Issue link: https://nnumagazine.uberflip.com/i/198021
AP PHOTO/DON WRIGHT the essential finding of its study in unequivocal terms: "The nurses speak of being able to deliver safe, adequate care as a result of these staffing patterns." Sharing similar operational interests driven by fee-for-service economic incentives, nursing and hospital management at the original magnet hospitals broadly agreed with nurses regarding the central factors that had an impact on recruitment and retention, citing: "adequate staffing and flexible scheduling," "good salaries and benefits," "participative management with active involvement of staff in planning and decision making," "primary nursing," and "a predominantly RN staff that is fully supported by nursing administration." Nursing executives emphasized the importance of RNs being able to carry out skilled nursing tasks themselves, without delegation to less trained individuals. And, the original magnet hospitals were founded on a commitment to maintaining a sufficient complement of direct-care RN staff to meet patient needs at all times, with virtually no use of agency personnel. This was the meaning and workplace reality of the "forces of magnetism" identified by the American Academy of Nursing twenty-five years ago, at a time when institutional providers and physician groups were generally thriving in a dominant "fee-for-service" market characterized by a close alignment of provider, direct-care nurse and patient interests and institutional economic incentives to ensure safe, therapeutic, effective and competent nursing care. Managed Care Financing of Healthcare Services— Forces of Magnetism Abandon Patients managed care capitation financing arrangements have APRIL 2010 become the dominant means for funding hospital and physician services. HMOs/insurers provide a share of the monthly premium dollar for a negotiated split between medical and hospital provider organizations, transferring to physicians and hospitals the risk of incurring costs for providing patient care services in excess of premium revenue, and the corresponding opportunity to gain surplus revenue by limiting services to ensure premium revenue exceeds costs. This radical change in hospital economics imposes operational mandates which determine the nature and methods of delivery of hospital patient care. The revenue generation priority of capitation-financed hospital service creates an inherently adversarial relationship between patients and institutional providers operating under financial incentives to limit hospital access, ignore individual patient needs, deny necessary services, and disregard minimum standards of safe, therapeutic, effective and competent nursing care. The financial imperatives require massive cutbacks in nursing budgets and concomitant reduction in the direct-care RN staff and administrative support that were the fundamental prerequisites for magnet hospital recognition as it was originally conceived. Managed care economics motivated a significant restructuring and downsizing of hospital nursing services and decimated the ranks of direct-care registered nurses in hospitals. At the same time, managed care imposed barriers to hospital access, producing an inpatient population that is far sicker and more medically fragile than ever before, and requires more intense, experienced and specialized nursing care. Managed care strategies to increase revenue generation by downsizing the direct-care registered nurse workforce W W W. N A T I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 23