ProPublica: Temp Agencies Are A Haven for Impaired Nurses
This is the second "bad nurses" story we've seen out of ProPublica and the L.A. Times, and while the issue's worth examining, seems to me there's an element of class discrimination to their focus.
I used to work as a medical fraud investigator, and during that time, I was shocked to discover that it was quite literally almost impossible for a doctor to permanently lose his license. I mean, there were doctors with ongoing drug and alcohol problems, doctors with falsified credentials, doctors who'd killed people - and they rarely got more than a slap on the hand and a temporary suspension.
So while it's of course a good idea to examine nurses, I'd like to see a similar examination of physicians, too:
Firms that supply temporary nurses to the nation's hospitals are taking perilous shortcuts in their screening and supervision, sometimes putting seriously ill patients in the hands of incompetent or impaired caregivers.
Emboldened by a chronic nursing shortage and scant regulation, the firms vie for their share of a free-wheeling, $4-billion industry. Some have become havens for nurses who hopscotch from place to place to avoid the consequences of their misconduct.
A joint investigation with the Los Angeles Times found dozens of instances in which staffing agencies skimped on background checks or ignored warnings from hospitals about sub-par nurses on their payrolls. Some hired nurses sight unseen, without even conducting an interview.
As a result, fill-in nurses with documented histories of poor care have fallen asleep on the job, failed to perform critical tests or stolen drugs intended to ease patients' pain or anxiety.
"A lot of them are really bad nurses," said Sandra Thompson, a nursing supervisor at Northridge Hospital Medical Center and Sherman Oaks Hospital, both in the San Fernando Valley. "Sometimes I see them here [at Northridge] and think, 'I wonder how long before I see them over' " at Sherman Oaks?
Some agencies are diligent about checking nurses' records, said Joey Ridenour, executive director of the Arizona State Board of Nursing.
Others are not. As a result, if wayward nurses want to work, "I think it's easier to hide in the registries," Ridenour said. "Some just sign them up."
"chronic nursing shortage"
I have a friend who works in a hospital (admin) and she has mentioned more than once how hard it is to fill the full time nurse positions while cutting costs. It is a no win situation as the hospital ends up using temps knowing the temps are not qualified to fill the full time position and will not be hired. The temps have little or no incentive to work hard or try to do a good job.
It is a mess.
And the doctors? Even worse (in different ways)
Of course - the dedicated career nurses are like angels when you are sick. Most do a great job and are under appreciated and over worked.
"I know that there are people who do not love their fellow
man, and I hate people like that! " ~ Tom Lehrer (1928 - )
Too bad, so sad.
They can't hire nurses at minimum wage. Not good ones at any rate. See my post below, b/c they are willing to pay MORE per hour to an agency than they are to individual nurses b/c their 'budgets' screw the staff.
The good nurses who actually care about patients and are overworked? Wouldn't be overworked if the hospitals would properly staff themselves. And that means paying RNs and specialized nurses with graduate degrees what they are worth.
I'd love to see the CEO's salaries capped and cut while their responsibilities double.
what else is new?
tort reform by republicans should be ignored. If a company wants to hire incompetent people then they should pay for their mistakes.
Republicans are liars and simply cannot be trusted.
The Republicans in Congress are so worried about the high insurance premiums that doctors have to pay but don't give a damn about the insurance premiums the rest of us have to pay. I know the Congress get Cadillac healthcare on our dime but maybe if a few more of the tea-bag birthers had to go to the average ER, they may be a little more reasonable.
I've known some physicians that have been fired for misconduct and within a week hired at the hospital that is literally attached to the hospital they worked at before.
The corporate hospital shell game
My SIL is a great nurse. She worked at an agency b/c the agency paid more money than working for Northwestern Hospital on staff.
So the hospital paid the agency double what the agency paid my SIL, but when they offer her a full time position, they offer a third less that she's paid by the agency.
Just to clarify--to fill the necessary position, they are willing to pay $100/hr to an agency, but only $35/hr to hire staff. If they paid my SIL the $50/hr the agency paid, she would go to staff immediately, but she has to take a pay cut to do EXACTLY the same job as she already does.
It is more important to the men running the hospital that nurses' salaries are capped than how much it actually costs to staff the hospital properly. They are more concerned with artificially keeping staff salaries down (since they are happy to pay an agency more) than they are with patient care.
Health care in this country is totally screwed up. It's all about the money, and the sick are damned unless they are rich.
In 2006, Kohlberg Kravis Roberts and Bain Capital, together with Merrill Lynch and the Frist family (which had founded the company) completed a $31.6 billion acquisition of the hospital company.
Hospital Corporation of America
dump them for a massive profit.
That's the ticket.
Hospital administrators are more concerned with the bottom line: PROFITS, than they are with patient safety or employee morale. Hospital nursing is back breaking work with schedules of weekends, nights, holidays, shifts in excess of 12 hours at a time & dangerous patient care ratios. It is the nurse who is with the patient 24/7. It is the nurse who relays information to the physicians. Just try running a hospital without them. Until hospital administrators understand that nurses are the backbone of a hospital & pay them the wages & the respect they deserve, the best nurses will continue to abandon hospital nursing in droves or leave the profession altogether & hospital administrators will be stuck with using temporary agencies to staff their facilities at the patient's peril. Healthcare needs to return to the focus of taking care of people NOT making money off them.
a Physician Assistant. (It's a fairly new profession)
You don't have to take on the time or expense of med school and the field is virtually recession-proof, owing to an ongoing shortage of primary-care physicians.
