So how do we overhaul a system where 'self serving' bean counters and administrators are calling the shots? Again, I say a 'single payor' system. But it would need oversight that we might find uncomfortable. But right now our system that profits from illness is broken. I agree the focus is no longer on patient care.

Our nation does have a broken "health care" system. The problem is that the system is designed to function around illness not "health" and it only gives lip service to the concept of "care" - with the result being less efficient/more expensive services and poorer quality of care.

In other words, for the consumer and the provider, it's a lose/lose situation. So, who wins???

After spending 16 years working for an agency that delivered health care to both rural and urban areas, it became apparent to me that doctors, nurses, therapists, dieticians, orderlies and YES, even hospital administrators were all very committed to do the best job they could - but every year they were being asked to do more with less.

The reason cited for the ever increasing demands coupled with ever dwindling resources was almost always the same - tougher and more complex insurance requirements, and NOT just from the government. I was often told that Medicare and Medicaid were simple and fair compared to Prudential, Kaiser Permanente, any HMO you can name, and the 500-lb gorilla known as Blue Cross/Blue Shield.

So it seems to me that private insurance company practices are a key (if not the main) cause of the higher cost/poorer service downward spiral we are caught in. A commonly stated performance statistic is that 30% of every health care dollar spent in the USA pays for administrative costs - that figure usually falls in the 10% range in other industrialized countries. That's an astounding - and alarming - difference.

Most if not all of the private insurance companies involved in our current free-market multiple-payer/player system have developed elaborate "quality review" systems designed to take decisions about a patient's health care away from a physician and put them instead in the hands of beancounters and financiers. Of course, this is done under the guise of "cost-savings" and "enhancing efficiency" for the consumer - but those words are camoflauge for the real purpose, which is strengthening the bottom line of the corporation.

Some of the strategies employed to improve an insurance company's bottom line include:
- denying claims on the first and even second submission on a routine basis
- forcing policyholders to submit themselves to a series of less expensive options as they 'climb the stairs' toward the procedure the doctor recommended
- denying coverage based on obtuse and confusing language in the policy
- and on and on.

While these practices may improve the company's bottom line on a quarterly or annual basis (which not incidently results in high dividend yields and fat executive bonuses), it plays havoc with patient care and personal quality of life. And it results in huge increases in administrative, professional and facility costs for health care providers. And those costs get born by - you guessed it - you and me in the form of direct billing, higher insurance premiums, and restricted access to health care. A secondary impact has been reduced choice of health care providers as more and more physicians - mainly specialists - simply refuse to take insurance leaving people with the choice of filing their claims themselves or simply finding another physician (who oftentimes would not have been their first choice).

(YIKEs!!! - how do these posts of mine get so long?)

Anyway, I'd just like to suggest that before we start painting scarlet letters on the doors of local hospital administrators, Iwe should examine the bigger picture - and the first question we need to ask is this:

Does the free market/capitalist model with multiple competitors motivated by financial profits serve us well in the medical sector? Or, is there a better way when quality health care is the goal?

If there is, we need to apply it STAT.

[This message has been edited by Steve Craddock (edited 1/23/2009).]

Of course everyone wants to defend their own turf, but the truth is that each person is important in the care of patients. Without even one health care professional involved in their care the patient can suffer. But, who spends the most time each day with the patient? Who is responsible, overall, for recognizing the patients needs and make sure orders are followed through? I would say the nurse with the help of the CNAs. Most people make the mistake of thinking that once you become a nurse you don't have to do any of the "grunt work" anymore (cleaning up, changing diapers, bathing, etc.). There are units, esp in large hospitals, where the CNAs do most of those tasks. This is partly because of the patient load, when there is a large number of patients for 1 nurse to care for he/she doesn't have the time to get all that done AND follow through with med orders dressing changes etc. That is why you have trained CNAs to complete these other tasks. But, the truth is, that esp in smaller units, such as the ICU and OB here, there is no CNA or ward clerk. The nurse is the CNA and ward clerk. Still, what would they do without the help of the other staff? The poor housekeepers could go work at McDonalds for the same or more pay.

