Economic Crisis: Impact to Hospitals

The financial markets are spinning. The world economy is faltering. The U.S. government is making a $700 billion or more bailout to avert a worldwide disaster. In this time of global financial crises, all hospitals and healthcare organization face an alarming financial scenario. Factors that accompanied the financial crises are decreasing revenues, increasing costs, and high consumer expectations (McNichol & Lav, 2008).

Many Americans has been laid off or facing mortgage foreclosures. With job loss comes loss of health insurance, thus hospitals are now caring for more uninsured patients. On the other hand, reimbursement has decreased for many patient conditions (Boyd, 2008).

According to Parry & Humprey (2009), the economic turmoil caused hospitals and healthcare systems to lose millions of their investment dollars, affecting their financial safety net. Losing the organization’s safety net present a complex challenge for Chief Executive Officers (CEOs), physicians, nurse executives, administrators, financial advisors and department managers who must not only lead in today’s climate, but also position their organizations for tomorrow’s financial confusion (Parry & Humprey, 2009).

The economic crunch has several effects to hospitals. First, the capital crisis is making it difficult and expensive for hospitals to finance facility and technology needs. Currently, there is an increased cost of borrowing and decrease access to financing. To be specific, nowadays there is an increased interest expense for variable rate bonds, increased collateral requirements, and inability to issue bonds. In addition, the hospital is also having trouble refinancing auction rate debt and inability to renew credit, coupled with acceleration of debt and inability to withdraw funds held by financial institutions. As a result, many hospitals are reconsidering or postponing investments in facilities and equipment (American Hospital Association, 2008).

Second, according to American Hospital Association (2008), many hospitals are seeing the impact of the economic downturn on the number and mix of patients seeking care. There are lower admissions and number of elective procedures have drop significantly. Hospitals are seeing significant decrease in inpatient and ambulatory surgeries, as well as emergency room visits. Employees who have been laid off became uninsured. For this reason, they are putting on hold their health problems and postpone or defer elective procedures.

Third, rising unemployment caused an increased uncompensated care. For every one percent increase in unemployment leads to a loss of employer sponsored coverage for an estimated 2.5 million employees and dependents. The majority of hospitals are seeing an increased in the proportion of patients unable to pay for care, and the need for subsidized care is increasing. With patients unable to pay, more physicians are seeking financial health from hospitals (American Hospital Association, 2008).

Fourth, financial health is worsening as patients seek less care and investment gains turn to losses. Many hospitals making or considering cutbacks by cutting administrative costs, reducing staff, reducing services, divesting assets, and considering merger (American Hospital Association, 2008).

Fifth, according to Smith, Rudowitz, O’Malley, & Marks (2008), stresses on state and federal budgets raise worries about cuts to Medicaid and Medicare provider payments. The Medicaid programs support half of patient care provided but the program is severely underfunded. Consider that Medicaid expenditures that have the largest portion of many state budgets have increase during this economic crisis even as the state tax revenues drop (Smith, et.al, 2008).
Sixth, as the economy weakens, hospitals are shifting insurance costs in the form of higher deductibles or higher co-pays for employees. This is very ironic considering that hospital provides care to patients. However, with the increasing cost of insurance premiums, the hospitals need to find cost-cutting measures to survive (Marmont & Bell, 2009).

The economic environment, exacerbated by the credit crisis, has put the healthcare industry in puzzling waters. The industry's quick response to this challenge is encouraging, but tough times lie ahead. Hospitals that address changing patient demands and shifting reimbursement cycles will be better positioned to mitigate the economic downturn (Hartman, Martin, McDonnell, & Catlin, 2009).

The Joint Commission (2008) in response to economic turmoil issued a report that directs hospitals to respond in new ways as escalating health care costs are hitting record highs and the conditions and care needs of hospitalized patients are growing more complex. The report is the work of an expert panel comprising hospital executives and clinical leaders, as well as experts in technology, health care economics, hospital design and patient safety.

The report recommends action in five core areas. The first core area focuses on economic viability. For hospitals to be economically viable, they must align performance and payment systems to meet quality and efficiency-related goals. Hospitals must use process improvement tools to increase efficiency, reduce costs, and pursue coverage options to ensure patient access to affordable health care services. It is also important to address how general acute hospitals and specialty hospitals can both fulfill the social mission for health care delivery (The Joint Commission, 2008).

The second core area is technology adoption. Information technology plays a major role in improving health care quality and safety, and can help to support the migration of hospital-based care into the community and even the home. The technological transformation of health care also invites the redefinition of the hospital (The Joint Commission, 2008).

