Who would best manage a Hospital?

[nate24168]

1. Nuns

2. City Board

3. Government

4. CEO

I know the first two are old school from the past.

[meggers49]

nurses

[jeepers]

Nuns who are nurses.

Btw, there are many who ALREADY have experience in this area.

[sgtmac_46]

*** do NUNS OR NURSES know about running a complex organization?

Managing a large organization is a specialized endeavor.........giving shots and taking vitals, while necessary, important, and requiring considerable expertise, isn't part of the same skill set.

When one says 'nurses run hospitals' they mean they do most of the actual physical act of patient care..........they don't make schedules, balance the books, bill accounts, hire employees, direct repairs expansions, write grants, pay salaries, and otherwise 'manage' a large organization.

[johnrocks]

We have two great hospitals in this area;one ran by Nuns and the other by a CEO, what they have in common is neither is a government bureaucrat.

[sgtmac_46]

We have two great hospitals in this area;one ran by Nuns and the other by a CEO, what they have in common is neither is a government bureaucrat.

Technically if one is run by Nuns, it's not really 'run' by nuns, it's really run by a hirearchy with over a thousand years experience running large organizations...........but your overall point is well made.

[johnrocks]

Technically if one is run by Nuns, it's not really 'run' by nuns, it's really run by a hirearchy with over a thousand years experience running large organizations...........but your overall point is well made.

lol,well yeah. Thanks for understanding what I was trying to state,btw.;)

[EmmanuelGoldstein]

nurses

+1

[EmmanuelGoldstein]

*** do NUNS OR NURSES know about running a complex organization?

Managing a large organization is a specialized endeavor.........giving shots and taking vitals, while necessary, important, and requiring considerable expertise, isn't part of the same skill set.

When one says 'nurses run hospitals' they mean they do most of the actual physical act of patient care..........they don't make schedules, balance the books, bill accounts, hire employees, direct repairs expansions, write grants, pay salaries, and otherwise 'manage' a large organization.

Uh... wrong lol.

[EmmanuelGoldstein]

Nuns who are nurses.

Btw, there are many who ALREADY have experience in this area.
Both my daughters were born in Catholic hospitals (and I'm not Catholic... ah well lol).

With my youngest, I'd had an emergent c-section at 2AM due to placental abruption. We both nearly died. After finally being taken to my room, I was in sooo much pain. I just laid there, hardly able to speak or move.

Later in the day, this nun came in to see me and asked how I was doing. I managed to whisper I was hurting. She then asked if the pain medicine wasn't helping. I told her I didn't know I could have pain medicine.

I will never forget the look on her face. She was quite obviously furious, but didn't say a word. She turned on her heel and within minutes a nurse was jabbing me in the butt with a shot of Demerol. (I'll never forget the look on her face either) And they offered it repeatedly to me throughout the rest of my stay lol. I guess she'd put the fear of God in 'em :lol:

[Mimiheart]

*** do NUNS OR NURSES know about running a complex organization?

Managing a large organization is a specialized endeavor.........giving shots and taking vitals, while necessary, important, and requiring considerable expertise, isn't part of the same skill set.

When one says 'nurses run hospitals' they mean they do most of the actual physical act of patient care..........they don't make schedules, balance the books, bill accounts, hire employees, direct repairs expansions, write grants, pay salaries, and otherwise 'manage' a large organization.Um, do you know any nurses? (Well, any nurses in the hospital setting...)

[sgtmac_46]

Um, do you know any nurses? (Well, any nurses in the hospital setting...)

Yes, and they don't 'manage' the hospital......they manage patient care, which is only ONE aspect of a modern hospital.

[sgtmac_46]

Uh... wrong lol.

The famous emm one line argument....'Uh...wrong lol.' :))

I know nurses and teachers are sacrosanct.......but they do not RUN the entire hospital. ;)

In the major hospital I have a working relationship with nurses represent less than half of all the employees......it's a large enterprise involving numerous different professionals in numerous different capacities, it's expanding services, making record profits, and providing ever increasing services to it's clients......ALL at the direction of a board of directors who operate it under a business model.


I got nothing against nurses, they're wonderful people, who are underpaid, overworked, and we need more of them.....BUT they do what they do......if I need medical attention I want a nurse and a doctor.......if I want someone to manage my investments i'll find someone skilled at that.......if I want someone to run a large business i'll find someone skilled at that. Running a hospital isn't the same as caring for a patient.......they are TWO ENTIRELY different skill sets.