Pre-reqs: A master's degree; 100 hours of training every two years; recertification every six.
There is a whole business called 'travel nursing" where nurses can work for an agency that fills positions short term all over the world. The first one that comes up on a Google search is www.nursesrx.com .
The short term fill-in jobs might be needed for many reasons. Strike-breaking is one that comes to mind.
And the odd thing was even when doctors lost their medical license they could move to another state, or region, take their medical exams and start all over again.
There's no real tracking system that I know of of doctors with a history of valid complaints even within a state, never mind between several.
http://www.youtube.com/watch?v=aqImkDgDwHU
Diabolus est Deus Inversus
As a Registered Nurse with about 30 years of experience in the trenches I could tell many of my own personal horror stories. I've heard, "You should write a book" too many times.
Yes, the traveling nurses do walk across picket lines. I remember many moons ago when nurses at a major San Francisco hospital were on strike and there was a big brouhaha over the travelers coming in to work. They should be ashamed of themselves.
But here's who else should be ashamed. The American Nurses Association. Here is an example of a highly elitist organization. The dues to join the ANA are very prohibitive I believe because there are forces at work making certain the dues and outreach to ALL the nurses in the U.S. is weak. Years ago I called national headquarters to make the suggestion that they lower the dues and do an outreach to ALL the nurses in the country making an offer for them to join by taking $10 out of their bank accounts once/mo. in order to fullfill the dues requirement. They wouldn't here about it. I knew if suddenly the majority of nurses in the U.S. belonged to the ANA they would be a major political force to be reckoned with.
Also by the strengthening of the national organization (union) standards for the quality of all nurses could be agreed to. Now standards are different all over the country. California used to have the highest standards in the country along with New York but something went wrong in the past twenty years.
Perhaps the nursing shortage caused the California Department of Consumer Affairs to slack off on its standards? I heard the horror stories about impaired nurses being allowed to work because they were in "diversion". Apparently the simple lack of frequent drug testing was allowing these nurses to continue abusing drugs/alcohol. There was a recent article in the L.A. Times detailing that the CDCA is about to clamp down on impaired nurses in diversion by doing random drug testing 130 times a year. Personally, I think these nurses (and doctors!) should find a different profession! Nurses and doctors should be a special breed apart from all others as we literally hold others lives in our very hands. There is no room for mediocrity in medicine.
I worked as a "Nurse Recruiter" about four years ago here in L.A. and this is the way my boss decided she was going to make more profits. (I have a sneaking feeling this is how all the traveling/temp. agency's are working as well). Rather than have these nurses become "employees" where she would have to pay their Social Security and do all the withholdings etc., she simply factored in the profit she wanted then forced these nurses to become "Independent Contractors". The client would pay the nurse a huge check for her services and then the nurse would pay my boss a "Finders Fee" for turning her on to the client. The nurses would of course have to take care of all their tax liabilities, medical insurance, workmen's comp, malpractice insurance etc. and after the dust settled they made little money.
I had to leave that job because the thought of screwing my own profession made me physically sick. I mean I literally got the flu of my life and couldn't work for three weeks and finally I realized that I had to quit.
When I worked in a hospital setting as a supervisor I would have to call the registry from time to time to get a nurse. Believe me, every staffing office has their "do not send" list. Staff nurses DO resent these nurses because many of them do make more money and they typically get the easy assignments as most Charge Nurses worth their salt won't give an unknown nurse a "hard" assignment.
Obama and the Congress should get truly serious about the health care quagmire in this country. There are plenty of quality young men and women who could be recruited into the field of nursing and competently trained to be GOOD nurses within two years.
And lastly, my understanding is that The California Nurses Association pushed through legislation for California in the past few years creating a LAW that no nurse is to receive more than five patients/assignment and that has to be factored with acuity levels (how much care each patient needs). I thought that would take some of the pressure off Cali nurses....?
"The US has an army of 90,000 soldiers in Afghanistan and is spending $100bn a year, but has still been unable to defeat 20,000-25,000 Taliban who receive no pay at all." - Patrick Cockburn
things aren't much different up here in Canada. There was a case a few years back in Ontario where a doctor was found guilty of sexual abusing several of his patients. He actually did time for this but when he got out he applied to have his license re-instated and the medical licensing board found him technically competent to practice but required his victims to travel to Toronto to give evidence if they wanted to object. Until the papers got hold of the story, of course.
Hasa Diga Eebowai
ProPublica's article on the nurses and doctor accused of euthanasia during the aftermath of Hurricane Katrina was almost a trial by press. The nurses were ignored and Dr.Pou, who was cleared by a grand jury, could not have her side heard because she is bound by confidentiality and also the target of several civil lawsuits.
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