To address technology in the future, hospitals should make the business case and sustainable funding to support the widespread adoption of health information technology, and redesign business and care processes in tandem with health information technology adoption. The hospital must also use digital technology to support patient-centered hospital care and extend that care beyond the hospital walls and hiring reliable authorities that will assess the technology and technology investment guidance. Moreover, the technology must be laborsaving and integrative across the hospitals (The Joint Commission, 2008).

The third core area is patient-centered care. The patient has the greatest stake in their care. Thus, patient needs to be respected as an equal partner in their care to promote quality and safety. Family members or others to whom the patient is emotionally tied are also part of the health care partnership (The Joint Commission, 2008).

According to the Joint Commission (2008), achieving patient-centered care should be driven by adopting of patient-centered care values that is a priority for improving patient safety and patient and staff satisfaction. Hospitals must also incorporate patient-centered care principles into the activities of hospital oversight bodies and transparency initiatives and address barriers to patient and family engagement. Moreover, hospitals must eliminate disparities in the quality of care for minorities, the poor, the aged and the mentally ill as well as improving the quality of care for the chronically ill through coordinated, multi-disciplinary care.

The fourth core area is staffing. Work force shortages have persistently plagued hospitals over the last several years. To address the fact that demand for certain health care professionals outstrips supply and to meet the needs of patients, the hospitals must establish fair migration and compensation policies for countries facing shortages of health care workers and expand health professional education and training capacity to accommodate the growing demand for health care workers.

Hospitals must also create workplace cultures that can attract and retain health care workers by develop professional knowledge and skills necessary in a more complex health care environment (The Joint Commission, 2008).

The fifth core area is hospital design. Hospital must improve safety with evidence-based design principles such as single rooms, decentralized nursing stations and noise-reducing materials. It is also important to address high-level priorities, such as infection control and emergency preparedness, in hospital design and construction. Inclusion of clinicians and other staff, patients and families in the design process to improve staff work flow and patient safety, and create patient-centered environments are vital processes to observe to promote safety (The Joint Commission, 2008).

The core areas were the result of the analysis of how socio-economic trends, technology, the physical environment of care, patient-centered care values and ongoing staffing challenges will influence the hospital of the future (The Joint Commission, 2008). The Joint Commission urges hospitals and public policymakers to use the principles embedded in their report to achieve that aim.

For the nurse leaders, they should play a pivotal role in implementing innovative strategies to enhance revenue for the organization. Strategies may include cutting supply costs, decreasing patient length of stay and limit or abolish overtime hours for the staff. According to Buerhaus (2008), in these economic downturn nurse leaders must restructure health care delivery on individual floors and spearhead innovations. The restructuring of the delivery system in the floor may be carried out by consolidating supplies to allow nurses to spend more time in the bedside, thereby increasing patient satisfaction scores and anticipating staffing mix in response to patient acuity.

When times are tough, nurse leaders and managers must avoid unilateral thinking. Nurse leaders must act with authenticity and determination to seek out voices and opinions contrary to prevailing thought. The nurse leader must go beyond the traditional to the nontraditional, to people, places, and resources that are not familiar to get a better grasp of the situation on hand. In addition, nurse leaders must be decisive in term of budget allocation, forecasting, and cost reduction (Boyd, 2008).

Finally, nurse leaders must stand ready in these tough times to educate patients and
their families about the uncertainty and unexpected financial cost associated with acute and chronic disease and the importance of staying healthy. In this tough economic time in health care, CEOs, physicians, nurse executives, administrators, financial advisors and department managers must understand and apply the principles of human and fiscal resources to stay afloat.

References:
American Hospital Association (2008). Rapid Response Survey. The Economic Crisis: Impact on Hospitals. Trendwatch. Retrieved from http://www.ihatoday.org/econcrisisreport.pdf

Boyd, D. (2008). State Tax Revenue Now Flat, for the First Time Since 2002 Recession: After Weak Third Quarter, Further Declines Likely Lie Ahead. The Nelson A. Rockefeller Institute of Government. Retrieved from http://www.rockinst.org/newsroom/news_releases/2008/2008-11-06state_tax_revenues_across_u.s._are_flat_for_first_time_since_2002_recession_new_rockefeller_institute_flash_report_shows.aspx

Buerhaus, P., Auerbach, D., Staiger, D. (2008). Recent trends in the registered nurse labor market in the US: Short-run swings on top of long-term trends. Nursing Economic$, 25(2), 59-66. Retrieved from http://www.medscape.com/viewarticle/556417_1

Hartman, M., Martin, A., McDonnell, P., & Catlin, A. (2009). National health spending in 2007: Slower spending contributes to lowest rate of overall growth since 1998. Health Affairs, 28(1), 246-261. doi: 10.1377/hlthaff.28.1.246

