a personally disturbing conversation
“nurse managers get incentives for tweaking with the budget. the more money they save, in whatever way, will mean more incentive.”
what does that mean?
“that means they are being rewarded for saving money, and often times, staffing is where they earn the big bucks.”
what does that mean?
“it means it is not always because a unit or a department is losing money that they are cutting on the number of staff.”
you’re kidding, right?
“no, i’m serious. it is a well kept, but well known secret among managers. it is all sorts of different things. bonus, holidays, points, you name it.”
does this happen in all hospitals?
“i don’t have a proof, but everybody knows it is pretty much the truth.”
even in christian hospitals?
“please. what’s the difference? incentives are incentives are incentives.”
you mean, it could even be happening in OUR unit?
“i am pretty sure it is happening. it’s all about the money honey.”
you mean it doesn’t matter that the staff is affected and that patient care is jeopardized….
“sweetie, you are so naive.”
okay, stop.
_________________
any of you know if this is absolutely true in ALL hospitals?
please say it isn’t. please tell me this is just a bad joke.
because it’s not funny.
because i feel like throwing up.
me and my idealistic stupid ideas!
I don’t think it’s like that everywhere, May. I don’t think it’s like that at my hospital. When we’re short staffed it’s because there’s no one available to come in. We are constantly buying new gadgets to use. There is lots of education opportunities to be had.
We aren’t cutting the number of staff at our hospital, and in fact we have added positions for nurse educators.
As for CNA’s, we have the same number that we’ve always had.
Come work with me, May
Comment by geena — April 22, 2007 @ 5:01 pm
I’d rather stay naive like you! I hope it is not everywhere. but I’m just cynical enough to believe that it is.
Comment by Lisa, RN — April 22, 2007 @ 6:24 pm
I don’t know about other hospitals, but it’s true in mine. The managers get huge bonuses while the staff is being worked into the ground. Every nurse position that isn’t filled, dspite plenty of applications, is money in their pockets.
Comment by Melissa — April 22, 2007 @ 7:27 pm
Don’t know about any managers that get incentives at my hospital but I’m sure that the senior management execs must. It’s all about the bottom line unfortunately. They really don’t care about how much we kill ourselves attempting not to kill patients. All we have ever asked for is just one more tech on each main hall and we’d be great. So far in 7 years, no go. Meanwhile the basic care is being compromised. It really sucks!
Comment by NPs Save Lives — April 22, 2007 @ 8:26 pm
I can honestly say, as one of those nurses in a management position, that it does not happen everywhere. When we don’t have enough staff to provide patient care at my facility, we as managers, will fill the spots ourselves. As a salaried employee I can tell you there is no extra pay or bonus for doing so, which is an incentive to keep our staffing positions full.
I can also say that I have had the extreme misfotune to work for one a facility int the past that was concerned with nothing more than the bottom line, so I know they do exist. That place was so bad that the staff actually took up a collection to pay a the vendor that supplied our portable oxygen tanks. The only way we could get our O2 refilled at the time was to pay cash up front.
Comment by Joe — April 22, 2007 @ 8:49 pm
Joe, you may not be getting an incentive, but someone is. Our hospital is now actually pitting dept against dept to save on staffing costs…The dept and the dept mgr who have the “save the most money on staffing” actually get bonuses. And who ultimately pays that “bonus” our patients either in substandard care or increased cost.
Comment by diane — April 22, 2007 @ 10:51 pm
The reason I don’t think this happens on my unit is that management seems to have no qualms about piling on the agency contracts while neglecting to incentivize their permanent staff.
I do however, have inside info that purchasing managers (those responsible for purchasing the equipment that we use) get bonuses for securing the lowest bid, and oftentimes this leads to clinicians getting stuck with stuff that doesn’t work.
