Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, November 27, 1994 TAG: 9411290017
SECTION: BUSINESS PAGE: F2 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
DATELINE: LENGTH: Long
This means a hospital must increase staff beginning in August, cut back in November and rev back up in the first quarter of the year. Elective surgery is popular in the latter part of the year because many people have met their insurance deductibles by then and can get full reimbursement. In the first quarter, hospitals are busy with respiratory cases, more common in winter months.
Lewis-Gale Hospital in Salem is a for-profit hospital owned by Columbia/HCA Healthcare, the nation's largest hospital chain. Lewis-Gale has been matching staffing to patient numbers since spring 1987, said President Karl Miller.
When Miller came to Lewis-Gale in 1986, it was "graciously" staffed, he said. The following spring, 11 people, including nine nurses in patient care, were laid off and the hospital adopted a philosophy to staff on a daily basis, meeting the level of demand for that day.
The hospital, licensed for 378 beds, has the equivalent of 1,041 full-time workers, or FTEs. Using an industry measurement of employees per "adjusted occupied bed," adjusted to account for outpatient business, Lewis-Gale's 4.4 FTEs per adjusted bed is close to the national average of 4.2.
"Lewis-Gale's philosophy is to not lay off, but not to hire," said Kereen Mullenbach, vice president for patient-care services. "The challenge is to get the right kind, the right number and not get too much."
"Quality still counts, just as in cars, but [health maintenance organizations] are changing things. An employee can't be just nice anymore. You have to be able and willing."
As hospitals look for ways to cut costs, specialist jobs created when registered nurses were in short supply are disappearing.
Mullenbach said she never believed in the fragmentation of care, anyway.
"What I want is a nurse taking care of that patient," she said. "I've always subscribed to generalist."
Hospitals that had to show a profit, such as Lewis-Gale, might have been more aware of costs all along. Lewis-Gale never had IV therapy team specialists, for example. It also pays nurses less than Roanoke Memorial does, Mullenbach said.
When Mullenbach arrived at Lewis-Gale, she said, she had to increase staff to be able to meet the needs of the more acutely ill patients the facility had begun seeing.
Because people are living longer and medical care has been so good, a patient coming in for cataract surgery might already have had cancer, a lung condition and a heart attack, Mullenbach noted.
That kind of critical care requires registered nurses who can make independent decisions, she said. In Virginia, licensed practical nurses can do the same work as a registered nurse only if supervised by an RN or a physician. Registered nurses are more versatile and in greatest demand, she said.
Where Community Hospital of Roanoke Valley is choosing a "collaborative practice or shared governance" approach to nursing, Lewis-Gale is giving its nurses a larger role in decision making through a case-management system.
In the case-management system, a nurse will be assigned a specific number of patients - perhaps five - and will make rounds with those patients' physicians and work as a team with the doctors.
Before that, a team of doctors, nurses, respiratory and physical therapists and a home health nurse will first develop what is called a "critical pathway" for treatment of a particular ailment.
A critical pathway is a plan or a "care map" for recovery that can be applied to most patients with a particular problem.
By focusing on an individual patient's needs with the treatment plan in mind, that patient should improve faster, which will save money because the patient will go home quicker, Mullenbach said.
In the past, when a patient was expected to be in the hospital for several days, health care providers didn't feel the urgency to get that patient home as fast as possible, Mullenbach said.
Part of dealing with a patient's illness, however, is getting the patient more involved, Mullenbach said. For example, diabetics should be encouraged to do their own injections while still in the hospital.
"We've got to move people into understanding disease," she said. "The patient is used to being taken care of. The hospital has encouraged that."
One of the greatest concerns about health care, she said, is that no one wants to see America's health care system, considered the best in the world, become mediocre.
Nurses are the first group to be affected by health care changes because they are the largest single group of providers, she said. Nurses are seen as a cost center. They're the most effective place to cut "because of their volume and because they are versatile."
"Nurses need to pro-act; they're on the wrong bandwagon," she said. "They're not listening to the futurists. Too many nurses are saying, 'Take care of me.'''
"Nurses will have to be flexible," Mullenbach said. "They fear having to change. It's difficult for this valley because it has a lot of long-term care workers. Jobs have never been threatened, and there hasn't even been much shifting between hospitals."
by CNB