Marmot, M. & Bell, R. (2009). How will the financial crisis affect health? Business Management Journal, 338, 858-60. doi:10.1136/bmj.b1314

McNichol, E. & Lav, I (2008). State Budget Troubles Worsen. Center on Budget Policy and Priorities. Retrieved from http://www.cbpp.org/archiveSite/9-8-08sfp.pdf

Parry J. & Humphreys G. (2009). Health amid a financial crisis: A complex diagnosis. Bulletin of World Health Organization, 87, 4-5. Retrieved from http://www.who.int/bulletin/volumes/87/1/09-010109/en/index.html

Smith, V., Rudowitz, R., O’Malley, M., & Marks, C. (2008). Headed for a Crunch: An Update on Medicaid Spending, Coverage and Policy Heading into an Economic Downturn. Kaiser Commission on Medicaid and the Uninsured. Retrieved from http://www.kff.org/medicaid/upload/7815.pdf

The Joint Commission (2008). Health Care at the Crossroads: Guiding Principles for the Development of the Hospital of the Future. Retrieved from http://www.jointcommission.org/NR/rdonlyres/1C9A7079-7A29-4658-B80D-A7DF8771309B/0/Hosptal_Future.pdf

Improving Nurse Satisfaction and Retention

The nursing shortage in America is a pressing problem that needs to address. Healthcare organizations are employing creative strategies to promote nurse satisfaction to retain their best nurses. The following are some suggestions to promote nurse satisfaction and retention:

1.Employees Benefits, Fair Compensation and Salary Adjustment based on market value
Pay and benefits issues often have to be first and foremost when employees consider whether they can remain in the organization. Additionally, when employees are unhappy about compensation, they often complain more about other issues, especially if they do not believe it is possible to correct the problems without leaving the
organization.

Managers need to ensure that pay systems have internal equity between jobs by paying them in accordance with their importance to the organization based upon job evaluation, establishing equity in pay between employees by proper distribution of rewards, and maintaining equity in pay between organizations by proper budget allocations.

2.Build on social strengths:
-Creation of calendar of social activities that include celebration such as:
Cultural diversity month – bring in food from different culture
Thanksgiving party
Christmas party for the unit
Breakfast with employees’ children and family in December
Valentines socials in February
Organize health and fitness activities (jogging, aerobics and dance class etc.)
Annual Team building retreat
-The major outcomes of team building retreats are
a.Staging ongoing activities that create, nourish, and nurture a positive morale
b.Professional development
c.Employees sharing a positive social experience
d.Staff satisfaction, rewards, and recognition initiating a celebration/morale committee developing a mission statement for specific unit/area and core beliefs goal setting

3.Enhance employee recognition to show employees that they are valued.
-Birthday and work anniversaries celebration
-Bulletin board recognizing employees with exemplary performance, thank-you card and commendations from patients and families

4.Promote work-life balance programs and policies
-It will help individuals balance their work and non-work lives, such as flexible work arrangements (self-scheduling), provision of childcare benefits, and others

5.One time cash incentive (1-2%) for passing certification exams and a plaque listing employees’ names and achievements placed in a prominent place where co-employees can see

6.Grievance processing system
-The system should enable employees to bring problems and questions to the attention of managers without fear of retribution.
-Such a process can be very helpful for managers to determine issues that could lead to undesired turnover if they are not resolved.
-Employees may be less likely to leave if they feel their problems can be addressed equitably in-house.
-To improve employee perceptions of equity in the process, the organization may want to consider alternative dispute resolution with an arbitrator selected to decide the issue if the employee and management cannot reach a mutually satisfactory outcome.

7.Promote shared governance
Shared Governance is an organizational structure in which clinical nurses have a voice in determining nursing practice, standards and quality of care.

The advantages of shared governance are twofold:
•It empowers nurses to use their clinical knowledge and expertise to develop, direct and sustain our own professional practice.
•It allows nurses to network with colleagues and to collaborate among units and departments.

Retention programs that focus on employee participation and involvement in decision-making processes are the ones most likely to experience long-term success. The common denominator for staff retention is to find ways to improve job fulfillment and staff satisfaction.

How Long does it Take for a Biopsy of the Vulva to Heal?

Vulvar biopsy is performed when a woman experiences persistent vulvar itching, pain, or a suspicious lesion. Biopsy of vulvar lesion is necessary for histology analysis, to differentiate benign from cancerous (neoplastic) lesions and it may be curative if the entire lesion is removed for biopsy. Vulvar biopsy is relatively minor and it is done under local anesthetic. Initially women may feel a wasp or bee sting or sharp pain during the injection of anesthetic to the vulvar area, then some burning. This usually lasts more than a few seconds.

