Last month, I mentioned that the hospital where I work is bringing Philippino nurses in to fill vacant positions for less money than hiring Americans. There is more news on that front.

We have been short staffed for nearly three years. They have made up the shortfall by paying huge bonuses to get nurses to work extra shifts. They tried foreign workers. Still, they don’t have enough. Determined to save money now that the COVID funding has dried up, hospital administration announced on Saturday that there will be no more bonuses offered. Once the shifts that are already promised bonuses are paid out, they will be no more. Nurses who were making $2500 a day for working a 12 hour over time shift are now being asked to work the same overtime hours, but for $600-$900 each 12 hour shift.

I know that I was working 60 hours or more a week. I was making good money to do that, but now that the money has dried up, I am not working those kinds of hours for a fraction of the pay. No one that I know is willing to do that.

So now the entire staff of the ED is not taking any extra shifts. They are working their contracted hours, and that is it. Me? My contract says that I have to work 4 shifts a month. That is all I am doing. Everyone else is doing the same. So now the hospital is even more short handed.

Here is what was texted out to us this morning by the ED department head:

Hello team
We know this week has definitely had its ups and downs already and we appreciate all the hard work done by everyone. While we all fight this same battle we still have patients who are expecting the best care we can provide.
Starting tonight through the weekend we could use anyone on any shift to assist your fellow team and patients.
Please any help is appreciated.

As if guilt tripping us will get us to work all of those extra hours for a third of what we were making before. I want to help my patients and coworkers, but at the end of the day, this is a financial arrangement. It’s business.

So now the hospital is getting desperate. A third of the ED beds were shut down today for lack of staff.

The hospital where I work can only fill itself to somewhere near 60% capacity because they don’t have enough nurses, and that was when people were working extra shifts for bonus money. That means that patients often stay in the ED until there is an open bed on the inpatient floors. Our ED is frequently more than half filled with patients on “admission holds” awaiting beds. Couple that with the fact that the ED is also short nurses, and you have a problem.

Picture a 50 bed emergency room. To staff a 50 bed ED takes 14 nurses, 4 paramedics, 4 general technicians, 3 doctors, a nurse practitioner or PA, a respiratory therapist, secretary, three registration clerks, two lab technicians, three radiology techs, and two janitors. Every shift.

Now picture that you only have enough nurses for 10 per shift. Now you can only handle 40 patients at a time instead of 50. Now also picture that you have 30 admit holds, taking up beds and waiting for an inpatient bed- some for more than 48 hours. Now you can only handle 10 patients because your staff is busy caring for holds. So the waiting room backs up.

This means you have people sitting in the waiting room for 4, 5, or even 6 hours as they wait for treatment. And all of that was happening before you cut off the bonus money.

Now instead of 60% staffed, you are more like 45% staffed. Instead of 10 nurses, you only have 7. Now picture that across the entire hospital. A 600 bed hospital with a 50 bed ED requires 100 nurses or more each shift. You only have 50 or 60. Now what do you do? There aren’t enough foreign workers to fill that many spots.

My hospital can’t be alone in this. Here is the warning: there is a potential collapse of health care coming. It takes 3 to 4 years to train a nurse to the point where they are licensed, and another 2 years or so for that nurse to be proficient enough in their job to staff an ED, even longer for places like the ICU.


GuardDuck · September 20, 2022 at 7:31 pm

Your hospital isn’t alone. My wife’s West coast hospital is the exact same – minus the foreign worker imports.

why · September 20, 2022 at 7:47 pm

And then there are those of us who were let go because we refused the vaxx…… been doing this since 1981, I have ZERO fooks left to give….Admin has spent years demanding more and more and giving less and less. Press-Ganey doesn’t help (I have colleagues who’s pay is based on their Press-Ganey score, like a druggie is going to give me good marks)

Jen · September 20, 2022 at 8:03 pm

ER nurse here. Our hospital just keeps filling the beds, even without the staff. I quit when 8 ER patients per nurse became our ‘new normal.’ Just. Not. Worth. It.