[EmmanuelGoldstein]

The famous emm one line argument....'Uh...wrong lol.' :))

I know nurses and teachers are sacrosanct.......but they do not RUN the entire hospital. ;)Regarding the nurse managers, directors, and VPs in my hospital:
When one says 'nurses run hospitals' they mean they do most of the actual physical act of patient care..........they don't make schedules [yes, they do], balance the books [yes, they do--one of my director's main job functions], bill accounts [we are responsible for outpatient billing, inpatient is through the general billing department], hire employees [oh most certainly they do], direct repairs expansions [yes, they do, in one hospital I traveled to a couple of years ago, the nursing staff (floor and directors) designed the new hospital], write grants [yes, re: nursing research], pay salaries [my director does payroll for our department; checks are actually cut by another department according to her direction], and otherwise 'manage' a large organization.

Nurses are more than just bedside care.

[EmmanuelGoldstein]

In the major hospital I have a working relationship with nurses represent less than half of all the employees.....it's a large enterprise involving numerous different professionals in numerous different capacities, it's expanding services, making record profits, and providing ever increasing services to it's clients......ALL at the direction of a board of directors who operate it under a business model.


I got nothing against nurses, they're wonderful people, who are underpaid, overworked, and we need more of them.....BUT they do what they do......if I need medical attention I want a nurse and a doctor.......if I want someone to manage my investments i'll find someone skilled at that.......if I want someone to run a large business i'll find someone skilled at that. Running a hospital isn't the same as caring for a patient.......they are TWO ENTIRELY different skill sets.

You need to educate yourself on the expanded role of nursing.

[mboncher]

Excellent question, but let's analyze.

1. Nuns. Devoting their lives to the health and well being of the body as well as the soul. You may not agree with their religion, but you cannot deny that they believe in a fervent calling to help man. Their business sense is non traditional in that they are part of a much larger structure of church hierarchy and that unto itself has been successful for many centuries. The calling may also cause the hospital to require the needs of charity from the community to provide better care because of it's lack of drive for profit and that can lead into budgetary problems, ultimately risking the more advanced care or even some basic care options that are more cash intensive. Healing is first and foremost. Not political power or profit.

2. City Council. These are people, appointed by a group of politicians to run a facility that keeps their voters healthy and grateful for their politicians. Some may be in this for the political power of the position. Others may be appointed because of their skill. You may get those who have a great passion for the work. But they are always appointed by someone else for ulterior motives that are usually centered on the predicate of being re-elected. And that is done by providing good service or at least keeping the electorate from complaining.

3. Government. Same as a city council except 2,3 or 4 steps removed from the city in which the hospital exists. Politics from greater levels get involved. Political appointees, and faceless bureaucrats that have no connection in the community or even direct knowledge of the needs of the hospital make policy. They may only go on reports and interviews that set policy for possibly even multiple hospitals across the country, setting it for mutliple hospitals regardless of fit.

4. CEO. Profit is one of the best motives for providing good service there is. You must provide for the needs of the public or you will soon be out of business and possibly ruined. Profit though often can result in lapses of caution in regards to doing the right thing versus making a profit as well. Now, if you add to this a corporate board, and things can get worse. Profit motive becomes far stronger, while care for providing good service is often balanced against the bottom line more than say a local owner. There is a drive to provide the best equipment as well, for that makes both for good PR and attracting more people to use your services.

So, with this rough sketch based on what I know of human nature and the nature of business, economics and politics, I'd have to rank the four choices in the following manner.

1. (tie) CEO/Nuns
3. City Council
4. Government (a very very very very very very very very very very [did I say 'very', yet?] VERY distant 4th place.

As for a nurse or doctor run hospital, File that under a CEO as 'employee owned'.

[RickRhetoric]

A little saggy-pants, affirmative-action hoodie with an online medical degree from Haiti.

[Theranna]

A little saggy-pants, affirmative-action hoodie with an online medical degree from Haiti.

FYI, I'm Haitian by my parents and find that comment highly offensive. There are a lot of very well trained and educated Haitians now living outside of Haiti because of the political situation, not because they're uneducated as you imply.

Feel free to leave your post, not worth the complaint, but know it smacks in unwarranted derision. And Haitian nurses are extremely competent and were sought after by hospitals, especially when they were trained in Port-au-Prince.

[mysticbeauty_nbeast]

Regarding the nurse managers, directors, and VPs in my hospital:


Nurses are more than just bedside care.