Most practitioners use a Keyes-type punch biopsy instrument to obtain a specimen of at least 3mm, but a Kevorkian or Kraus biopsy forceps could also be used. In the case of a single lesion to be completely excised, a scalpel is used. Bleeding in small biopsy sites of less than 5mm is stabilized by applying pressure. Silver nitrate is also applied to biopsy site to prevent infection and promote healing. However, vulvar biopsy with larger lesions should be reapproximated with suture. After the procedure, the patient should be taught about sitz baths to keep the area clean and use of oral over-the-counter analgesics.

Complete healing could take 2-3 weeks. A follow-up appointment with your doctor should be scheduled within two weeks to check biopsy site healing and review pathology and culture results.

Reference:
Heller, D & Wallach, R. (2007).Vulvar Disease: A Clinicopathological Approach. CRC Press

Nurses and Technology

Technology is on the rise! Globalization in healthcare is the current trend. Information highway accessibility is a convenience that nurses need to explore and exploit.

For decades now, technology has been a part in the life of the nurses in patient care. Collision of healthcare and technology has created an industry that now drives both the cost and the standard of healthcare. While nurses are utilizing technologies such as intravenous therapy, ventilators, glucometers, chest tubes, telemetry packs and monitors, arterial lines, microchips driven IV pumps and many others, most documentation and communication in many hospitals have remained tied to pen and paper, face-to-face or phone-to-phone encounters.

Computer technology revolutionized patient care. The routine, dull nursing care transformed into a challenging high-technology patient care. Many hospitals accross the nation is adapting computerization in their facility. However, this new technology raised several concerns in the nursing profession. Several questions have been raised, questions such as: Does technology detract from the humanistic side of patient care? Does it diminish quality patient care? Does it minimize the value of the nurse’s skills? Looking into all these concerns led me to several points about the advantages of utilizing the new technology.

In my personal opinion, the use of computers and information systems have helped nurses perform their jobs better and more efficiently. Nurses can readily access patient records or check patient’s medications and laboratory results while at bedside. Technology can also improve job satisfaction, reduce errors, and give nurses more time for direct patient care. Furthermore, technology help nurses take information and turn it into insight to make life-saving decisions at patient’s bedside.

However, many nurses are still cynical with the use of computers especially for nurses who are not computer savvy. Most nurses would think that using computers would drive them to spend more time and effort to complete their documentation. Technology should not get in the way of patient care. It should help nurses perform a better if not the best patient-centered care. It is therefore the role of the hospital administration to choose a system that would allow the nurses to do what they usually do and not to reinvent their job because of the new technology in the facility. The nurse educators must also train the staff about the ins and outs of the new technology to make them comfortable and confident in using the technology.

I believe, with the right attitude, openness to change, integration to IT environment through skills training and support from a competent nurse educators and unit administrators, nurses will have a better chance to learn new technology that will help them deliver holistic care to their patients.

What do you think???

Nurses with Disability?

The term suited for nursing means to me when an individual has the physical and psychological capacity to take care of sick persons. It is the nurse educator's moral and social responsibility to examine the capacity of a nursing student to become a registered nurse or a nurse who become disabled to stay in the profession.This is stipulated in ANA Code of Ethics for Nurses, which states that, “The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintain integrity of the profession and its practice, and for shaping social policy.” However, the defining line of who is suited and not suited to enter and stay in the nursing profession is still a subject of debates, deliberations, and controversies in the academia and in the clinical practice.

Accepting students with disability in the nursing profession and allowing nurses who become disabled to stay in the profession are controversial issues because of its legal implications. Rehabilitation Act of 1973, Section 504 states that, “No otherwise qualified handicapped individual in the United States…shall solely by reason of handicap be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.” Moreover, the American disabilities Act of 1990, “…prohibits discrimination on the basis of disability by entities providing public and private preschool, elementary, secondary and postsecondary education. It also prohibits discrimination on the basis of disability in employment, public accommodations, commercial facilities, transportation and communication.”

It is my personal belief the persons with disabilities may be given a fair chance to enter the profession and practice nursing. The institutions on the other hand, must provide disabled students and nurses physical, psychological, and social support, based on their individual needs.As nurses, we always consider the safety for our patients. This is so, because it is part of our ethical practice to adhere to the universal moral principles. Nevertheless, consider also those disabled individuals who want to enter the profession and those disabled nurses who want to stay in the profession. Let us not leave these individuals who have the hearts and minds in the nursing profession provided they can skillfully practice safe nursing care.