    Divemedic · September 20, 2022 at 8:21 pm

    Last July you were the one who planted in me the idea of going PRN. It was great advice.

    The ED has been averaging 6 patients each for the past couple of months. It’s going to get worse. We now spend more time on divert than we do fully open.

Jen · September 21, 2022 at 6:03 am

Exile1981 · September 21, 2022 at 6:26 am

Where are the people? Its a serious question.

I work oil and gas, start of covid saw most companies slash staff 20%. Now they are looking to hire again but no one is applying. All the companies keep saying the people let go must have moved to other industries. Except ihave frienfs in aerospace, construction and a few other fields and they all also xant find competent bodies either. So where are all those people?

J. Smith · September 21, 2022 at 8:39 am

DM, is it true when hiring foreign nurses, docs, medical personnel, they can hire them with much less training, schooling, standards, etc…because they are foreigners? I was told this by someone in the medical field, and makes sense which is why i refuse to use VA facilities because all the hateful, blacks in some VA facilities, and foreign could give a crap less docs. I use community care in a small Florida town, and my care has been pretty good.

Im pretty sure with the purposeful collapse of the US and all its institutions, medical collapse post-plandemic/kill shots is purposeful also for the culling, chaos and rebuild FUSA in the commie image.

Mister Two · September 21, 2022 at 11:04 am

These issues have not changed since I retired in 1996. Except the taking back of power and patient advocacy – that has actually gotten worse.

Stay strong brother, DOL

Paulb · September 21, 2022 at 11:55 am

To address Exile 1981’s comment, my company increased pay by 8% and is rumored to be upgrading the health care package. We lost 15% of our workers in the past year. The losses stopped when the wallet opened up. Plenty of people changed careers and stopped chasing the almighty dollar, though. Those people won’t be back.

Nate · September 21, 2022 at 12:40 pm

I’m a travel ED RN in the Midwest. I’m seeing much the same, minus the foreign workers. At the same time systems are cutting incentives for staff, they’re reducing rates and contract lengths for travelers. The boarding situation is cutting throughput across the board, I’ve seen it from community hospitals to Level 1 hospitals in the last year. It’s only going to get worse. Here the solution being adopted is to dump new grads into slots as fast as they can. Anybody who understands can see worse times coming.

    Aesop · September 21, 2022 at 9:00 pm

    That crashes the new grads, they burn out and walk away at 3X normal, and you’ve just wasted 3-5 years of educational prep and haven’t even kept them in the job long enough to break even on that investment.

    That’s called filling the boat faster than you can bail it out.

    It seldom works out well for the person in the boat.

      Nate · September 22, 2022 at 12:27 pm

      Seems obvious, right? One hospital’s onboarding plan involves doubling up, two new grads to one preceptor. Which means burning out the experienced with the new.

paracelsus · September 21, 2022 at 3:34 pm

Hire more administrators

s · September 21, 2022 at 9:01 pm

This explains an experience I had just this morning.
I had a minor cut on my index finger, right on the inside fold line. It was border line whether I needed stitches or not, I went in because of the location of the cut. At 6am there were three people in front of me, it took over an hour before I was in an exam room. they led me through into what I will call a pod of 6 rooms cordoned off by doors on each end there were at least 10 pods that I saw, based on drawn curtains most pods were empty or had at best one room occupied.
After about an hour the PA came in and looked at my finger and we decided to glue the cut. she told me I would be out of there shortly. It was another 2 hours before the EMT came in to clean the wound and then another half hour before the PA came back to glue me up.
All told it was 3.5 hours to squirt some CA and wrap me in a band-aid.
Not complaining about my care, but this post just might explain why it took so long on a quiet morning that the people I came in contact with said there were no big emergencies at the moment.

Aesop · September 21, 2022 at 9:03 pm

Cross-posted reply from BRM:

Collapse, no. Triage at levels that we haven’t seen since the 70s, maybe WW2, that’s a lot more likely.

