Fixing the nurse shortage
Regarding your story, "Importing controversy" (March 31, p. 20), on the nursing shortage and foreign nurses: A high percentage of hospitals and other healthcare providers across this country look for a short-term fix to a long-term problem.
When I started working in hospital human resources in 1971, the facility I worked for was recruiting nurses from all over the world. For the past 32 years, I have seen the same pattern over and over again. A nurse shortage occurs. Hospitals raise salaries, bring in foreign nurses, change the patient-care mix, etc., but nothing is really ever done to solve the underlying problem of the shortage.
At our facility we have less than a 2% registered nurse vacancy rate, we don't do foreign nurse recruiting and we don't spend tens of thousands of dollars on advertising and outreach. What we do is to begin talking to students at the junior high level through high school and get them interested in nursing (and other healthcare careers), provide scholarships for RNs and licensed vocational nurses, allow students to work while in school and mentor them along the way so that when they graduate they will come to work for us. This takes time (at least four to five years to see the first results) and you have to have a chief executive officer, nursing vice president and others committed to this approach for it to work. We do.
Additionally, colleges and universities in the U.S. need to expand their nursing programs, and hospitals and other healthcare providers near these educational institutions need to work together to improve the quality and quantity of nursing graduates.
Vice president, human resources
Providence Health Center
Less privacy, more care
Regarding your article, "Whose info is it, anyway?" (April 14, p. 4): In times of increasing costs of delivering healthcare, growing numbers of the uninsured and declining payment resources-particularly among government payers, who often are the majority revenue source for physicians and hospitals-I think patients would be better served by investing more in nursing coverage and other clinical quality enhancing programs rather than in medical records privacy.
We have created a huge bureaucracy to protect records when we should be protecting patients. Most people didn't know or think there was a problem and are sure to be confused by the tidal wave of disclosures. There may have been some reason for this Health Insurance Portability and Accountability Act administrative boondoggle, but the road to hell is paved with good intentions.
Acadian Health Care Alliance
CRNAs aren't anesthesiologists
I challenge the comment made by Allied Consulting Vice President John Hawkins that certified registered nurse anesthetists represent a "lower-cost alternative to anesthesiologists" (Modern Healthcare's Daily Dose, April 14).
The statement infers that CRNAs and anesthesiologists are the same. This is a common public misperception. Anesthesiologists are physicians who have been through medical school and four years of specialty training. CRNAs are nurses with intensive-care unit experience who have undergone two years of technical training. The two are hardly the same.
Saying that CRNAs are alternatives to anesthesiologists is the same as saying that a family nurse practitioner is the same as a family practice physician. Certainly CRNAs are capable of handling the technical aspects of anesthetic delivery.
However, the interpretation of data, application of that data to a patient's underlying illnesses and re-evaluation as necessary requires a physician's input.
Anesthesia is best provided in a care team model with a CRNA or anesthesiologist assistant and a physician. There is an extremely important role for CRNAs, but they are not an "alternative" to an anesthesiologist.
M. Abey Albert
Commonwealth Anesthesia Associates
Kudos on Iraq coverage
I want to congratulate Jeff Tieman on his timely, well-written article on military healthcare ("Hospitals get battle-ready," March 31, p. 4). I have a reason for being so interested in this topic: My sister is a Navy lieutenant commander and anesthesiologist stationed at the San Diego Naval Medical Center and one of the roughly 500 deployed on the USNS Comfort.
The challenges and trials the military faces in providing healthcare make for interesting reading. It also was nice to read some behind-the-scenes coverage of the liberation effort in Iraq. Our military providers reflect one more piece of the tremendously high cost of that thing so many take for granted: freedom.
Willamette Valley Medical Center
A specialty double standard
I read with interest your April 7 article on a bipartisan congressional effort to limit physician ownership of specialty hospitals ("The buck stops here," p. 9). It seems relevant to point out that there is a possible double standard brewing in the boardrooms and executive offices of our country's hospitals and healthcare systems.
It wasn't long ago that hospitals in competitive markets were aggressively buying and developing physician practices. We all know this occurred for one reason--control of physician referrals. Patients were only to be referred to those specialists on staff at the local hospital, and physicians were reminded not to consider developing their own competitive outpatient surgery or imaging services.
Fast-forward five to 10 years and the situation has flip-flopped. Physicians no longer desire to be owned or controlled by hospitals. They have grown tired of years of managed care, Medicare and Medicaid payment reductions, and hospital bureaucracies. In the entrepreneurial spirit, physicians have sought to accept the risk of owning and managing their own hospitals. As long as they maintain an acceptable standard of quality, outcomes and service, why should this be considered inappropriate?
I understand that most hospitals rely on profitable lines of business to offset unprofitable services. I ask, however, if it is fair to legislate against a free-market economic environment when such a philosophy was widely accepted only recently.
Chief executive officer
Valley Orthopedic Associates