Nailed it Emma...I was bobbing my head up and down in agreement as I read your post to Sgtmac. I wish my job as a nurse had only been bedside care...god..what a breeze that would have been! :whistle: No such luck in some systems.

To Sgtmac: Most hospitals in my area run a two prong approach in the day to day running of a hospital. A CEO business type entity deals with all non medical issues...maintenance, repair, running of non medical staff, cleaning/sanitizing of facility, laundry and food staff; and co-op out their billing; which is dependent upon the nursing manger staff and floor nursing staff. All medical essentials are run by nursing staff. MSN's usually..but a few actually have a PhD in nursing. They are responsible for all medical related goings on within the facility; which is not just patient care...but the day to day business of the floor/hospital itself. The really great running hospitals have the CEO take their marching orders from these nurse managers...and it works great.

See Sutter Hospitals, Mercy Hospitals, University California Davis hospitals and clinics. No system is perfect...but these come darn close to the models that should be used nationwide. ;) Great care, great staff, and a true working cohesive system between business and medical staff.

~Mysty

[EmmanuelGoldstein]

Nailed it Emma...I was bobbing my head up and down in agreement as I read your post to Sgtmac. I wish my job as a nurse had only been bedside care...god..what a breeze that would have been! :whistle: No such luck in some systems.

To Sgtmac: Most hospitals in my area run a two prong approach in the day to day running of a hospital. A CEO business type entity deals with all non medical issues...maintenance, repair, running of non medical staff, cleaning/sanitizing of facility, laundry and food staff; and co-op out their billing; which is dependent upon the nursing manger staff and floor nursing staff. All medical essentials are run by nursing staff. MSN's usually..but a few actually have a PhD in nursing. They are responsible for all medical related goings on within the facility; which is not just patient care...but the day to day business of the floor/hospital itself. The really great running hospitals have the CEO take their marching orders from these nurse managers...and it works great.

See Sutter Hospitals, Mercy Hospitals, University California Davis hospitals and clinics. No system is perfect...but these come darn close to the models that should be used nationwide. ;) Great care, great staff, and a true working cohesive system between business and medical staff.

~Mysty

Actually, when you consider that all aspects of a hospital's "business" relates either directly or indirectly to patient care (even those you list as non-medical), nursing is the core department that runs the facility, period.

[EmmanuelGoldstein]

And Haitian nurses are extremely competent and were sought after by hospitals, especially when they were trained in Port-au-Prince.
I second this. Excellent nurses.

[mysticbeauty_nbeast]

Actually, when you consider that all aspects of a hospital's "business" relates either directly or indirectly to patient care (even those you list as non-medical), nursing is the core department that runs the facility, period.

Correct...guess I didn't make that part of my post too clear? Thought I did....:shifty:

I like the hospitals where the business side CEO..is actually working by orders or directives of the nursing managers...works seamless. I don't know why the majority of hospitals don't work that way?

Get into this Obama national health care system..and you can kiss that type of management good bye. Sad. Non medical bureaucrats are gonna make a hell of a mess. :whistle:

~Mysty

[Dual867PowerMac]

Not the government! The

http://i17.photobucket.com/albums/b94/BengalsManiac/threestooges.jpg

Could run a hospital better.

[EmmanuelGoldstein]

Correct...guess I didn't make that part of my post too clear? Thought I did....:shifty:You did. I was just echoing your post for those who might not realize how all-encompassing our jobs are. For example, environmental services function under the directives of Infection Control... and guess who that is ;)

I like the hospitals where the business side CEO..is actually working by orders or directives of the nursing managers...works seamless. I don't know why the majority of hospitals don't work that way? The best ones do.

[smyrna]

nurses


You are absolutely correct meggers49.

[EmmanuelGoldstein]

BTW, these folks --> http://www.ania.org/
can write their own ticket.

[jimjames418]

To Sgtmac: Most hospitals in my area run a two prong approach in the day to day running of a hospital. A CEO business type entity deals with all non medical issues...maintenance, repair, running of non medical staff, cleaning/sanitizing of facility, laundry and food staff; and co-op out their billing; which is dependent upon the nursing manger staff and floor nursing staff. All medical essentials are run by nursing staff. MSN's usually..but a few actually have a PhD in nursing. They are responsible for all medical related goings on within the facility; which is not just patient care...but the day to day business of the floor/hospital itself. The really great running hospitals have the CEO take their marching orders from these nurse managers...and it works great.

