This article seeks to analyse the causes of the shortages in the nursing profession on both the patients and nurses vis-a-vis the commercialisation of the health sector by the various hospital administrations through the managed care consultants all over the United States.
Many factors seem to be responsible for these. However, the most important ones stem from an aging population of the available practising registered nurses to the rigours associated with bedside nursing. Nursing is physically, psychologically and emotionally demanding. Hence, nurses expect that they be respected and appreciated more, either through the reward system or improving the conditions of service in their various hospitals. However, the most significant factor is the cost cutting venture embarked upon by insurance companies and government payers such as Medicaid and Medicare. According to them, the inefficiencies that pervaded the hospital system ranging from the use of costly drugs to costly diagnostic technology to costly procedures and treatments had to be eliminated due to the ever increasing healthcare costs. It was thought that managed care would result in healthy price competition between hospitals, insurers, doctors and even nurses. Protagonists of cost cutting argued that once healthcare becomes a market commodity with business principles and efficiencies applied, a lot of money will be saved without compromising access to quality healthcare. On the long run, the influence of the cooperate world on healthcare delivery was increased. Majority of the managed care organisations were out to maximize their profits without caring less about the care received by the patients. Doctors had their practise patterns vetted and in some instances had to call some dedicated toll free lines to obtain approval for treatments, suggested procedures and length of hospital stay. Hospital stay reduced significantly as this was a major money saver. Competitions among hospitals for managed care contracts increased drastically and hospitals started sending their recovering patients to nursing homes/ rehabilitation hospitals who also receive a certain amount of money. They in turn discharge the patients quickly to nursing homes or invariably the patients receive their nursing care from home care agencies. Quality of care and compassion for the patients was sacrificed on the altar of profits. Hence, increased competition among the hospitals was about providing healthcare at cheaper prices with lesser staff and nurses. Hospitals hired management consultant groups like the Hunter Group, Earnst and Young, Arthur D. Anderson and American Practice Management to downsize in a bid to save more money, while huge amounts were paid to these consultants. Since nursing budget was in directly in control of the hospital administrators, the nursing budget became the easiest target to cut costs. There was little or no resistance from the nurses because they were poorly organized and had no common voice to fight the injustice and also had poor connections to the media. In some instances, nurses were recruited by the consulting firms and paid huge sums of money. They in turn justified the actions of these management consultants. They formulated different models and developed computerized patient acuity systems. Hospital administrators therefore could calculate the number of nurses needed on an hourly basis. Also, clinical pathways were developed by the consultants, all in a bid to increase their own profits and cut costs for the hospitals. In the process, a lot of nurses were layed off. Those who lost their jobs were promised management jobs and encouraged to venture into community nursing.
In conclusion, though, the managed care system has saved a lot of money, it should be noted that nurses shortages will undoubtedly affect the quality of care rendered to patients and even the performances of nurses. The employed ones could be given a sense of belonging by providing an enabling working environment and improving their conditions of service.
(2005) S. Gordon Nursing against the odds, how health care cost cutting, media stereotypes and medical hubris undermine nurses and patient care H.R Press