I don't know how to fix the dilemma, there are so many factors controllable and not, but I do think that people need to know what is going on and where the money is going.

Steve,

You nailed it. Having multiple payer sources limits physicians and providers both ethically and financially. It amazes me that very few people realize this. It is impossible to 'fix' health insurance, the concept is flawed, unless you go to a single payer system.

Untill we remove the 'middle man' from healthcare and create a single payer system, healthcare will continue to cost more and more. Physicians will continue to raise prices, insurance companies will continue to charge more and reimberse less, and people will continue to suffer.

Of course, people could limit their intake of sodas, cell phones, cigarettes, (not beer!) so that they have more resources to actually pay for their medical care...

I don't often post replies but I occasionally check in to see whats going on in old Miles Town and this discussion peaked my interest. So I decided to do a little research into what is going on in Health Care on a national level. I also called some folks to see what is going on in Miles City.
On the National scene: Well, Health Care just like other industries has seen a downturn in patients and revenues. Some have lost investments just like everyone else. This combined with severe shortages of Healthcare professionals and non-professionals alike ie. Doctors, Nurses, CNA's, Therapists, Lab Techs, Xray Techs and it goes on and on. The only position not listed in the shortages seemed to be administrators. Of course this was not the picture everywhere but seems to be an ongoing theme. Certainly difficulties with reimbursment of medicare and medicaid add to the troubles.
So whats going on in M.C. Well most were very reluctant to say much, do to the fact they are afraid of losing their jobs.But it seems HRHC is in a little trouble itself. The doctors and Nurses are trying to do their best to keep patients safe and the hospital doors open but it hasn't been easy. It seems others have a different agenda. Apparently they will need pants with deeper pockets.
So I encourage all of you who still live in M.C. to stay informed about whats going on. HRHC is vital to your community in many ways.
I also found in the 110 congress a Senator from Hawaii sponsored a bill called the Registerd Nurse Safe Staffing Act of 2007 that certainly would have protected patients and nurses in difficult times. Of course it "died on the floor" Ha Ha. So call your congressmen and tell them you think this act is a very needed thing. Ask them to reintroduce it into this years legislation.

[This message has been edited by extreme conditions (edited 1/25/2009).]

In a true Capitalist free market there is something about supply and demand regulating price; add in an injection of Socialism (read government support) and the balance can be tipped. Want to reduce health care costs while alleviating the shortage of trained professionals? Flood the market with doctors and nurses! How do you do that, you ask? Simple, pay for health care education for a decade, completely cover the expenses of going to college and med school for health care practitioners.

A wad of people would go into it. Quite a few of them would graduate and seek jobs; wages would be forced down. It's not nice, but it would work.

On the other hand trimming out middlemen selling the service of handling money for health and limiting payouts for lawsuits would reduce overhead as well. I'm really surprised nobody has mentioned malpractice insurance and lawsuits?

Perhaps all of the above need to be combined with socialized health care in order to get a grip on costs. Odd though, how foreigners and our friends to the North come to the USA for more delicate procedures....

Lately, citizens of the U.S. have been heading for places like Thailand, India and some Eastern European countries for medical care because it is cheaper and in equal if not better quality. Seen that quite a bit in the news of late.

The thing to remember about U.S. health care it is the best in the world if you are rich and not even in the top 10 if you are poor. If you are poor, non-white and uninsured and end up in an emergency ward in a big city with major trauma, you might as well shoot yourself because you have a much better chance of dying than a wealthy, white insured person would in the same circumstances.

We have two medical systems. One, for the rich, is great. The other, for the rest of us, not so much.

Chad said: I'm really surprised nobody has mentioned malpractice insurance and lawsuits?