Comment by beth — April 23, 2007 @ 7:41 am
My hospital is part of a network of not for profit medical centers. The entire system has begun what is called “incentive compensation” for managers and directors. Last year it was rolled out to directors only and I (a manager) had no knowledge of it. IC is a bonus system where employees have the opportunity to receive a one time payment in January of anywhere from 10-20% of their salary. In order to get the $$$, these directors and managers have to meet pre-established goals and the entire system must meet financial benchmarks. This bonus is in addition to the normal performance/cost of living structure that happens annually. The part that I find disturbing is that the IC plan is not disclosed to the staff. *who often have a large part in the success of the manager who has set department goals* Even more disturbing is the fact that the plan is veiled in secrecy. Non-management employees do not know that the IC plan is in place. Personally, I think this is unethical. I feel so strongly about this that I 1-disclosed it to my staff and 2-will share any financial gains that come my way and 3-have voiced my desire it be rolled out to all employees. What you all are talking about is really happening. Under a plan like this managers are under a LOT of peer pressure to save money and we all know staffing has a high price tag. My advice—ask for incentive compensation for staff. Or just ask your directors/ceo’s etc if there is an IC plan in place for managers. I think that is a fair question.
Comment by Misha — April 23, 2007 @ 7:47 am
I wouldn’t be surprised that what you’re saying is actually happening. Health Care has pretty much evolved into a menacing corporate industry that is merely concerned of generating profits as opposed to the traditional social institution it was. I can see the NHS here heading towards that direction as well - with wards being downsized and health workers replaced by finance consultants that earn obscene loads of money by designing ways to cutdown spending and reap the rewards once they actually save money. The CEO’s and Managers might be finance experts but most are quite daft as to what entails patient care. In the end, it is still cheaper to pay a few people than give everyone a fair share.
Really sad.
Comment by howling — April 23, 2007 @ 2:17 pm
While I am positive this happens in some industries (and maybe in hospitals outside of California), I know for sure this is not the case in any California hospital — ratios make managers obliged to staff for all patients. It may be true that some hospitals have eliminated CNAs or unit clerks, but those dollars are going to nursing positions, not managers.
If you think your managers are making the big bucks by keeping you down, use a little of those wonderful nursing critical thinking skills for a minute. Unhappy nurses mean nurses who will leave for another hospital. It costs a lot more to hire a nurse than to retain one.
Misha, I think it’s great that you will share with your staff.
Comment by Candy — April 23, 2007 @ 5:55 pm
I work at a not for profit, and I know there is no financial incentive for the managers. They will jump in and staff the floor if needed. The Christmas bonus that every employee of the hospital gets is tied to the financial status (plus our evaluations) of the hospital every year. So it is in everybodies interest to keep the cost down.
Comment by annemiek — April 24, 2007 @ 5:25 am
Sorry, it works that way at our hospital. Last year our hospital managers didn’t get their bonus, and they howled. “What bonus are you crying over,” we asked. Yeah, like we didn’t already know. Working at our hospital is like living in a small town, no one can keep a secret.
MJ
Comment by Mother Jones RN — April 24, 2007 @ 7:26 am
I asked a number of nurse managers in California hospitals about this, to make sure. Here’s the response from one Cental Valley unit manager:
Every manager has to worry about a budget, but the budget is based on the needs of the unit, taking into account the ratio laws, type of patients, etc. Some days we go WAY over budget because we start with a certain number of patients (like 34 for example) and staff for that, then we can have 10 discharges, but only 5 admissions, so the midnight census is only 29. The hospital gets paid from payers (like Medicare or Insurance) based on the midnight census, so the budget is based on a midnight census. You just hope the next day you go from 28 to 34, so you can make budget! But we all use staffing tables so that we can have the right number of staff to take care of the number of patients we have to care for.
Sometimes managers get bonuses, but mostly it is based on whether the whole hospital (or system, or whatever) makes budget and whether or not we made our other goals, like patient satisfaction or inlier index, etc. It doesn’t really depend on a certain dept. I have made budget, but the hospital lost money, so no bonus, and visa versa.
Comment by Candy — April 24, 2007 @ 7:01 pm
[…] don’t get me wrong, i don’t consider NM as my enemy. i am just so frustrated about the fact that we don’t have a PCA (patient care assistant) when our patient census is 21 and below, and more frustrated that no matter how everyone agrees to this PCA frustration, our request is simply overruled and ignored. another frustrating thing is the fact that other units in the hospital do not suffer the lack of PCA. for the record, i respect NM because i still want to remain naive and not believe the insinuations, so let’s not even go there. […]
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