Sunday, February 28, 1999
'I'd never be a patient'
BY PETER BRONSON
The Cincinnati Enquirer
Sometimes it's the little things, like plastic vs. silverware. “We eat in a place that's like a rundown high school cafeteria. They don't even wipe the tables down,” said a nurse at a local hospital. “The administrators eat in a private dining room with silverware and linens.”
Sometimes the last straw is bigger, like million-dollar bonuses and 50 percent raises for HMO executives, while nurses struggle on $45,000 and 2 percent cost-of-living adjustments, under “constant, constant threats of layoffs.”
“They get all kinds of perks — free cars, expense accounts. We can't even buy tape without approval,” one nurse said.
OK, so life is unfair. The big tunas gulp different air. But when they breathe their last gasp, they will probably be in a hospital, hoping there is a nurse nearby. And she might be gone, a casualty of staff cuts or burnout.
“The good people are getting out,” nurses told me all week. They e-mailed, called and wrote letters to add exclamation points to what two nurses said in last week's column: Pressure from managed care has cut nursing staffs, causing epidemic burnout, high turnover and unsafe care.
“You are dead on (no pun intended) when you write that nurses are leaving the profession to seek ways to support themselves and their families, that include better working conditions,” one wrote. “I work in management. If I had to return to floor nursing, I would change professions also. IT'S JUST NOT WORTH IT!”
The friends and families of nurses hear this, “But there's a lot the general public doesn't know,” the nurses say.
Some are too busy or too demoralized to speak up. Most are just scared. Several letters ended: “Please DO NOT use my name. I could lose my job.”
Here's what they said:
• “How can I continue giving quality care and do the work that by national standards should be done by 2-3 nurses?”
• “For the first time in anyone's memory, we are hiring new graduates in the E.R.”
• “Everything is a crisis, from staffing to the new computer system ... Quality leaders are ground down and frustrated, unable to do what must be done because they are too busy dealing with mindless cost-cutting. ... They just don't care anymore.”
• “I can't take care of my patients the way they should be cared for, and I run myself ragged for eight hours and pray that some child doesn't pay the price.”
• “I resent that I do not have the opportunity to practice nursing the way I know is best for my patient.”
• “If you go in the hospital, you need someone to watch over you because the nurses can't do it anymore. I would never be a patient in the hospital where I work.”
• “Why are our insurance premiums so high and we get so little? Maybe because the big guys controlling it are sitting back in the lap of luxury. I was appalled at the compensation of the (HMO bosses) and I wish a simple nurse could make that kind of money, because ultimately, without me and others like me who are dedicated to their professions, those fat cats wouldn't have a job.”
The “appalling” salaries I found in Ohio Department of Insurance records showed salaries up to $1.6 million and raises as high as 117 percent for top officers of managed care insurance companies.
So several nurses asked, “Why not report top salaries of the administrators at local hospitals that continue to cut jobs?”
OK. Here are rounded-off salaries, not including perks and other compensation, for local hospital executives in 1997 (latest available):
• The CEO of the Hospital Alliance: $515,000. Salaries for senior V.P.'s who run Alliance hospitals (Jewish, Christ, University, St. Luke): $260,000 to $300,000.
• Franciscan Health System: $417,500.
• Mercy Health Partners: $410,000.
• Deaconess: $410,000.
• TriHealth Inc. (Bethesda and Good Samaritan): $385,000.
• Children's Hospital: $290,000.
I'm in favor of higher salaries, especially my own. But nurses are getting the short end of the plastic fork while the bosses pig out on filet mignon “savings.”
The Ohio Nurses Association is pushing an Ohio Patient Safety Act (SB-19) to publicly disclose quality of care, protect nurses who speak up, and require name tags to identify nurses from unlicensed “care extenders.”
Another bill in Ohio would require annual reports of CEO compensation. But the HMO lobby rules in Columbus.
And if managed care companies don't stop turning patient pain into personal gain, Congress may surgically remove their immunity from malpractice litigation.
“The bottom line is that when anybody has immunity, they abuse that immunity,” said Cincinnati lawyer Stanley Chesley, a national expert in class-action lawsuits.
Allowing lawyers to copiously bleed HMOs sounds like a primitive way to make hospitals healthier. But the bosses who mismanage managed care are asking for it.
Peter Bronson is editorial page editor of The Enquirer. Call 768-8301, or write to 312 Elm Street, Cincinnati, Ohio 45202. E-mail: letters@enquirer.com
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