Federal officials reject LSU hospital deals: How will this effect university health operations?
Last Friday, federal health officials refused to pass Louisiana Gov. Bobby Jindal’s healthcare administration which consists of privatizing six state-run hospitals; unfortunately for the Governor and Louisiana, this unapproved contract already resulted in the turnover of several hospital management teams, with the bottom line being that the state is operating off of an unapproved fiscal budget.
The unapproved mandate concerned formerly LSU-oriented hospitals Shreveport, Monroe, New Orleans, Lafayette, Houma and Lake Charles, with the Shreveport and Monroe hospitals reopening October 1st of last year as University Health when placed underneath new management of the Biomedical Research Foundation subsidiary. The management teams of each respective institution have been made aware of the CMS’s decision, as has the state department of health by the CMS, personally. Management board Chairman Steve Skrivanos commented on the CMS’s decision saying, “[The] CMS’s rejection is for technical reasons, not related in any way to quality of or access to care by Medicaid or uninsured patients.” Skrivanos said in the statement.
The reasoning for declining Jindal’s budget was indeed no reflection of any respective hospital’s performance or management staff as Skrivanos states, but that the proposed budget inherently failed to meet federal Medicaid and Medicare standards. The CMS stated the agreements did not meeting federal guidelines governing how the appropriated Medicaid dollars would or could be spent.
The Center for Medicare and Medicaid services recently issued a statement commenting on their decision stating, “To maintain the fiscal integrity of the Medicaid program, CMS is unable to approve the state plan amendment request made by Louisiana,” the federal agency said in a statement. “We look forward to continuing to work with the state to ensure Louisianans receive high quality Medicaid coverage.”
The big picture problem here is that not only is this a significant blow to the Jindal administration, but that this decision could create massive upheaval within the state’s budget. The predetermined budget for the 2014 year depended upon secured Medicare/Medicaid funds, but now the state is operating within a budget that has been refused. Additionally, Jindal did not wait for CMS approval before making the decision to shift hospital management teams, as alluded to above, and now the hospitals are operating underneath management plans without state approval.
Although state health department officials say there are no short-term budget impacts on the hospitals, the whole seems to be growing for Jindal and his administration to crawl out from. Some Louisiana hospitals have already shifted into the privatization plans, those in New Orleans, Lafayette and Houma, as late as last June.
“In a meeting between the Louisiana Department of Health and Hospitals and the former LSU hospitals last week, Acting Secretary of DHH, Kathy Kliebert, informed the new owners that complex technical appeals involving Medicaid funding could extend over a year. Consequently, no change in funding can occur before September 2015.”
“In our conversations with CMS officials, they indicated that they want to start early next week discussing a financially viable alternative for the partnerships. The state does have other options to fund the partnerships, including alternative types of uncompensated care payments,” Kliebert said in the statement.
A silver lining of the debacle resulted in one federally-approved partnership concerning the transfer of inpatient services from LSU’s Earl K. Long Medical Center in Baton Rouge to a private hospital, Our Lady of the Lake Regional Medical Center. The privatization deals have already taken effect in eight university hospitals and their respective clinical, with one still left to go. As a way to cut state costs, Jindal and his administration hoped these initiatives would improve care for the poor and uninsured and enhance medical training programs; however, the deals are costing the state a total of $1.1 billion in its budget this year, with most of that relying on expected federal health care dollars.
COVID-19 "causing mass trauma among world’s nurses"
Healthcare providers are facing ongoing nursing shortages, and hospitals are reporting high rates of staff turnover and burnout as a result of the COVID-19 pandemic. In June a report found that levels of burnout among staff in England had reached "emergency" levels.
Registered nurses Molly Rindt and Erika Haywood are nurse mentors on US recruitment platform Incredible Health. In this joint Q&A they tell Healthcare Global about their own experiences of burnout and what can be done to tackle it.
What does it mean to be suffering from burnout?
Some of the most common reasons for nurse burnout include long work hours, sleep deprivation, a high-stress work environment, lack of support, and emotional strain from patient care.
