As director of nursing at a critical-access hospital in Northern California, I remember all too well how the Patients' Evaluation of Performance in California was promoted-through media scare tactics ("Voluntary problems," June 23, p. 6).
Hospitals not participating were listed in newspapers along with the question, "What are these hospitals trying to hide?" The implication was that by not participating in PEP-C hospitals were being less than honest. The truth was, at the time many rural hospitals were closing and others, such as my hospital, were in dire financial straits. We couldn't justify spending thousands of dollars on PEP-C when we were using up our line of credit to make payroll.
Trinity Hospital in Weaverville, Calif., mentioned in your article, participated the first year because it was a test site and received the survey free of charge. It dropped out when it had to pay.
Other, larger facilities in our area had already spent hundreds of thousands of dollars for another type of patient survey, so PEP-C would have been redundant.
This past year my hospital's financial status improved slightly because it won critical-access designation. We spent several thousand dollars (that we didn't actually have) on PEP-C because we felt patient satisfaction was important and because PEP-C eased its strong-arm tactics. What PEP-C did for us was reinforce the fact of what we already knew-we do a great job of patient care and patients responded accordingly.
Director of nursing
Mayers Memorial Hospital
Fall River Mills, Calif.
I agree wholeheartedly with Todd Sloane's editorial, "The vanishing workforce" (June 16, p. 20). As a clinical pharmacist for more than 20 years I have at times found myself torn between doing what's best for the patient and working within financial constraints.
Are we really working together in this industry? It seems like more and more departments in the hospital seek to develop their own efficient checklists, and then the patient moves downstream for further care and evaluation.
Unfortunately, any and all unresolved issues or problems (especially with medications) that were not addressed initially move downstream too, creating more work for nurses and pharmacists who struggle each day just to provide the basics of care, with diminishing resources.
This certainly leads to burnout, and traditional measurement tools may not be sensitive or specific enough to detect it.
Career ladders and other advancement opportunities are helpful, but there are competing internal interests, and in this fast-changing environment, it's often difficult to discern just where the organization is going, what the opportunities are and where we as individual practitioners fit in.
In many instances, salary isn't the most critical job satisfaction issue. It's being supported by managers, administration and medical staff, and being empowered to provide care in a safe, patient-driven environment.
Grand Rapids, Mich.
No translation needed
I would like to respond to the June 12 item in Modern Healthcare's Daily Dose on a proposal by Democratic presidential candidate Sen. John Edwards to create a national hot line for translation services for hospitals. I believe that taxpayer money would be better spent to teach immigrants to speak English than to force every institution to hire translators.
We already have every school and numerous other resources in place and fully funded that can teach our national language.
Since our founding, English has been our national language and we have been accommodating of much diversity in many ways. What percent would he calculate we need to achieve before we are required to hire additional translators for French, Russian, German, Afrikaans, Tagalog, etc.?
What legislation to have us spend money to solve a single symptom of his personal perceived problem would be next?
Force all hospitals to buy cars for patients because some of them do not own cars?
Practice director of management consulting
CTG HealthCare Solutions
No stalling on ratios
As the sponsor of the California law requiring all hospitals to maintain minimum nurse-to-patient ratios, we don't share the gloom and doom being peddled by the hospital industry ("Ratio daze in California," June 16, p. 30).
California hospitals that created the shortage in the first place with misguided layoffs and restructuring have had four years to prepare for final implementation of safe staffing ratios to ensure quality patient care. The time for stalling is over.
Advertising for registered nurses as you would a pair of shoes or a can of beer will hardly fill those nagging vacancies and meet the ratios. The first step is for hospitals to hang on to their RNs already on staff with improved staffing levels, compensation and secure pensions, all factors that are driving out many of their most experienced RNs.
Some hospitals are showing that vision. For the others, build it-safe ratios-and the RNs will come.
Some RNs who have left the hospital setting or are working in other states have expressed interest in returning or moving to California when conditions improve. The California Nurses Association is also working with some hospitals, colleges and universities, and state officials to train a new generation of RNs and help other healthcare employees become RNs. Help, with ratios, is on the way.
California Nurses Association
We commend you for and agree wholeheartedly with your interest in promoting the use of bar coding, as expressed in the editorial cartoon (June 16, p. 20), in which the Food and Drug Administration is seen pushing reluctant pharmaceutical and hospital representatives across the bar-coding bridge.
In fairness, though, the cartoon paints the hospital industry "pushee" with too broad a brush. The Federation of American Hospitals long has advocated the use of a standardized bar-coding system for drugs and all medication, including unit doses, as noted in our testimony on July 26, 2002, before the FDA.
Federation of American Hospitals