Chetzemoka ,

Good.

Pay is only part of the equation. Our number one demand in all of the recently increased number of nursing strikes is preservation of patient safety through safe nurse to patient ratios and prevention of burnout and turnover. Pay is a primary factor in attracting more staff to achieve those other goals.

To understand the impact of nurse to patient ratios: We are expected to "round on" or see all of our patients once per hour during a shift. We give medications, perform procedures, provide education and emotional support, but above all else, we monitor to see how you're doing and make sure nothing is changing for the worse. Oh, and then document in a computer every single time we blink an eye.

If a nurse has 4 assigned patients, this provides 15 minutes per patient per hour. Naturally not every patient will need exactly 15 minutes of care every hour. Some will just need a quick glance while another needs 30 minutes. At 4 patients per nurse on a "regular" medical-surgical floor (what you typically think of when you think of a hospital floor), that's pretty easy to balance and remain aware of the condition of all the patients and provide everything they need.

If you push that ratio to 5 patients per nurse, the time provided decreases to 12 minutes per patient per hour. At 6 patients, it's 10 min/pt/hr. At 7 patients, it's 8.5. You see how this goes. Oh and each additional patient requires the exact same amount of computer documentation, further decreasing the actual time spent caring for the patient.

There is absolutely an upper limit of how many patients one human nurse can safely monitor and care for at the same time. And it also depends on what level of care is being provided. An ICU nurse can't care for 4 unstable patients the way a med/surg nurse can care for 4 mostly stable patients.

Because nurses are a net labor cost for hospitals (nursing services are billed as part of a flat rate "room and board" charge rather than being billed separately - a historical holdover from the time when nurses were also housekeepers and not trained medical professionals in their own right), hospitals are always incentivized to reduce nursing staff and force nurses to take on more and more labor. If something goes wrong and a patient gets injured because we made a mistake, the hospital will just wash their hands of it because we're the licensed professionals responsible.

In our current system, hospitals will always have to be forced to provide you, the patient, sufficient nursing care. They'll never do it voluntarily. So we strike.

seeCseas Mod ,

if COVID has demonstrated anything, it’s that nurses need to be paid more!

TheK ,
@TheK@lemmy.world avatar

My first thought was the nurse slow-down on Scrubs.

afraid_of_zombies ,

My wife is a nurse.

The workload increases. They can’t onboard nurses fast enough. The nurses pull in longer and longer hours. Eventually one gets burned out and takes some time off. The workload piles on the remaining nurses. Another gets burned out. The workload piles on even fewer nurses…

Solution A: bring in temp nurses. Problem, they cost more.

Solution B: go overdrive on onboarding. Problem, more time spent training less on patient care. Additional problem, there is a shortage.

Solution C: massively increase salary and find the workaholics. Problem, the insurance companies won’t change their pricing structure.

Added to all this is cost disease. You need about the same number of nurses per patient as you did decades ago.

swnt ,
@swnt@feddit.de avatar

Can you elaborate on solution C please and explain it in a bit of detail?

jeffw ,

Currently studying this. It depends on your payer mix. Medicare and Medicaid never negotiate. Insurers will negotiate reimbursement rate to docs/hospitals, depending on the situation. If one insurance company dominates the market, they won’t negotiate. Why would they? They insure 80% of a city, what can a hospital do? Refuse patients on that plan? Then they lose access to 80% of potential revenues

Edit: this is an oversimplification, but I’m not here to write an entire essay on reimbursement mechanisms. Fee for service is increasingly rare, but the same logic applies. There is another side to the argument of course. If you’re the best hospital in the area, you have leverage over the insurance company. It all depends on who you are and how popular you are, both for a hospital system and an insurer. Just like any company negotiating buying a wholesale good from another company.

min_fapper ,

Thanks for the write up. It was informative.

jeffw ,

You’re welcome! Happy to talk other questions that I can give short answers to. Insurance is a wild world

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