~Mysty
As long as the nursing staff understands and works with the business side, that is the best. It takes a "business" person to understand cash flow, how to meet payrolls, how to pay for the equipment needed, and to manage the money (usually millions of dollars). The business person must understand that their role is to support the medical people to provide the best care possible. But if the medical staff tries to overule the business person when he says there is no money for what they want to do, then you have problems.

[RickRhetoric]

FYI, I'm Haitian by my parents and find that comment highly offensive. There are a lot of very well trained and educated Haitians now living outside of Haiti because of the political situation, not because they're uneducated as you imply.

Feel free to leave your post, not worth the complaint, but know it smacks in unwarranted derision. And Haitian nurses are extremely competent and were sought after by hospitals, especially when they were trained in Port-au-Prince.

You are quick to rush to conclusions and unfounded judgement with no basis. There was absolutely nothing derogatory in the post. By your assumption that there was, you found it necessary to defend something that needs no defense.

Haitian medical doctors and nurses are rated among the finest and they are much sought after. Why do you automatically seem to have doubts by implying that they are considered to be incompetent? You seem to suggest that the general public thinks they are a joke. What would cause you to think that?

[jimjames418]

Actually, when you consider that all aspects of a hospital's "business" relates either directly or indirectly to patient care (even those you list as non-medical), nursing is the core department that runs the facility, period.
How does the investment of surplus funds affect, either directly or indirectly, patient care?

How does managing cash flow to insure money is available to meet payroll affect, either directly or indirectly, patient care?

Just two of many other questions that have nothing to do, either directly or indirectly, with patient care. :doh:

[EmmanuelGoldstein]

How does the investment of surplus funds affect, either directly or indirectly, patient care?

How does managing cash flow to insure money is available to meet payroll affect, either directly or indirectly, patient care?

Just two of many other questions that have nothing to do, either directly or indirectly, with patient care. :doh:

:lol:

You're kidding, right? The ability to meet payroll has nothing to do (directly or indirectly) with patient care? Hint: we don't work for free ;)

The bottom line IS patient care. EVERYTHING a hospital does is to that goal.

[jimjames418]

:lol:

You're kidding, right? The ability to meet payroll has nothing to do (directly or indirectly) with patient care? Hint: we don't work for free ;)

The bottom line IS patient care. EVERYTHING a hospital does is to that goal.
Agreed that the goal of a hospital is the best patient care possible. However, before that care can be provded, someone has to insure that money is available to pay for the nurses and doctors, bills like electrical, gas, etc. are paid. Because like you said, they don't provide the electricity and gas for free.

I learned early in life that every organization has two functions, one is to meet the goal of the business, in this instance quality patient care. The other is to ensure that the money is available to make that possible. Without those two measures working together as a team, neither will last very long. IMHO of course.

[EmmanuelGoldstein]

Agreed that the goal of a hospital is the best patient care possible. However, before that care can be provded, someone has to insure that money is available to pay for the nurses and doctors, bills like electrical, gas, etc. are paid. Because like you said, they don't provide the electricity and gas for free.

I learned early in life that every organization has two functions, one is to meet the goal of the business, in this instance quality patient care. The other is to ensure that the money is available to make that possible. Without those two measures working together as a team, neither will last very long. IMHO of course.

I understand what you're saying; my point is every aspect of a hospital's function is related to patient care (or community healthcare in a broader sense).

[sgtmac_46]

I understand what you're saying; my point is every aspect of a hospital's function is related to patient care (or community healthcare in a broader sense).

But not direct patient care in the sense of a nurses job......that's like saying that because every aspect of the military is related to national security, every private is qualified to be the Chairman of the Joint Chief's of Staff. ;)

An organization works BEST when those trained in their given role are in that given role.

[sgtmac_46]

Agreed that the goal of a hospital is the best patient care possible. However, before that care can be provded, someone has to insure that money is available to pay for the nurses and doctors, bills like electrical, gas, etc. are paid. Because like you said, they don't provide the electricity and gas for free.

I learned early in life that every organization has two functions, one is to meet the goal of the business, in this instance quality patient care. The other is to ensure that the money is available to make that possible. Without those two measures working together as a team, neither will last very long. IMHO of course.

Bingo!

[sgtmac_46]

You need to educate yourself on the expanded role of nursing.

So nurses are going to business school for another four years now, in addition to their medical training, huh? ;)

You know it's funny......if I said it takes no training to be a nurse, we'd see people go apoplectic.......but some folks think it takes no education to run a business....perhaps that explains the sad state of our economy. :wall: :doh:

[jimjames418]

You know it's funny......if I said it takes no training to be a nurse, we'd see people go apoplectic.......but some folks think it takes no education to run a business....perhaps that explains the sad state of our economy. :wall: :doh:
That is one of the reasons for the poor educational system in this country. The teachers unions have had laws passed that a person must have a teaching certificate to be a business manager in a public school district. Nothing is said about having either business experience or education in business.