I don't know why others haven't mentioned it, but I left it out for the simple reason that I think the whole "lawsuit abuse" issue is more fiction than fact.

Regarding medical malpractice, the medical community could take a hugely meaningful first step toward addressing the problem by adopting meaningful policies and procedures to identify and weed out its "bad apples" instead of aiding and abetting them (much as the Catholic Church did with pedophile priests for so long -- and we all know how well that worked out).

Until the medical community provides a process we can trust to ensure that only good doctors are allowed to practice and we, as consumers, have easily accessible information about who those good doctors are and aren't - well, I'm just not going to be very keen on giving up what is currently the ONLY effective mechanism for holding "the system" accountable (from a consumer's POV anyway). As ineffective and cumbersome as it is, the court system is still better than nothing - which in effect is all the AMA has offered to date.

As for lawsuit abuse, have you examined who pays for all those ads and studies that decry what a menace to society trial lawyers and -- heaven forbid -- juries comprised of people like YOU and me are. Well, show me a list of financial contributers to "Citizens Against Lawsuit Abuse" and I'll show you a list of corporate CEOs and key stockholders. Talk about an issue that divides America into the Haves and the Have-Nots -- this is IT, folks.

For every wacky lawsuit award that makes one victim-cum-victor super rich, there are hundreds of cases of corporate misconduct and greed that never get reported or tried -- and these abuses end up costing the American consumer much, much more in fitness and fortune than any number of lawsuits ever could.

For every Liebeck vs. McDonalds (the "coffee lawsuit"), there's an Anderson vs. Pacific Gas and Electric (the "Erin Brockovich lawsuit"). And, if you go to http://lawandhelp.com/q298-2.htm , you'll discover that the facts of the coffee lawsuit make that jury's decision seem pretty justified. But the folks up on Wall St. and Madison Avenue would rather we little people fight amongst ourselves rather than focus on making the companies they represent conduct business ethically and responsibly - so they spend lots of money to make sure we hear their side of the story whenever a jury verdict doesn't go their way.
http://www.sourcewatch.or...suit_Abuse

Until the Better Business Bureau (or, for cripe's sake, the Security Exchange Commission) is given teeth and then PROVES that it is willing to use them, us "little folks" should NOT let anyone close the doors to the only room where everyone is viewed as an equal - and that's a COURT room.

Disclaimer: For those who know my father was an attorney and are thinking that is the reason I am "defending" torts, my father's practice was for the most part limited to business, corporate and real estate law.

[This message has been edited by Steve Craddock (edited 1/26/2009).]

I can not really say I have ever agreed with any of Ammorette's posts and that's still true today. So I'm not sure how many big hospitals you've been in Ammorette or small hospitals for that matter. But you must have been in some cause I'd like to know what good drugs your on? Also when I looked up "poor" in the dictonary I did not see your picture.But really I'm not here to pick on Ammorette so forgive me. I certainly agreed with Chad in his first post it hit the nail on the head. Steve your second post certainly has merit.I totally agree with Reese. We can post all day about the health care industry on a national level it's problems and our thoeries on how to "fix" it. But really I don't foresee that happening soon.So all we can do is try to protect what we have.

