[Easyrider]

Originally Posted by Russ_Boston

Been there 2 years and don't know one nurse that left for patient safety reasons. Many nurses come and go but that's no different than anywhere. Many are still with the hospital but on different units or different shifts. As far as I know our nurse to patient ratio is on par with most hospitals in the U.S. (i.e. med/surg 5 or 6 to 1; icu 2:1 etc.)

PS> Just re-read every post in that thread you linked. Most of it was pathetic overstatements with very little fact behind it. There was almost no mention of people leaving TVRH or Leesburg for patient safety reasons. Let's also remember that TVRH is part of CFHA and is not run or operated by the Morse family. We are growing by about 100 beds (including 27 in the ED) over the next two years. Funding is getting squeezed by Medicare (our main source) but I'm sure it's the same everywhere.

_________________


Actually I was leaning a little bit your way until I saw the statement highlighted/underlined above..

What proof do you have that this was the case? Saying they were pathetic overstatements sounds pretty defensive especially if you don't work the emergency room. Does every nurse receive information on everything that goes on in the entire hospital?

[KeepingItReal]

Originally Posted by dillywho

My husband would not have survived his first heart attack had he been transported to either Ocala or Leesburg. Fortunately, he was already in TVRH when he had his second one this year.

Not sure how you could possibly know that he would not have survived his first heart attack on the way to Ocala or Leesburg but I do know if he had had to wait as long as we did he could have been in Atlanta or even beyond.....Glad he made it OK.

[blueash]

Curious and seeking data from those who claim that a hospital cannot survive when the overwhelming number of their patients are medicare. From what I am lead to believe, perhaps wrongly, TVRH has almost zero non-paying patients while most other hospitals have huge numbers of them. They also have almost no Medicaid patients, and Medicaid pays significantly lower than Medicare for the same service. So if TVRH does not have either of these two major financial sinkholes, I would have thought that having nearly all your patients paying rates very similar to those commercial carriers provide would be wholly sufficient.

[Shirleevee]

Originally Posted by Russ_Boston

Thanks Gracie - Is TVRH perfect? heck no! My (everyone's) main goal is always patient safety. Our scores in that aspect are very good. Patients don't like the food but that's another story

I was recently given the task of being one of the charge nurses for the medical floor (2nd floor) and one of the things we do every day is call patients who were discharged. The vast majority of them are complimentary of the care they received. Do some complain? Of course but if I call 20 people a day I'll bet I get no more than 2 minor complaints and we make every effort to work on those issues and get better.

In the past three years I would consider my husband to be a frequent flyer at TVRH....Angiograms (2); Stent: Abdominal Aortic Aneurysm surgery; Heart arrhythmia.......and we would rate all the visits and stays as excellent. The nurses and doctors are so much more than what we read and hear from others. As former NY'ers, we are used to great care and TVRH compares!

[KeepingItReal]

Originally Posted by ilovetv

Until people understand that a hospital cannot operate financially with 85% of the revenue stream being Medicare's low and shrinking reimbursement rates that cannot pay the bills there, and that the amount seniors pay in premium for their supplemental coverage doesn't do it either, nothing will change there.

Medicare is a problem and will soon be a larger one. But....we are not on Medicare yet and...

For one visit which turned into about 8+ hours we were billed over $12,000.00 and over $5,000.00 was for a single MRI so I don't see how much more we could have been charged to make them profitable. The remainder of the $7,000.00 charges was unbelievable. Got one injection and nothing else but we got bills from numerous doctors that not even the hospital (TVRH) office could tell us who they were when we went to pay the bill. Said we would have to call Leesburg??? I cannot imagine what the bills submitted to Medicare must look like...

[Shirleevee]

Originally Posted by Russ_Boston

Thanks Gracie - Is TVRH perfect? heck no! My (everyone's) main goal is always patient safety. Our scores in that aspect are very good. Patients don't like the food but that's another story

I was recently given the task of being one of the charge nurses for the medical floor (2nd floor) and one of the things we do every day is call patients who were discharged. The vast majority of them are complimentary of the care they received. Do some complain? Of course but if I call 20 people a day I'll bet I get no more than 2 minor complaints and we make every effort to work on those issues and get better.

Russ,

Do you know the triage protocol for TVRH..? I worked in Mental Health and seem to remember that the ER evaluated patients based on the severity of their illness.......I know that last Sunday, my husband had chest pain and was seen in 5 minutes.

[ilovetv]

Originally Posted by blueash

Curious and seeking data from those who claim that a hospital cannot survive when the overwhelming number of their patients are medicare. From what I am lead to believe, perhaps wrongly, TVRH has almost zero non-paying patients while most other hospitals have huge numbers of them. They also have almost no Medicaid patients, and Medicaid pays significantly lower than Medicare for the same service. So if TVRH does not have either of these two major financial sinkholes, I would have thought that having nearly all your patients paying rates very similar to those commercial carriers provide would be wholly sufficient.

