Comments on: a personally disturbing conversation http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html a nurse blog. Thu, 20 Nov 2008 12:00:41 +0000 http://wordpress.org/?v=2.0.7 by: Free Online Tax Returns http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-62640 Wed, 31 Oct 2007 08:29:16 +0000 http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-62640 <strong>Free Online Tax Returns</strong> I couldn't understand some parts of this article, but it sounds interesting Free Online Tax Returns

I couldn’t understand some parts of this article, but it sounds interesting

]]> by: the french pedicure. a LONG story » about a nurse http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-24951 Thu, 26 Apr 2007 18:12:51 +0000 http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-24951 [...] 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. [...] […] 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. […]

]]> by: Candy http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-24368 Wed, 25 Apr 2007 02:01:22 +0000 http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-24368 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. 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.

]]> by: Mother Jones RN http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-24119 Tue, 24 Apr 2007 14:26:12 +0000 http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-24119 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 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

]]> by: annemiek http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-24079 Tue, 24 Apr 2007 12:25:12 +0000 http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-24079 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. 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.

]]> by: Candy http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-23895 Tue, 24 Apr 2007 00:55:23 +0000 http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-23895 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. 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.

]]> by: howling http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-23840 Mon, 23 Apr 2007 21:17:32 +0000 http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-23840 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. 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.

]]> by: Misha http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-23738 Mon, 23 Apr 2007 14:47:45 +0000 http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-23738 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 $$$, these directors and managers have to meet pre-established goals and the entire system must meet financial benchmarks. This bonus is in addition to the normal performance/cost of living structure that happens annually. The part that I find disturbing is that the IC plan is not disclosed to the staff. *who often have a large part in the success of the manager who has set department goals* Even more disturbing is the fact that the plan is veiled in secrecy. Non-management employees do not know that the IC plan is in place. Personally, I think this is unethical. I feel so strongly about this that I 1-disclosed it to my staff and 2-will share any financial gains that come my way and 3-have voiced my desire it be rolled out to all employees. What you all are talking about is really happening. Under a plan like this managers are under a LOT of peer pressure to save money and we all know staffing has a high price tag. My advice---ask for incentive compensation for staff. Or just ask your directors/ceo's etc if there is an IC plan in place for managers. I think that is a fair question. My hospital is part of a network of not for profit medical centers. The entire system has begun what is called “incentive compensation” for managers and directors. Last year it was rolled out to directors only and I (a manager) had no knowledge of it. IC is a bonus system where employees have the opportunity to receive a one time payment in January of anywhere from 10-20% of their salary. In order to get the $$$, 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.

]]> by: beth http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-23734 Mon, 23 Apr 2007 14:41:04 +0000 http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-23734 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. 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.

]]> by: diane http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-23618 Mon, 23 Apr 2007 05:51:00 +0000 http://www.aboutanurse.com/2007/04/a-personally-disturbing-conversation.html#comment-23618 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. 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.

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