And face it, any organization that has a $8 million budget (like my local school district with 1,000 students) or an organization with a $185 million budget like a district with 10,000 students, without some knowledge of business practices a lot of the money is wasted.

[sgtmac_46]

That is one of the reasons for the poor educational system in this country. The teachers unions have had laws passed that a person must have a teaching certificate to be a business manager in a public school district. Nothing is said about having either business experience or education in business.

And face it, any organization that has a $8 million budget (like my local school district with 1,000 students) or an organization with a $185 million budget like a district with 10,000 students, without some knowledge of business practices a lot of the money is wasted.

That's because Teachers and Nurses are worshiped by the left (nothing wrong with that) but BUSINESS is demonized (MUCH wrong with that!)

[DRS]

Why was doctor not an option
'
'

[Angra Mainyu]

I'd have it run by nuns. Some of you think being a nun disqualifies you from being mathematically numerate, but it doesn't.

[EmmanuelGoldstein]

But not direct patient care in the sense of a nurses job......

You continue to labor under the assumption that "a nurse's job" consists of delivering bedside care. Nurses function in a number of positions in hospitals that are not 'direct patient care'. I personally know one who (essentially) never worked at the bedside. She went straight into informatics out of nursing school (minus less than a 6 month period where she was waiting for the position to open up). Her starting pay as a green as grass new grad was easily half again more than my current salary as a nurse with over 20 years experience.

[EmmanuelGoldstein]

So nurses are going to business school for another four years now, in addition to their medical training, huh? ;)


Some are; the director of my unit at my ex-hospital did. She furthered her education and received a master's in healthcare administration (last I heard, she was working on her doctorate). She is now VP of that hospital. The same hospital where the CEO was a former floor nurse (hands down the best administrator we ever had; sadly he retired). Some nurses are specializing in informatics. Some are specializing in healthcare administration. Some are specializing in healthcare law.

[Broseph]

I would say some sort of medical personnel, but that's not an option. I don't trust any of the options, although government and city board would be my last 2 choices.

[EmmanuelGoldstein]

This is a specialty within nursing:

http://www.discovernursing.com/jnj-specialtyID_253-dsc-specialty_detail.aspx

Nurse Executives are primarily involved with management and administration concerns. They provide leadership roles in the designing of care, the planning and developing of procedures and policies, and administration of budgets in hospitals, health clinics, nursing homes, and ambulatory care centers.


http://www.nursingspectrum.com/StudentsCorner/CareersInNursing/NursingPositions/DC.htm

Name: Nurse administrator/Director/CEO

Description: The nurse in an executive position establishes department directions and strategies, plans programs, and administers budgets to meet the overall institution's or agency's goals. Administrators set and interpret policy and develop structures for operating units. Administrators assume a broad organizational perspective and represent their organization to their constituents, including the community

Settings: Hospitals, nursing homes, public or community health nursing settings, ambulatory care, student health service, nursing schools, or education departments

[EmmanuelGoldstein]

Certainly not all-inclusive:

http://www.discovernursing.com/nursing-careers

[sgtmac_46]

Some are; the director of my unit at my ex-hospital did. She furthered her education and received a master's in healthcare administration (last I heard, she was working on her doctorate). She is now VP of that hospital. The same hospital where the CEO was a former floor nurse (hands down the best administrator we ever had; sadly he retired). Some nurses are specializing in informatics. Some are specializing in healthcare administration. Some are specializing in healthcare law.

Want to know the KEY words you just said? 'Specializing'! They aren't just 'nurses', they've gone to TRAIN to be BUSINESS ADMINISTRATORS, because it's a separate specialized field that simply being trained in the medical side DOES NOT COVER! My point from the beginning.

The point you've actually made is that MEDICAL ADMINISTRATION is a specialized field unto itself.......not that being trained as an RN is qualification enough to pursue it........having an RN and THEN a Masters in ADMINISTRATION on top of it (with considerable training in business finance) is qualification.

[sgtmac_46]

You continue to labor under the assumption that "a nurse's job" consists of delivering bedside care. Nurses function in a number of positions in hospitals that are not 'direct patient care'. I personally know one who (essentially) never worked at the bedside. She went straight into informatics out of nursing school (minus less than a 6 month period where she was waiting for the position to open up). Her starting pay as a green as grass new grad was easily half again more than my current salary as a nurse with over 20 years experience.