What you say seems correct, but I think it leaves out a key factor at TVRH in particular because of the disproportionately high number of patients who are on Medicare and are chronically ill in their last two years of life--the time in life when a patient's care produces the highest Medicare expenditures:

Medicare spending per patient during the last two years of life

Overall, the average spending per chronically ill Medicare patient in the last two years of life increased 15.2 percent from $60,694 in 2007 to $69,947 in 2010.

In 2010, spending rates per Medicare beneficiary varied from a high of $112,263 in Los Angeles, Calif., to a low of $46,563 in Minot, N.D.From 2007 to 2010, Bloomington, Ill., was the only region in the nation showing a decrease in spending, as spending per Medicare patient decreased from $57,802 in 2007 to $53,674 in 2010....

Patients seeing 10 or more doctors during the last six months of life

Overall, chronically ill patients were significantly more likely to be treated by 10 or more doctors in the last six months of life in 2010 than they were in 2007, as the national rate increased from 36.1 percent to 42 percent.

In 2010, patients in East Long Island, N.Y. received the most intensive care by this measure, with 62.3 percent of patients seeing 10 or more doctors in the last six months of life.

Other regions with high rates included Ridgewood, N.J. (62.1%) and Royal Oak, Mich. (60.2%). Regions with low rates included Idaho Falls, Idaho (14.5%), Grand Junction, Colo. (17.7%), and Missoula, Mont. (18.2%). Only seven regions decreased in this measure from 2007 to 2010, including Neenah, Wis. (from 25.2 percent in 2007 to 21.4 percent in 2010) and Santa Cruz, Calif. (from 31.8 percent in 2007 to 28.9 percent in 2010).

- See more at: The Dartmouth Institute » Barbara A. Koll, MS

Another illustration:

Why 5% of Patients Create 50% of Health Care Costs

While there are various ways to reduce the costs of health care, this fact (Cohen & Yu, 2012 Agency for Healthcare Research and Quality) should make you stop in your tracks: most business people have an 80/20 rule they apply in a variety of settings (20% of your customers generate 80% of your volume, etc.). This rule tells us that an enormous amount of the health system cost is centered in a very concentrated group of people. Who are they, why are they so expensive, and can we address this relatively small population to the benefit of the whole?

This is when the discussions about courage and character by lawmakers, practitioners and patients moves front and center. These patients tend to be newborns with serious issues and the elderly, who are often quite ill. According to one study (Banarto, McClellan, Kagy and Garber, 2004), 30% of all Medicare expenditures are attributed to the 5% of beneficiaries that die each year, with 1/3 of that cost occurring in the last month of life......

Why 5% of Patients Create 50% of Health Care Costs - Forbes

And meanwhile, Medicare underpays compared to costs of providing the care. I think the high concentration of aged, chronically ill Medicare patients in their last two years of life hits TVRH extremely hard, financially.

[Russ_Boston]

Yes we do have about 87% Medicare payments BUT the other 13% are almost all non-pays. Very seldom do we get an under 65 year old who has private insurance. Not sure how that ranks with other hospitals but I know it is a drag on our revenue.

[dillywho]

Originally Posted by KeepingItReal

Not sure how you could possibly know that he would not have survived his first heart attack on the way to Ocala or Leesburg but I do know if he had had to wait as long as we did he could have been in Atlanta or even beyond.....Glad he made it OK.

He was in the throes of his attack when the paramedics arrived. I guess the fact that the cardiac cath lab team and the cardiologist were called in before he was transported and he was taken immediately into the lab is my basis. He had his stent in place in less time than it would have taken to arrive in either Ocala or Leesburg.

Do I know for certain that he wouldn't have made it going further away? No. I'm just not willing to chance it, though.

[graciegirl]

They are building an addition to the hospital as we discuss this. At this very moment.

Now if only we could get some really good medical staff to want to hang out here in central Florida and live with a lot of old-er people.

[NotGolfer]

Over the years and several moves I've heard the stories about the "local" hospital. Some very negative and some glowing. ER's always triage patients according to severity of the issue. What we would deem to be "horrible" and "needs" to have immediate attention--they may not, due to their protocols. Have you all heard the ad on the radio re: the hospital's Urgent Care across 441 from the hospital?? They even have a shuttle across to the hospital (according to the ad) for transport. Some folks will go to the ER for their issues when in fact they probably should go to the Urgent Care (it can be any of them in the area). IF you think it's a 'life-threatening' issue---call 911.

My experience with the ER and TVH is exemplary care. So from reading the many posts on this thread I would say it's a matter of perception in some cases.

[Madelaine Amee]

Originally Posted by graciegirl

They are building an addition to the hospital as we discuss this. At this very moment.

Now if only we could get some really good medical staff to want to hang out here in central Florida and live with a lot of old-er people.

