“The experts I’ve spoken with over the past few years generally agree that nurses are tremendously undervalued given the importance of their work in delivering quality health care. Research has found repeatedly that more nursing staff leads to patients reporting a better experience in the hospital and better health outcomes.
But the problem is, given the way health care in the US is typically paid for, hiring more nurses and making their work environment better doesn’t necessarily make good economic sense for these hospitals.”
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“Nurses point to exorbitant executive compensation (which soared nationwide during the pandemic) and multimillion-dollar real estate deals to explain their decision to strike. They have a point: Hospitals behaving on pure altruism would spend more on clinical staff without their nurses needing to go on strike to force their hand.”
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“Slashing executive pay (Montefiore’s CEO makes $6 million a year) can only pay for so many new nursing positions. Canceling a $38 million land deal in White Plains would make more money available, but when revenue depends on the number of services that a hospital system provides, buying land and building new facilities does make fiscal sense.”
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“Under the fee-for-service model that still dominates American health care, where every physician service can be billed by the hospital where they work, hospitals have every incentive to expand their services but little incentive to hire more nurses to support that work. From a hospital’s accounting perspective, nurses are entirely a cost. They do not generate any revenue directly, even though they are necessary to providing quality medical care.”
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““What we forget is when hospitals put profits over patients, they are operating well within the system of economic carrots and sticks that we created for them, and within the system we created, hospitals are acting completely rationally as any other economic agent would,” Olga Yakusheva, a health care economist at the University of Michigan, said. “There is no economic incentive, right now, for hospitals to invest in adequate nurse staffing, pay nurses well, or provide a good working environment for nurses.”
Until the US gives hospitals good financial reasons to invest in their nursing staffs, these labor disputes are going to occur again and again. As much as we want our health system to be focused on quality health care, in America, health care is a business.
Good health care and profitable health care are not always the same thing. The failure to value nursing in the way we pay for medical services, which laid the groundwork for NYC’s nurses strike, is a stark example of that.”