Nope, I labor under the REALITY that medical training alone is insufficient to run a hospital organization.....even you've illustrated that point nicely, by pointing to NURSES who went on to get BUSINESS DEGREES in order to run hospitals........if specialized training in business wasn't required........why was it required? ;)

[EmmanuelGoldstein]

Nope, I labor under the REALITY that medical training alone is insufficient to run a hospital organization.....even you've illustrated that point nicely, by pointing to NURSES who went on to get BUSINESS DEGREES in order to run hospitals........if specialized training in business wasn't required........why was it required? ;)
It is a specialization within nursing, as part of their advanced degree within their nursing education. See above...

http://forums.hannity.com/showpost.php?p=57972181&postcount=43

ETA: Yes, there are nurses who get degrees in other areas (business, law, etc.) and use those in related fields; I know quite a few that have. My point is that (judging from your posts) you seem to be under the assumption that nursing is strictly direct patient care. That is not the case. And, as I point out here, there is education that is a part of advanced nursing programs that address nurses as executives. I've never held that an ADN could run a hospital. My point is that the scope of nursing is much broader than you seem to realize.

[jeepers]

Emm, they don't get it.

Nursin' is ahhl 'bout flinging bedpans.... :))

Which is like saying, law enforcement is about writing tickets. And that a cop never ends up Chief...managing personnel, budgets, yadda yadda.

[jeepers]

It is a specialization within nursing, as part of their advanced degree within their nursing education. See above...

http://forums.hannity.com/showpost.php?p=57972181&postcount=43

ETA: Yes, there are nurses who get degrees in other areas (business, law, etc.) and use those in related fields; I know quite a few that have. My point is that (judging from your posts) you seem to be under the assumption that nursing is strictly direct patient care. That is not the case. And, as I point out here, there is education that is a part of advanced nursing programs that address nurses as executives. I've never held that an ADN could run a hospital. My point is that the scope of nursing is much broader than you seem to realize.


http://www.nursingspectrum.com/StudentsCorner/CareersInNursing/NursingPositions/DC.htm

[EmmanuelGoldstein]

Emm, they don't get it.

Nursin' is ahhl 'bout flinging bedpans.... :))

Which is like saying, law enforcement is about writing tickets. And that a cop never ends up Chief...managing personnel, budgets, yadda yadda.
Hell, even I am surprised at the scope of nursing practice, both inside and outside the institutional setting. Perhaps our current CEO is not a nurse (he's an MD). But if you were to remove all nurses except for those working with patients (and their immediate nurse supervisors), the place would cease to function. Except for the possible exception of our police force, nursing has extended its tentacles into every aspect of the workings of this hospital lol.

[EmmanuelGoldstein]

http://www.nursingspectrum.com/StudentsCorner/CareersInNursing/NursingPositions/DC.htm

I addressed his initial post:

http://forums.hannity.com/showpost.php?p=57953381&postcount=14

by showing we DO those things he claims we don't. Heck, the outpatient billing for our unit is done by us peon floor nurses through our director (we enter the charges and she puts her final approval on them before they are sent out).

[mysticbeauty_nbeast]

As long as the nursing staff understands and works with the business side, that is the best. It takes a "business" person to understand cash flow, how to meet payrolls, how to pay for the equipment needed, and to manage the money (usually millions of dollars). The business person must understand that their role is to support the medical people to provide the best care possible. But if the medical staff tries to overule the business person when he says there is no money for what they want to do, then you have problems.

Emma has explained it best...but I'll throw in my own two chits on the topic.

That 'business' person you mention...who needs to understand 'cash flow'..meaning where it is most valued and needs to be spent to ensure high quality patient care...is actually a nurse/nurse manager. ;)

Payrolls?...all submitted and cut by floor nursing manager...or the office of ADON (Assistant Director of Nursing) or DON (Director of Nursing...we call um God for short..lol).

Equipment purchases?...how would some bean counter business head know what type of equipment to buy unless told by someone who uses that equipment? So even equipment purchases go through nursing managers by request of nurses who use said equipment. That covers repairs as well. See, nurses can use that thing they call a brain too..usually saving the hospital money by repairing an item instead of buying a new item to replace it. This means a maintenance staff that is over seen by...wait for it...nurses. ;)

Basic money management...who do you think makes money for that hospital? Business only run hospitals run in the red..why? Waste. Pure and simple. Nurse run hospitals keep waste (if any at all) to a minimum, which increases the money inflow to that hospital. Ask any nurse what a ICD 9 code is...and get ready for a good long chat...damn billing is enough to make ya pull your hair out some days. Ensuring the proper billing is applied to a patient based on his or her insurance/private pay type...to put it mildly...it's a nightmare...but nurses make it work..and give the best care possible regardless what type of billing needs to be done per patient.