To dispell some inaccuracies- I have worked in health care for the last 20 years. I have never worked in a large urban hospital so I'm not sure how they operate but my colleagues say it's about the same everywhere. Of course some better some worse. I have worked in smaller hospitals in the West including Miles City.Granted it has been a while since I worked in Miles City but I still have many friends there and family that use the hospitals services. So I feel vested.
In 20 years I haven't seen many law suits thank the Lord.So I agree law suits are not a huge huge issue. I feel they are out there but over hyped.
As for the poor not getting good health care. Not true the poor and the elderly get the best due to medicaid and medicare(working tax payers $)Its the non-insured(those who actually pay their bills)and the working insured who foot the bills again and again. Of course the rich are the rich no worries for them.
In my opinion the true corruption is just what Chad said in his first post before he bumped his head. They have taken the care out of health care and to many business people got involved. CEO's,SEO's CFO's,CNO's,Foundation Directors, such and such Directors make huge money and keep cutting from those actually taking care of the patients. I'm sorry there is something wrong when the administrator of the hospital makes double and triple of what the highest paid doctor makes. If you want to complain about how much nurses make I'm sorry but we are on the lower end of the barrel with ton's of heavy, difficult work. Ton's of responsibility and absolutely no say or power.So my measly 22/hr is a drop in the bucket when you look at the big picture. I don't know any nurses who made it rich doing bed side nursing.
You have a great little hospital in Miles City. HRHC is very fortunate to have the medical staff it has. The nursing staff is very experienced and many are very committed to your community. Administrators and some doctors seem to come and go. Some of the nurses I know have been there 30,25,20,15 years.That's unheard of in most hospitals today. Most try to function with travling nurses to fill large gaps in staffing.
Years ago at Holy Rosary you used to see some office personnel,switchboard etc. There was always a Nun around and an occasional priest. Lots of nurses and other staff in scrubs.Some doctors around. The last time I was at HRHC I was amazed at the changes. I saw no Nuns, no Priests, no doctors. I saw a few nurses in scrubs. I was amazed at how many people I saw in short skirts and high heels and in suits. The amount of offices they have is unreal. I had to stop and ask how many beds HRHC had because for such a small hospital they are way top heavy.
So with HRHC being a major employer in M.C.(400+) I would be a little concerned. We all know what the closing of the VA hospital did to M.C.
well enough for now.

[This message has been edited by extreme conditions (edited 1/26/2009).]

I have had loved ones cared for in their last few days in big city hospitals and small town hospitals. One thing has been consistent: with very few exceptions, nurses everywhere CARE for their patients.

Unfortunately, there was one particular health care "professional" at HRH that --- well, I'll stop there. All I will say here is that if anyone I care about ever again needs emergency help in the middle of the night and that man is on duty when we arrive at HRH, I'll pull out my own first aid kit and take care of the situation myself - after all, I've watched actors play doctors on TV, and I'm pretty sure that's more training than he had. I do wish someone at Holy Rosary had answered my letter/evaluation form on this matter... they've had nearly a year to do so... (note to self: follow up on that).

But, back to the nurses... I want to attest to the excellent care my father received at Holy Rosary. The nurses and technicians in the emergency room (ESPECIALLY them!), the recovery/PT ward (sorry, I forget the real name for it), and the surgical/intensive care ward were not only excellent health care providers, they were all so sweet and kind to him you would have thought he was their father. And yes, each of the physicians who tended to him after that first unfortunate night were wonderful, too.

So, it's hard to be critical of how Holy Rosary operates (npi) because the quality of care we received there was absolutely top notch. And all that fancy furniture and modern equipment - well, I gotta say that when you're family is dealing with a crisis, it's nice to have a comfortable, attractive, spotlessly clean and modern facility. Valid or not (and I happen to think it is), nice surroundings and state-of-the-art technology does provide you with some peace of mind when you need it most.

Before y'all jump on me for saying that, I realize that buying and replacing furnishings, facilities and equipment on a regular basis does drive up the cost of health care. But if we're going to start cutting out things, that isn't where I would begin.

One area we could look at is "end of life" care. How much time and treasure is spent prolonging life "one more day" for patients who are at the natural "end of the road" and have no quality of life left. I don't mean to be insensitive here. Deciding when to go from active treatment to 'comfort care' is a heart-rending experience. It was made easy for my family because my father had expressed to each of us that he didn't want to be kept alive by tubes and machines. When the moment came, there was no dissent among our family - we all knew what our loved one wanted.

