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> Hospitals have made sure they hire JUST ENOUGH nurses to cover shifts and no more. This is a two-edged sword. If you hire more than you need, the nurses' ho

> Hospitals have made sure they hire JUST ENOUGH nurses to cover shifts and no more. This is a two-edged sword. If you hire more than you need, the nurses' hours will be cut during normal situations and they won't make enough money. If hospitals don't cut extra hours and instead keep the staff on the clock, a public scandal will erupt surrounding well-paid medical professionals sitting around doing nothing.

tinco 5y ago
> a public scandal will erupt surrounding well-paid medical professionals sitting around doing nothing I don't think that's true. Increasing the amount of nurses means simply increasing the amount of care. If you have twice as many nurses, you'll have twice as much care for your patients. No way nurses would be sitting around doing nothing.
- coryrc 5y ago
  That's not how healthcare works. That it is does not function that way is why free-at-point-of-use public healthcare systems are capable of working.
  - bumby 5y ago
    Not sure why you're being downvoted, but the idea that doubling nurses doubles the amount of patient care shows an ignorance of the healthcare system. "Patient care" is a nebulous term and needs to be further defined in that statement. Do you now get two catheters instead of one? Or get your vitals taken twice as often? Both double patient care but only one is relevant.
    - ikiris 5y ago
      It's because it would actually double the amount of care on most floors, because they're usually at 60% of the staffing they need as a start because they've been able to get away with that for years.
      - bumby 5y ago
        That doesn't really answer the question. "it would actually double the amount of care". It would double the amount of staff hours. How those staff hours are used is a measure of patient care and not all hours are equally relevant to the patient. As an example, if we assume you are a software engineer and you double your work hours, will you double your code output? Probably not, just like it's not a 1:1 translation of nurse hours to patient care.
        deleted 5y ago
        [deleted]
        ikiris 5y ago
        Comments like this are showing just how much you don't understand maintaining a service level based care, and are stuck in thinking in terms of producing a product. Combined with willfully ignoring that basically all floors are intentionally understaffed and have been for years.
        bumby 5y ago
        I can tell you from my years in healthcare that many of the people who think they know how the system works only have a very myopic understanding and they usually are the one's who have the most confidence that their simple solution will fix the problem. Unfortunately, there's a lot of nuance in complex systems like healthcare. We probably agree about the staffing levels to an extent, but I would be curious to hear the staffing estimation methodologies used in your experience.
        ikiris 5y ago
        Yeah, I agree. You sound like many healthcare admins I've worked with and for. I'm not sure its the flex in this argument you think it is.
        bumby 5y ago
        I wasn't healthcare admin and most of my department was staffed with nurses. But we were very data oriented and it helped buffer us from emotional responses to problems.
    - Firmwarrior 5y ago
      I could definitely imagine nurses having twice as much time to carefully read my charts, or twice as much time to sleep at night and be well rested so they don't fuck things up, or being able to come by and help with something twice as quickly
      - bumby 5y ago
        That would provide better patient outcomes, I agree. Whether hiring more nurses translates to actually doubling that, is another question. To be clear, I'm not saying that increased staff is not part of the solution; it's just been my experience that it's rarely the sole part (or often even the majority part) of the solution.
tomc1985 5y ago
At the rate that healthcare charges in the US, hospitals can more than afford to keep X+1 or +2 needed nurses around in three 8-hour shifts. They just don't.
- conductr 5y ago
  Not even close. Most hospitals have trouble staying afloat as is. And there are disciplines within nursing, so you'd have to overstaff by quite a bit more such that closer to 2x is a backup but leads back to the GP's point. They employ on-call, PRN, contract nurses, etc to fill in the gaps which mostly works in non-pandemic situations.
  - a2tech 5y ago
    Reading threads like this really hammers home most of HN have never worked in health care. Hospitals BARELY make their budget. 1% over cost of doing business is considered a really good year for my institution. Also if I never have to hear people complain about bloated admin budgets in education and healthcare ever again it’ll be too soon. Those admins aren’t sitting around on their thumbs—they’re dealing with the ridiculous legal and administrative system the insurance companies and government have created. Those people are absolutely critical for the institution to exist.
    - jonlucc 5y ago
      Hospitals have been paying 4x staff rates for travel nurses for multiple years now, though.
      - conductr 5y ago
        I’ve never seen that even before the pandemic. 1.5x-2x is normal for all the usual reasons a contractor cost more. Taxes, benefits, agency that needs a margin, etc. I’m guessing if you’ve seen that is hyper localized to some place/issue.
        5y ago
runnerup 5y ago
You can pay people fixed monthly salary + overtime hours. You don’t need to cut their hours and their pay, though that’s often the choice that employers make.
- munk-a 5y ago
  Exactly, choosing to cut hours or pay due to a lull in business is a choice made by the employer. It's not like these hospitals are sputtering along right at the fringe of solvency and one bad choice will bankrupt them - private health providers tend to make pretty comfortable profit margins and the fact that they can pay such outrageous surge prices for travel nurses is a pretty clear proof of how much they have to spare.
  - nradov 5y ago
    Many hospitals literally are sputtering along right at the fringe of solvency. This is particularly a problem with non-profit hospitals in poor and rural areas. Summer have shut down in recent years, and the pandemic is accelerating that trend. https://www.beckershospitalreview.com/finance/12-latest-hospital-bankruptcies-closures.html https://www.beckershospitalreview.com/finance/12-latest-hosp...
    - munk-a 5y ago
      Some hospitals are sputtering right along, and a list of 12 isn't a great piece of evidence that those hospitals (many of which are run by regional organizations which are essentially consolidating patient pools into a central location) are being run effectively - especially if these hospitals are paying 10k/week for travel nurses. If there's a location that isn't profitable to operate a hospital in then the hospital will probably fail. America is the country still clinging to market-driven healthcare services and the market can be a cruel mistress. And all that doesn't at all erode the fact that nurses are paid pauper's wages at extremely profitable hospitals - some tech companies are going out of business, some probably closed their doors today... that doesn't mean that all engineers are expected to work for 60hrs/week at $15/hr.