When a business only person tries to over-rule a nurse manager...that's were it gets rough...not the other way around.

I'm truly shocked that the main populace has no real idea what it is nurses do within their 8,12 hour shifts. As Jeeper said...we don't just fling bedpans folks. ;)

I miss my profession...I truly loved what I did. If I were to ever become well again..I'd go right back in. In any given day I'd wear several hats...medical care nurse, wound care specialists, billing, assistant payroll manager, death and dying counselor, patient advocate/ombudsmen, nurse manager/staff manager, medicare/medical billing assistant...and all around go to gal for when doctors hit the floor at a moments notice ready to do rounds. Add to that the daily scheduled of any nurse of patient care (which can be crushing at times), labs (oh yeah, we have to read them and flag those necessary for when their doctor comes for rounds), blood draws (usually we have our 'vampires' phlebotomist draw...but on busy days we do our own), breathing treatments (again, usually a respiratory therapists does this..but on busy days we do our own), medication (for 6 to 99 people depending on what floor and or what type of facility your working in) floor administration (and boy do we have plenty that the business heads can't even touch as they don't have the background to 'fill in the blanks') , charting (which is an endless throughout your day practice..thank god most hospitals are turning over to computers in each room for charting instead of hand written charting.) not to mention keeping supply cupboards full and hitting the minor day to day floor issues that may arise.

Seems like allot for 'just a nurse' doesn't it? Makes ya wonder what in the hell the business guys are doing up there in those offices doesn't it? They say most nurses will burn out of their jobs in 7 years. Many here who are nurses have been doing it allot longer then that...I was in for 14 years before I became disabled...but hey..the business heads came up with that figure..so it must be right right? :whistle:

~Mysty

[jimjames418]

That 'business' person you mention...who needs to understand 'cash flow'..meaning where it is most valued and needs to be spent to ensure high quality patient care...is actually a nurse/nurse manager. ;)

Payrolls?...all submitted and cut by floor nursing manager...or the office of ADON (Assistant Director of Nursing) or DON (Director of Nursing...we call um God for short..lol).
Not to argure with you, but payroll is a lot more than cutting the checks to pay the people. There are tax withholdings to account for and pay (state, federal, and local), benefits to account for (401k, health ins, etc.). It is all a part of the Human Resource chain, and it is important.

Equipment purchases?...how would some bean counter business head know what type of equipment to buy unless told by someone who uses that equipment? So even equipment purchases go through nursing managers by request of nurses who use said equipment. That covers repairs as well. See, nurses can use that thing they call a brain too..usually saving the hospital money by repairing an item instead of buying a new item to replace it. This means a maintenance staff that is over seen by...wait for it...nurses. ;)
When you purchase that piece of equipment do you know the legal requirements for submitting a RFP (Request for Proposal) or putting together a bid specification? There are specific laws that must be followed when using tax payer money, and those are not taught as part of any nursing program I know about. :whistle:

In other words, it takes a team effort, from the business side as well as the nursing side. And when they fight (like we are doing here) instead of working together, nobody wins, everybody loses. And that is a shame. IMHO anyway.

[mysticbeauty_nbeast]

Not to argure with you, but payroll is a lot more than cutting the checks to pay the people. There are tax withholdings to account for and pay (state, federal, and local), benefits to account for (401k, health ins, etc.). It is all a part of the Human Resource chain, and it is important.

Not to argue with me?...who says your arguing? We're cool. :mrgreen:
Yes..the 'accounting department' (aka Bean Counters) have a large role in payroll...they are the support mechanism to the nurse manager who deems the actual payroll, schedule (to prevent overtime), State by state mandates, which every nurse manager is aware of (at least at every hospital I've worked at in California and Arizona) for FICA, State, County and Fed taxes along with any 'benefits' that may be offered like a 401 K. Their reports are submitted so some bean counter can fill in the numbers and send out the check for non essential (meaning non-medical) staff. Maybe it works different where you live. Here? It works great.

