Cost

A comment to my post on cashing in:

Very enlightening. Up to now, I assumed it was big pharma and greedy insurance companies that caused health care costs to skyrocket. The correct answer, as it turns out, is all of the above; everything connected to healthcare.

No offence to oldvet, this post isn’t an attack upon him, but is a classic case of supply and demand. The ED wants to open, but there is a shortage of qualified nurses. They have no choice if they want to stay in business- by law, an emergency room has to be open 24/7. So they have to:

• do whatever it takes to get qualified people to come in: that means paying enough to entice them or
• lower standards and risk medical errors

Since the US has a climate of legal liability, medical care is a field that has zero room for errors. People who can treat patients without making a single error are rare and in high demand. That means there is a bidding war for their time.

Skilled people cost money, which is why it costs $165 to have a plumber snake a drain. No one wants to look up while having a medical emergency and see the cheapest nurse caring for them- they want the best, or at least someone who is good at what they do.

It takes 3-4 years to train a basic nurse. More than 3/4 of those who begin the education don’t make it.

Then it takes another year to train for the ED specialty. Two more years before they reach a point of proficiency without needing guidance and supervision.

Of the nurses here who manage that seven year slog, just over ten percent are good enough to be board certified in emergency medicine. Only a quarter of those have two board certifications.

In other words, of the 257,000 actively licensed RNs in Florida, 17,000 are Emergency Room nurses. Of ED nurses, only about 2500 of them are board certified. Only about 800 of them have two certifications.

Are two specialties really needed? Certified Emergency Nurse, sure. How about a nurse certified in stroke care? Pediatrics? Trauma? Vascular access? Critical care? Each of those is a subspecialty that is needed in the ED on a daily basis.

Now consider that there are 477 licensed emergency departments in Florida, all competing for those nurses. Everyone wants the best, so those who have multiple certificates and degrees demand (and get) top dollar. My last employer had 162 ED nurses and still didnt have enough for their patient load. That drives up costs.

They only way to eliminate the nursing shortage is to either lower demand or increase supply. Lowering demand isn’t going to happen. Raising supply can be done in two ways:

• Raise pay
• Lower standards

In today’s legal climate, lowering standards would actually cost more in increased litigation caused by more medical errors. In the ED, 95% of patient care is performed by nurses. We write orders for imaging, lab work, and treatment. What kind of provider do YOU want at your side during your next medical emergency?