tinco 5y ago

> a public scandal will erupt surrounding well-paid medical professionals sitting around doing nothing I don't think that's true. Increasing the amount of nurses means simply increasing the amount of care. If you have twice as many nurses, you'll have twice as much care for your patients. No way nurses would be sitting around doing nothing.

coryrc 5y ago
That's not how healthcare works. That it is does not function that way is why free-at-point-of-use public healthcare systems are capable of working.
- bumby 5y ago
  Not sure why you're being downvoted, but the idea that doubling nurses doubles the amount of patient care shows an ignorance of the healthcare system. "Patient care" is a nebulous term and needs to be further defined in that statement. Do you now get two catheters instead of one? Or get your vitals taken twice as often? Both double patient care but only one is relevant.
  - ikiris 5y ago
    It's because it would actually double the amount of care on most floors, because they're usually at 60% of the staffing they need as a start because they've been able to get away with that for years.
    - bumby 5y ago
      That doesn't really answer the question. "it would actually double the amount of care". It would double the amount of staff hours. How those staff hours are used is a measure of patient care and not all hours are equally relevant to the patient. As an example, if we assume you are a software engineer and you double your work hours, will you double your code output? Probably not, just like it's not a 1:1 translation of nurse hours to patient care.
      - deleted 5y ago
        [deleted]
      - ikiris 5y ago
        Comments like this are showing just how much you don't understand maintaining a service level based care, and are stuck in thinking in terms of producing a product. Combined with willfully ignoring that basically all floors are intentionally understaffed and have been for years.
        bumby 5y ago
        I can tell you from my years in healthcare that many of the people who think they know how the system works only have a very myopic understanding and they usually are the one's who have the most confidence that their simple solution will fix the problem. Unfortunately, there's a lot of nuance in complex systems like healthcare. We probably agree about the staffing levels to an extent, but I would be curious to hear the staffing estimation methodologies used in your experience.
        ikiris 5y ago
        Yeah, I agree. You sound like many healthcare admins I've worked with and for. I'm not sure its the flex in this argument you think it is.
        bumby 5y ago
        I wasn't healthcare admin and most of my department was staffed with nurses. But we were very data oriented and it helped buffer us from emotional responses to problems.
  - Firmwarrior 5y ago
    I could definitely imagine nurses having twice as much time to carefully read my charts, or twice as much time to sleep at night and be well rested so they don't fuck things up, or being able to come by and help with something twice as quickly
    - bumby 5y ago
      That would provide better patient outcomes, I agree. Whether hiring more nurses translates to actually doubling that, is another question. To be clear, I'm not saying that increased staff is not part of the solution; it's just been my experience that it's rarely the sole part (or often even the majority part) of the solution.