For those who aren't fortunate enough to know what to do and when to do it with that level of certainty, each day is torturous - and torturously expensive. How many individuals have been restrained from a graceful entrance into the next life (or, for you non-theists out there (BRIAN!!!), a graceful exit from this one) simply because they didn't talk about "those things." How many family emembers have had to struggle with themselves and each other to figure out the right thing to do? And how many dollars and other resources have been spent prolonging the inevitable with nothing to show for it in the end - except perhaps torturous memories....

So, if you are looking for something to do to help rein in runaway health care costs, here's something very simple and effective that ANYONE can do: Talk about it...now...with your family.

I really have to agree. It seems so hard for many families and even doctors to bring up end of life issues. In my experience, nurses have been very good at bringing it up and supporting the family and the patient. They say you can tell an internist just by their "save everybody" and "I have a pill for that" way of practice. But, many people do believe in quality over quantity of life. What's the joy in living when you are miserable every moment, stuck in the hospital, can't walk around or perform every day activities? Now, I do agree that the "prettiness" and certain technology can be comforting to both the patient and the family, but in hard times what is the best compromise? Clean and functionable? Or more?

So I have been on a mental "vacation", so now I come back with several thoughts and new news. 1st...A few less meeting and committees should save some money. Seems nothing can get accomplished without a committee and at least 5 or 6 meetings. Sure, some are needed I will agree. My next pondering was about providers... HRH has a total (in the clinic) of 2 PAs, 1 FNP (family nurse practitioner), 1 family med physician, and 1 internal med physician. There are other physicians in the clinic, but they aren't employed by the hospital, they rent the space in the clinic. There are also some providers in the ER, but they don't see patients admitted in to the hospital. Only 2 (the internal med and the family practice physician) see patients admitted in the hospital. Now...Billings Clinic Miles City has 2 family med physicians, 3 internal med physicians, a traveling internal med physician to cover a few days a month, 1 FNP, 2 PAs, 1 APRN for OB/Gyn, 1 OB/Gyn physician, and 2 pediatric physicians. 8 of these see patients admitted to the hospital.

Next...this one could get lengthy, but people have a right and need to know. All that has, is, and will take place in the local hospital has been very hush-hush and secretive. Employees get reprimanded for "leaking" info. The statement was that it is because the employed have not been properly prepared, but with all that has taken place the employees have yet to be properly prepared in most persons definition of the statement. Just about a week ago in a meeting that took place @ HRH the administration said that no one is losing their job and all the concern and talk spreading through town was all just lies and rumors. So imagine certain employees surprise when they were called in for a meeting today and their positions had been eliminated. There was then an e-mail sent to the employees informing them of what had taken place. That 9 positions were eliminated and that some other positions will have reduced hours. Now tell me... which are the lies now? I next started to wonder what a hospital that technically has capabilities for around 50 beds needs with 25 managers. Perhaps that number includes the clinic, but still that's a large number. Now 1/2 of med/surg is currently closed until further notice, so... that decreases med/surg's capacity from 36 to 24 if there are no private rooms. So here is an example of what has taken place: 3 nurses and 1 CNA for 24 patients, but with the latest changes there would be only 3 nurses on night shift and no CNA. So let's do some math: say...3 nurses for 20 patients. That is 7 patients each for 2 nurses and 6 patients for a 3rd nurse, doesn't sound so bad?

There are 12 hours in a shift, so 3 nurses X 12 hours= 36 total hours for patient care

36 hours divided between 20 patients= 1.8 hours per patient per shift that is allowed to each caregiver.

Doesn't sound quite so good anymore? Now consider this...the duties that must be accomplished each shift include giving meds (some patients take over 50 pills a day), initial and follow-up assessments, as needed meds (pain pills, anti-nausea meds, etc), clean-up of patients when they vomit, are incontinent of urine and stool (some very frequently), changing bedding, baths/showers, dressing changes (depends on need and order for frequency), calls to doctors to report changes etc, admits and discharges, care of confused and immobile patients, emergencies, and the list goes on. These are every-day occurrences. So if you have 1 patient who takes up more than their 1.8 hours another patient's time is taken away. This doesn't even include charting which can, at times, easily take up 20mins to 1/2 hour each patient.