And again...yes...Human Resources is an important part of the hospital..no doubt about it. Grant proposal writing for funds; unemployment pay outs; law suits, etc are all part of the 'support' staff so that the hospital can function in the black. Did you know that most Human Resource directors are MSN's? (MSN= Masters of Science Nursing). Usually those MSN also have a BA in Human Resources...or in Accounting...or in Grant Writing; etc etc etc. We nurses multi-task like most of you breath. ;)


When you purchase that piece of equipment do you know the legal requirements for submitting a RFP (Request for Proposal) or putting together a bid specification? There are specific laws that must be followed when using tax payer money, and those are not taught as part of any nursing program I know about. :whistle:

Short answer...yes. Long answer: Nurse floor managers and Nurse hospital managers (Like DON's and Nurse Administrators) 'have to know' what type of equipment can be purchased, why it's needed/requested, how it must be maintained, what type of staff is necessary to maintain said equipment..as well as their State regulations on said equipment standards. At least...where I live that's how it works. Maybe your state is different? If so..they should look at the models I presented earlier in this thread to see just how well it works. ;) (IE: Sutter Memorial Hospital System, University California Davis Hospital System and Clinics, Mercy General Hospital System, Shriners Children Hospital) All are fantastic examples of what Jeepers, Emma and I have been speaking too. Sutter is a Non-Profit, UCD is a university teaching hospital and Mercy is part of the Catholic Care West system and Shriners...a pure Not for Profit Children's Hospital that is free and clear of any and all debt and runs on pure donations...like it's sister feeder hospital, UCD . ;) A little something for everyone.

In other words, it takes a team effort, from the business side as well as the nursing side. And when they fight (like we are doing here) instead of working together, nobody wins, everybody loses. And that is a shame. IMHO anyway.

Sure, it takes a team effort to run an effective health care system/hospital. Essential (Medical) and Non Essential (Non-Medical) staff working in tandem and under the directions of nurse managers and nurse admin. What many don't seem to understand here is that nurses are what makes that entire system viable. Not doctors...not Bean counters...not some Ivy League MBA...not accountants...but nurses. Todays modern nurse is more then a floor nurse...more then pill pushers..more then bed pan brigades....they are Administration...they are in Human Resources...they are Insurance billing...they are in the position to hire and fire...they are..for lack of a better term..the meat and potato's of the health care system. Without them...it all goes to poo in a bed pan..and quick!

Best working system I've ever worked in is where the business side takes it marching orders and direction from it's nursing admin staff and managers..which lays them directly inside business end of the system. Little to no waste is seen; higher patient care is seen; maintenance of equipment and buildings is seen; lower employee and patient incident ratio's are seen; billing is less screwy, and those hospitals actually see a profit. And where does that profit go? Into ensuring patient care is top notch, higher wages, adding to the system in further health care services and higher benefit packages for all hospital staff. ;)

Back in the 80's, they tried the whole Bean Counter Ivy League approach to health care...and ya know what?..it cost a mint!..nearly bankrupted a hospital! (see Sutter stats 1984 through 1988) Seeing that approach didn't work...nurses stepped up and cleaned house. Now we have in just my local area some of the best run hospital/health care system in the nation due to nurses running the system. Hmmmm...could there be a correlation there? Business run only equals bankrupt and poor care...Medical run means money in the coffers, good patient care and a stable health care environment. But hey...we're just nurses right? Couldn't be something as simple as that...could it?

If Obama is smart..he would personally send a team out to investigate those hospitals in our Nation that not only run in the black...but also provide top medical care to the area's that hospital services. That is where we would save billions on the topic of heath care. You get a bunch of Ivy League business heads and Bean Counters running cold numbers without medical input from nurses as it pertains to healthcare..and your gonna have what Canada has...a mess!

~Mysty

[jimjames418]

If Obama is smart..he would personally send a team out to investigate those hospitals in our Nation that not only run in the black...but also provide top medical care to the area's that hospital services. That is where we would save billions on the topic of heath care. You get a bunch of Ivy League business heads and Bean Counters running cold numbers without medical input from nurses as it pertains to healthcare..and your gonna have what Canada has...a mess!

~Mysty
I am glad you agree with me. It takes someone with a knowledge of business practices to make sure monies are not wasted in an organization. It makes no difference if that person has knowledge of the underlying concepts of the organization or not, as long as they don't have final say.

Most non-accounting people when you say "Fund Accounting" to them think you are talking about accounting for the funds. ;) And not many people know the difference between base line budgeting and zero based budgeting. And if you don't know and understand the differences you can't be effective in managing the business of an organization, period. :rolleyes: