There's a storm coming!

In the Nursing Forum yesterday, nurses were apparently told in no uncertain terms that there will be no raises. Sorry. Absolutely not. Can't get there from here. But nurses were encouraged to stay, if stay they are determined to do, because of "collegues and patients".

This would seem to overlook the fact that there are "collegues and patients" in every nursing job...and some nursing jobs pay a whole lot better, and come with annual raises to boot. This is because nurses are people, too, and have families and household obligations. In fact, they work primarily in order to take care of their families and household obligations; if they didn't HAVE to work, they wouldn't. In other words, nurses are not a charitable non-profit organization, donating their time entirely out of love. They do, in fact, need to make a living...and can make a better one everywhere else in town....and can have collegues and patients there, too.

The nurses are annoyed that the most woefully underpaid among them, the 1's and 2's, will see a "cost of living" (that's not quite the cost of living) raise, while the physicians get a 33 1/3% raise and the managers already are making several times what the 1's and 2's are making. There's a feeling of unfairness in the air, exascerbated by the fact that there is a nursing shortage, that nursing turnover is quite definately high enough to adversely impact quality of care, and that all they have to do to get paid more is work for somebody else.

So how did the HS Department achieve those physician raises? They submitted a "Supplemental" request to the Joint Budget Committee. This included several paragraphs like this:
The Department indicates in its request that the institutes have recently lost several psychiatrists: one to a community mental heath center at 40 percent above current salary, one to a private health insurance provider in an inpatient setting at 36 percent above salary, and one to DOC at 11 percent above salary. Currently, the turnover rate is 20 percent at Fort Logan (of the positions even filled) and 23 percent at Pueblo (again of the positions even filled). More important than the turnover, however, is the fact that the institutes are having trouble even filling the vacated positions now. This appears to be the real supplemental issue in staff's opinion.

A salary table is shown, reasons to fund and not to fund are given.

Under "reasons to fund" we have:
While turnover rates are an important indicator of a management and salary problem, quality of care, including quality of client evaluation/assessments are factors that are not evidenced in turnover rates.
and
The Neiberger lawsuit and the corresponding need to maintain appropriate staffing rations for lawsuit settlement compliance, along with the need to ensure metro area beds by keeping units open at Fort Logan are weighty and serious issues for the mental health system.

So, although these remarks are given in response to a request to increase physician salaries, they apply as well to nursing staff, don't you think?...Yes, we need good Doctors, no doubt about it...but the Doctors don't do the day to day care of patients; we need nurses just as badly. Nurses directly affect patient quality of care enormously and quality of care is the stated objective in these funding priorities.

Now, under reasons not to fund there's this:

The mental health institutes have requested a 0.2 percent base cut ($120,117 GF) in personal services in its November FY 2006-7 budget. This is an executive common policy; however, it is staff's understanding that the Department did not request or consider an exemption to this policy. This requested decrease would appear to run counter to the supplemental and budget amendment request.

and this:

The mental health institutes are given a budget each year to manage and have the opportunity to do a comeback through the Governor's Office if the funding is estimated to be short.

And,finally, this:

The institutes report a funding shortfall that exceeds this request (e.g. nursing). It is hightly likely that those areas will request funding in the future as well.

At last! nursing is mentioned...and we see that no request was made for nursing this year.

Each of these things speaks to the concern nursing staff have about management and their administration of the hospital...Why didn't the Dept of HS "request or consider an exemption" to the 0.2 percent base cut??? Surely, by the look of things, we need every penny...why just let this go? If the mental health institutes are "given a budget each year to manage", aren't they then responsible for how the money is divided up? Why the huge gulfs between the salaries of line staff and their supervisors? Why didn't anyone ensure that there was a funding request for nursing salaries? I imagine the process involves people talking to people, doing salary surveys, pointing out the vacancies and turnover rates, talking about how quality of care has been impacted...making the argument to the JBC, as was done for physician's salaries. I'm pretty sure the physicians themselves didn't get together and produce the request...the administration did...why didn't it do the same for nurses?

In the staff recommendations section of this document it says:

Staff's methodology for this budget is to consider impacts on patient care as the #1 requirement with other areas secondary to this goal. However, because having psychiatrist on staff at the mental health institutes is necessary, the lack thereof could threaten a unit's closure. This is a concern in Pueblo because of the competency evalutaion backlog. This is also a concern in the metro area (Fort Logan) where the shortage of psychiatric hospital beds is beginning to present itself as a crisis.

It seems to me that nursing staff have two points of leverage here. One is our impact on patient care - seen as the "#1 requirement" in the budgeting process; the other is the metro area shortage of psychiatric hospital beds, which is "beginning (!) to be a crisis."

Nurses are important. Our nurses are underpaid and leaving daily. Without nurses this facility cannot operate. Period. It can't. And, apparently, not even the most rudimentary effort was made by management to get nurses realistic raises; worse, management has not inspired confidence in its management of the available budget.
Nurses feel adrift on a rudderless ship, with a captain who's "thinking of other things"; the first mate is playing solitaire in his cabin; the cargo in the hold is beginning to shift; there's a storm brewing way out on the horizon....the rats have begun to leave the ship.......and there's this damned fly buzzing around...

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