Our country's financial situation is pretty scary right now for many of us, including the situations we are faced with right here in our own town. We are all on the edge of panic, wondering how we'll stay afloat, and rumors and half-truths that abound don't help the situation any. Reese, I don't know who told you that there would be no jobs lost. The message I received was that at the current time (when meetings began on the issue) no layoffs were planned-hence the bazillion managers meetings. I think I feel better knowing that there was plenty of discussion and research done before any huge decision such as layoffs was made. It has driven us all nuts not knowing what plan was in the making, but I respect the management's discretion in the matter until final decisions were made. It may be easier to cope with loss of hours, increased workload, and watching your coworkers be let go if you are able to point a finger at someone--anyone. Those dishonest, greedy upper managers (a picture you've painted) would be a logical target except for the fact that if you happen to watch the news, or read the newspaper, or hear from other healthcare workers in other states you'll see that this is happening everywhere. This facility is trying to do whatever it can to stay open to serve our community-there are hospitals in others areas that aren't so lucky. The financial crisis is not the fault of any one entity at Holy Rosary-it's just the way it is all over this nation. Do we really have 25 managers? Maybe so. I suppose that if you take a look at the facility phone directory you'll see that there are at least that many departments. There may only be 50 hospital beds, but there is also a clinic, surgery dept, emergency dept, cafeteria, physical therapy, respiratory, housekeeping, laundry, maintenance, nursing home, outpatient chemotherapy, accounting, etc. We need all those departments and there should be leadership in each area. None of this is going to be easy before it is all over. I, for one, believe that whether I have a job tomorrow or not, or whether I have to continue to figure out how to cram 8 hours of work into 3 hours, the whole reason we work where we do is to care for the patients and just do the best we can with what we have. And maybe I'm naïve, but I believe that is the main objective of Holy Rosary, too. We just need to try to get through this crisis. I know this website is a place to vent, so I suppose that is what I'm doing as well. I just don't think that posting one side of this situation to a community that is already facing a lot of uncertainty is very productive to the overall situation.

[This message has been edited by TamiLY (edited 2/5/2009).]

Reese,I just reviewed my last message and I think it sounds as if I am attacking you for expressing your opinion. Please understand that I am not. You have every right to feel hurt, angered, betrayed, overwhelmed--whatever the emotion, we are all going through this together. I guess if anything else, the point I'm trying to make is that none of this situation is in the hospital's control and the managers are trying to make the best of it as well. None of the cuts are personal, just business. However, we are only human and when we are having to sacrifice on a personal level, this situation certainly becomes personal. I'm sure that if you spoke to any of those managers that had to let an employee go they'd tell you how difficult it was for them to keep telling themselves that its not personal, just business. I still believe that Holy Rosary is one of the best places to work. I believe in the mission. And I believe in the work I do there. By your frustration, I know you believe in your work there as well. The resources we are left to deal with are less than ideal-- seemingly impossible some days. But still better than the alternative, which is not to have a healthcare facility at all.

I suppose I need to apologize because I don't mean that managers and administrators aren't at all important or needed, I'm questioning whether so many are needed. Maybe there does need to be that many, I can't say for certain, but I am also aware that some managers oversee more than one department. So, not every one of those departments listed has their own manager, maybe at one point in time they did, but not any more. I also know that things change and it can happen fast, so there probably weren't any plans of layoffs at that time. I can't really agree with doing the best we can with what we have because we are talking about peoples lives and health care professionals licenses and certifications they have worked hard for. There is an extent to which we can do so, but there will be a breaking point. I guess we will find out where that point is if/when we reach it.

[This message has been edited by Reese (edited 2/5/2009).]