tomc1985 5y ago

At the rate that healthcare charges in the US, hospitals can more than afford to keep X+1 or +2 needed nurses around in three 8-hour shifts. They just don't.

conductr 5y ago
Not even close. Most hospitals have trouble staying afloat as is. And there are disciplines within nursing, so you'd have to overstaff by quite a bit more such that closer to 2x is a backup but leads back to the GP's point. They employ on-call, PRN, contract nurses, etc to fill in the gaps which mostly works in non-pandemic situations.
- a2tech 5y ago
  Reading threads like this really hammers home most of HN have never worked in health care. Hospitals BARELY make their budget. 1% over cost of doing business is considered a really good year for my institution. Also if I never have to hear people complain about bloated admin budgets in education and healthcare ever again it’ll be too soon. Those admins aren’t sitting around on their thumbs—they’re dealing with the ridiculous legal and administrative system the insurance companies and government have created. Those people are absolutely critical for the institution to exist.
  - jonlucc 5y ago
    Hospitals have been paying 4x staff rates for travel nurses for multiple years now, though.
    - conductr 5y ago
      I’ve never seen that even before the pandemic. 1.5x-2x is normal for all the usual reasons a contractor cost more. Taxes, benefits, agency that needs a margin, etc. I’m guessing if you’ve seen that is hyper localized to some place/issue.
      - 5y ago

runnerup 5y ago

You can pay people fixed monthly salary + overtime hours. You don’t need to cut their hours and their pay, though that’s often the choice that employers make.

munk-a 5y ago
Exactly, choosing to cut hours or pay due to a lull in business is a choice made by the employer. It's not like these hospitals are sputtering along right at the fringe of solvency and one bad choice will bankrupt them - private health providers tend to make pretty comfortable profit margins and the fact that they can pay such outrageous surge prices for travel nurses is a pretty clear proof of how much they have to spare.
- nradov 5y ago
  Many hospitals literally are sputtering along right at the fringe of solvency. This is particularly a problem with non-profit hospitals in poor and rural areas. Summer have shut down in recent years, and the pandemic is accelerating that trend. https://www.beckershospitalreview.com/finance/12-latest-hospital-bankruptcies-closures.html https://www.beckershospitalreview.com/finance/12-latest-hosp...
  - munk-a 5y ago
    Some hospitals are sputtering right along, and a list of 12 isn't a great piece of evidence that those hospitals (many of which are run by regional organizations which are essentially consolidating patient pools into a central location) are being run effectively - especially if these hospitals are paying 10k/week for travel nurses. If there's a location that isn't profitable to operate a hospital in then the hospital will probably fail. America is the country still clinging to market-driven healthcare services and the market can be a cruel mistress. And all that doesn't at all erode the fact that nurses are paid pauper's wages at extremely profitable hospitals - some tech companies are going out of business, some probably closed their doors today... that doesn't mean that all engineers are expected to work for 60hrs/week at $15/hr.