While every profession has its stressors, the nursing industry has some of the highest burnout rates. The massive influence on patients’ lives, the long hours, and many other factors put nurses at risk of severe burnout. And with the rise of COVID-19, many healthcare professionals feel the strain more than ever.
Burnout in nurses affects everyone — individual nurses suffer, patients are impacted, and employers struggle with enormous turnover. This is why it’s crucial for healthcare systems and management to watch for signs of nurse burnout and take steps to provide a healthier workplace. Employers should be careful to watch for burnout symptoms in their healthcare staff — and not ignore them.
Symptoms include constant tiredness, constant anxiety related to work, emotional detachment and unexplained sickness.
How widespread is this problem?
Unfortunately, burnout affects approximately 38% of nurses per year and even the WHO recently labelled burnout as an official medical diagnosis. To put this statistic into perspective, nearly 4 out of 10 nurses will drive to work dreading their shift. Burnout is a reason nurses leave their positions.
Other top reasons for leaving included a stressful work environment, lack of good management or leadership, inadequate staffing, and finding better pay or benefits elsewhere.
Even before the pandemic, demanding workloads and aspects of the work environment such as poor staffing ratios, lack of communication between physicians and nurses, and lack of organisational leadership were known to be associated with burnout in nurses.
Have either of you experienced burnout?
Rindt: I have experienced burnout as an RN. I was constantly fatigued, never felt like I was off work, and would frequently dream I was still at work taking care of patients. In my particular situation, I needed to take a step back and restructure my work schedule to allow for more time off. After doing this, I was able to reduce burnout by deciding to work two shifts back-to-back and then have 2-3 days off.
Haywood: I definitely experienced constant anxiety related to work - so much so it would impact the days I wasn’t at work. At one point, I was even on medication to help combat the anxiety and stress I was facing on the job.
I had heart palpitations, chest pain, and wouldn’t be able to sleep before working the next day, which slowly started to impact other aspects of my life. I knew I couldn’t continue to live this way, it wasn’t sustainable. Because of this, I began to focus on my needs and prioritising self-care, especially during the beginning of the pandemic. Putting my needs first and not feeling guilty were necessary for me to overcome burnout.
What impact is COVID-19 having on nurses' wellbeing?
Some nurses have suffered devastating health consequences. Many nurses have dealt with excessive on-the-job stress, fears of becoming infected, and grief over seeing patients succumb to COVID-19 while isolated from their families.
New evidence gathered by the International Council of Nurses (ICN) suggests COVID-19 is causing mass trauma among the world’s nurses. The number of confirmed nurse deaths now exceeds 2,200, and with high levels of infections in the nursing workforce continuing, overstretched staff are experiencing increasing psychological distress in the face of ever-increasing workloads, continued abuse and protests by anti-vaccinators.
However, other small silver linings that came from the pandemic include increased professional autonomy, leadership opportunities and career growth potential.
How much of the cause of burnout is due to the hospitals or healthcare providers, and what can they do to address it?
Nurse fatigue poses serious problems for healthcare organisations, and a recent survey from Kronos found 63% of nurses say their job has caused burnout. The survey also found that more than 4 out of 5 nurses think hospitals today are losing good staff because other employers offer a better work/life balance.
Nurse burnout not only contributes to staff turnover, but it can impact the facility’s quality of care, patient satisfaction, and even medical outcomes.
Strategies to address burnout include training improving nurse-to-patient ratios, include nurses in policy discussions, and prioritise fostering a healthy work culture in hospitals.
What does your role mentoring nurses on the Incredible Health platform involve?
Rindt: My role can vary based on the needs of the nurses. The nurses love knowing they have someone in their corner who can give interview preparation advice or provide suggestions on how to improve their resume. Knowing that there is someone who is well-versed in the job process and can help set expectations on what to anticipate, really helps to remove a layer of uncertainty.
Haywood: When screening nurses, it is customised to what their individual RN or nurse practitioner needs, and at a time that is most convenient for them. Nurses are busy and often aren’t thought of first. Being able to provide support from the very beginning of their career advancement journey helps tremendously. We also provide resources such as resume templates and tips that can help nurses be successful and feel supported.