Ok..Im not trying to stir the pot any but isnt a hospital one of the few things that are recession proof? Just a thought, as I am curious what will be said. People are going to get sick no matter what the economy is. As a matter of fact, wont more people get sick from people not being able to afford to feel their families healthy and the proper food. If thats the case wouldnt a hospital (or clinic, or any medical facility for that matter. Not just HRH) want to have enough people to care for the patients properly without waiting? Really, im not trying to upset anyone. Im just curious as how this is going to work or how it is right when the patients may very easily be the ones suffering when they are having to wait for the care that is needed.

In the long run, this is probably good for the healthcare industry. People will quit going to the doctor now and allow their health issues to get more serious until they seek care, that's where they make the big bucks.

To quote Ebeneezer Scrooge: Better to die and decrease the surplus population.

I'm moved by what I've been reading in this earnest and thoughtful discussion. Thanks, especially, to Reese, Steve and TAMily for your stories.

Reese: Are the nurses and CNAs at HRH unionized?

TamiLY, Apparently you are one of the too many HRHC managers or administrators we are speaking about. Obviously you aren't someone doing bedside or patient care at HRHC.The true employees at HRHC defiantly do not feel as you have stated. Your reference to "We're all in it together" seems familiar and suspicous. Maybe you are the CEO?
I would just like to state not all hospitals are in this same position and many have come up with innovated ways to save. Many included their employees in brain storming meetings and not after the fact as HRHC. Example Billings Clinic's salaried administrators and physcians took a 5% cut in pay and stopped accruing vacation for 6 months because they are actually in it "togther". One of HRHC biggest blunders is about a year and half ago several inexperienced and naive managers as a project decided to close a rehab unit and open a larger hospital unit with swing beds. All so they could get a little better reimbursment from Medicare. Many employees warned them it wasn't a good idea but they went forward.Of course they remolded and spent thousands on new equipment.They had to hire more staff. Well then the economy slowed and with no new providers on the horizon they couldn't fill the beds. Hence today that unit stands dark and abandoned. So TamiLY you certainly give a different view point but maybe only the views of 25 or so. The rest of the 386 feel differently.

[This message has been edited by extreme conditions (edited 2/5/2009).]

Mayor Whalen, No they are not. They tried to organize a collective barganing unit with the MNA appox. 2 years ago but it failed by 3 votes. The nurses had to endure a torturous anti-union campaign(corporate campaign) put on by HRHC and the Sisters of Charity. Many feel some of the cuts at HRHC have been in retaliation of the Union bid by the Nurses. Bet they wish they had a union now.

Dear extreme,
No I am not one of the managers, nor am I the CEO. Despite your nastiness, that actually caused me to chuckle. In fact, I'm one of the lucky shmucks who was impacted by the conversion of rehab to a swing-bed unit. HRH administrators may not have made some of the best decisions in the recent past, but it's pretty easy for you and I to offer our wisdom now, after the fact. There were several factors contributing to the financial ill-success of the swing-bed unit, factors that are being reevaluated and (hopefully) rectified along with many other areas in need of improvement. Ever since that project, our patient numbers have not bounced back and because of this I and the few I supervise are now dealing with cutting our hours by more than half. I DO believe we are in this together-I did not say any of this would be, or is easy-and we will only be able to get through things by trying to be supportive of one another no matter what our particular pecking order may be. Let me assure you, I am only a lowly employee of HRH--though I've always felt valued by my employer (I'm sorry you and Reese don't share that perception) and have been with them for many years. I worry for the patients I work with daily as well as for my coworkers, and the uncertainty of this all is making us sick. How will we be able to handle the increased workload in a fraction of the time without comprimising patient care? If it makes you feel better, I have no flipping idea how I will be able to make ends meet in the months (or possibly years) ahead, or how I'll provide for my kids. Because I do honestly feel we should be looking out for each other, I chose to equally share the few work hours my department has been allotted so I and those I supervise will be able to add some vacation time and scrape together enough hours each pay period to at least maintain our health insurance benefits. I could take care of myself first, but I don't believe that is how we, as a team, as a healthcare facility, or as a community will survive any of this. I'm sorry my lack of venom seems all too suspicious for you, but I'm trying to get through this crisis one step at a time just like everyone else. As far as I can see, we can choose to go forward and try to make the best of a really crappy situation or we can point fingers, call names, and blame the managers for what they (for the most part) are stumbling through and trying to make sense of themselves. My outlook may change in time as this all drags on or if things become even more bleak, but for now I intend to focus on the reason I work at Holy Rosary and I choose not to condemn those who are (in my opinion) trying their best to keep us afloat.