^That, right there.

We use a five-level acuity model.
A 1 is someone dead who we’re doing CPR on.
A 2 is a heart attack, a stroke, or an unstable patient, physically or mentally.
A 3 is someone moderate to serious, but stable, requiring multiple interventions (imaging, labs, etc.). This is two thirds of all legit ER patients.
A 4 is someone with a broken bone, needing stitches, or having a simple UTI. Urgent, but not serious.
A 5 is someone with nothing-burger complaints, and/or a total waste of time: headache for 20 years, sore throat, ran out of my meds I’ve been on for years, my 30-year chronic back hurts, etc.

We’re going to start letting the 4s and 5s sit in the lobby for ten or twenty hours, and telling the 5s they either need to go to Urgent Care (which means they have to pay up front – the Horror!!!), or else wait two weeks to see their own doctor on his schedule, rather than misuse the system and come to the ER, unless the place is literally empty. And the 3s that could’ve solved their own problems are getting short shrift as well. 10th visit this month? Your fault; wait in flourescent light therapy room as punishment for being repeatedly terminally stupid. (Actual Example: woman diagnosed with gallstones six months ago, here for her third abdominal pain flare-up, who arrives with fingers covered in the red residue of a party-sized bag of Flaming Hot Cheetos. I am not making this one up.)

Manlingerers and hypochondriacs are getting kicked to the curb at light speed too. If chronic fatigue, “fibromyalgia”, or 20 ER visits for pain meds for your chronic problem are in your history (and we can see every ER visit you’ve made within 500 miles going back years and years), expect to spend a lot of time in the lobby watching Lifelock infomercials and reruns of Gilligan’s Island.

And calling an ambulance for your snivvel complaints and miscellaneous B.S. will just get us to have them dump you in the waiting room, you won’t jump the line, and you’ll get a $1500 bill copay for unnecessary transport.

COVIDiocy and stupid vaxx mandates cost us half the ICU nurses, and 1/4 of the ER staff, not counting the ones it literally killed or crippled, and they’re never coming back.

Hospital manglement (not a typo) was informed by multiple staffers that the troop morale “check engine” light was on two months ago; they don’t care, and don’t want to hear it. Okay, suture self.

If you don’t make time and budget for scheduled maintenance on your car, it will make the time for repairs for you, at three times the cost or more vs. the price of Preventive Maintenance. The same is true of employees, in any job.

Hospital manglement forgets this to their own peril. And patients are about to learn firsthand that “prevention is the best cure”. And the Emergency Department is for emergencies. Failure to plan ahead and chronic gross human stupidity are seldom emergent.

    Divemedic · September 22, 2022 at 6:08 am

    We’re already doing that. Our 4s and 5s are routinely sitting in the lobby for 5 or 6 hours. A UTI is routinely a 5 hour visit. Last week, we had someone with a hemoglobin of 3 that waited 3 hours before being transfused.

      Nate · September 22, 2022 at 4:05 pm

      Same here. When staffing allows, we do a pretreatment nurse. After patient is triaged, taken into a fast track room for IV and blood, urine collection, etc. then sent back to the lobby to wait.

        Divemedic · September 22, 2022 at 4:44 pm

        Our triage nurse does that. Standing orders for certain meds, entering orders for CT, cultures, etc. back out to the lobby.
        To wait.
        For hours. Sometimes with fluids hanging, sometimes with meds.
        Some of our patients get treated and discharged from the lobby.

Anonymous · September 21, 2022 at 11:20 pm

Cost of living increase of 6.5%, then 10%, then 15%:

> (1.065^(2014-2000+1))*(1.1^(2020-2015+1))*(1.15^(2022-2021+1))
[1] 6.025539

The purchasing power of your salary has decreased by a factor of 6, or 83%, since the year 2000. Clearly, more salary needs to be taken from worker bees and spent on administrators. Applying Windows updates is a waste of time, too.

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