[This message has been edited by TamiLY (edited 2/5/2009).]

I don't suppose you (Tamily) has been working at HRH long enough to experience what occurred in the union vote 2 or 3 years ago. Everyone I have spoke with who was present for it said that they were promised big things and that things would get better, but it didn't come true. They were bullied and manipulated. It's hard to trust someone after that. Now with what is taking place now, it's no wonder people have a hard time believing what they are told.

I was there during the attempt to unionize. I don't dispute safety issue nurses are facing when their patient load increases and the nursing hours decrease--none of any of that is fair to iether the nurse or the patient. As has already been stated, this won't change until laws change. My argument is the whole "them" versus "us" theory with the management during this crisis. I'm trying to remember, but I don't think the nurse managers present in HRH today are even the same individuals involved during union voting. As far as the large salaries at the top of HRH--I'm sure someone will be kind enough to correct me if I'm wrong--but it's my understanding that their pay doesn't even come from the facility, but at a corporate level. So HRH's financial losses are not contributed by their 6-figure incomes and we did not lose employees so they can continue to sit "fat and happy".

[This message has been edited by TamiLY (edited 2/6/2009).]

TamiLY, I apolgize for trying to point out the humor in your post.I was trying to go with your theme of dishonest and greedy and evil was the only picture I found to go with it. I do not feel their management is dishonest or greedy. I just feel they have too many and they get paid too much. Also if you truely believe mid management has any say or power at the hospital you are in some wonderland. They are the Patsies(sp.), the fall guys. Obviously you are a "wannabe" and you should know that the hospital has had some very good managers in the past. They currently have a few(in my opinion) but most(the smart ones) at one point see the writing on the wall and leave that position. It's all about respect and believe me respect is a two way street.So its seems you've bought what their trying to sell and I wish you good luck with that. At HRH it hasn't always been "us vs them" but it has been for quite a few years. I had the luxury to work with some great SEO's, CEO's and CNO's but they seem to either go to better hunting grounds or become someones fall guy. In my opinion the current administration will go down in history as being one of the worst.So again I wish you good luck and don't take off those rose colored glasses.

Suppose any of the staff are a little afraid of being led by someone that was a throw-away from St. Vincents? The new-ish CNO (chief nursing officer) has arrived and many employees haven't even met her yet. Perhaps she is too busy texting, checking e-mail, or whatever she does on her Blackberry all the time. I personally would be quite bothered by being led by someone who doesn't even know what RT would possibly do during a code (CPR in a hospital). I'm sure a good portion of the general public may not know either, but shouldn't someone occupying that position have enough experience in the field to know? Why should the staff feel comfortable with a boss who doesn't even have enough experience to know who is needed in an emergency situation such as that?

Plus, it seems the Holy Rosary way is to have someone do the dirty work and fire a few people, and then fire them. Guess you should never feel "safe".

Perhaps a change of career / workplace is in order?

I'm sure there are a lot of people who think so too, but are afraid to because of the ecomony. I guess sometimes you just have to go for it.

Still there is shortage of trained caregivers. As experts suggest service of a trained caregiver for elders, there won't be any issue in this field in the near future. http://www.caring.com/blo...caregivers

[This message has been edited by Sharron Livingston (3/24/2010)]

[This message has been edited by Sharron Livingston (3/24/2010)]