That's a rather "blanket" statement, care to tell us exactly what you mean by "really good medical staff". I've been here 8 years and we have had excellent care, both in TV Hospital and in Ocala Hospitals - did not care for Leesburg, but the staff were very kind and thoughtful, and excellent surgical care at Mayo. Our only real complaint is the food - it is awful everywhere you go. One of my husband's doctors told me to bring him in fruit and yogurt! Right now I am getting ready to go into TV Hospital for elective, but necessary, surgery and I'm hoping Russ Boston is going to keep an eye on me!

I do think we have many physicians working the medicare system with too many tests, but that is up to the patient to refuse them.

[jojo]

To add to the anecdotal records - we recently had a positive experience at TVRH in the emergency room. The patient was taken in immediately - within 5 minutes of arrival. She had several tests done within a 2-hour span and the results were available within 30 minutes. The emergency room doctor called her physician as he was making the diagnosis and determining treatment. From the time of arrival to release with tests (CAT Scan, EKG, blood work etc.) was 4 hours. I was kept informed. The emergency room was not busy when we arrived at 8:00 in the morning but was overflowing when we left late morning.

[rn1tv]

Russ, I must speak up and say I am one of the nurses who left due to safety issues among others I know that have left. Management does not give a damn about nurses or the nurse to patient ratio on the floor which includes patient safety. It's all about the almighty dollar! They would rather push out the older, more experienced nurses (who mentored the new grads) for the cheaper salary they have to pay. In the years I was there (many more than you have been there), I begged for them to look at acuity when making assignments but it was ignored. You got no support from your charge nurse, only your coworkers who, too, were overwhelmed. And, God forbid, you did not leave on time; your file was documented!
You may have worked as a charge nurse on 2nd, but my experience was the "charge nurses" were given those positions because they were "yes" people in management's eyes but had/have no nursing skills to work on the floor. People with AD's are in management positions??? Where I worked prior to TVRH, a BSN and Master's in Nursing was required to be a manager or, as TVRH calls it "a director." At TVRH, if you are a "yes" person, you only need an AD with no requirement to pursue additional education. And their clinical ladder is nothing more than a joke! It's not about skill, education, and expertise but what you can do for TVRH.
I see you defend TVRH yet you are willing to explore other opportunities at other locations when suggested by others on this website; interesting!

[Russ_Boston]

Originally Posted by rn1tv

Russ, I must speak up and say I am one of the nurses who left due to safety issues among others I know that have left. Management does not give a damn about nurses or the nurse to patient ratio on the floor which includes patient safety. It's all about the almighty dollar! They would rather push out the older, more experienced nurses (who mentored the new grads) for the cheaper salary they have to pay. In the years I was there (many more than you have been there), I begged for them to look at acuity when making assignments but it was ignored. You got no support from your charge nurse, only your coworkers who, too, were overwhelmed. And, God forbid, you did not leave on time; your file was documented!
You may have worked as a charge nurse on 2nd, but my experience was the "charge nurses" were given those positions because they were "yes" people in management's eyes but had/have no nursing skills to work on the floor. People with AD's are in management positions??? Where I worked prior to TVRH, a BSN and Master's in Nursing was required to be a manager or, as TVRH calls it "a director." At TVRH, if you are a "yes" person, you only need an AD with no requirement to pursue additional education. And their clinical ladder is nothing more than a joke! It's not about skill, education, and expertise but what you can do for TVRH.
I see you defend TVRH yet you are willing to explore other opportunities at other locations when suggested by others on this website; interesting!

Take them one at a time in no particular order:

1. Explore other possibilities: Any employee is crazy not to look into opportunities that can advance their career and move them towards their eventual goals. I have left a couple of great companies in my previous career when the opportunity was right. For now I enjoy TVRH.

2. Patient to nurse ratio: I know the ratios have not changed on the medical floor (6 to 1); or IMCU (4 to 1); or ICU (2 to 1) since I have been there. Sometimes they are less but never more.

3. Experienced nurses: On the medical floor we have at least a dozen nurses with over 10 years of experience. All four of the full time charge nurses have over 25 years of floor experience each! I am the exception but I am relief charge (weekend - holiday - vacation cover etc.). But I do have prior management experience from a previous profession (IT). I still work on the floor and I still have lots of nursing skills to learn. To my knowledge not one single nurse has been "pushed out" as you mentioned. At least not on the 2nd floor.

4. Education: You are correct on the education front. A lot of AD in nursing degrees. There are many other second career folks like myself that have a BS in something else from back in the day and then an AD in nursing. I am pursing a BSN in the event that I decide on a management track (not sure yet). Our Director does have a BSN but not a masters degree like would be required in many other places.

5. Patient acuity: There are times when it gets skewed. If I have a few rooms to pick from I will try to balance out the room assignments. But there are times when I only have 1 room open and the patient needs it. Should we move patients? Perhaps, but then patient satisfaction is affected. When I'm the charge nurse it is my responsibility to help the nurse who may be overwhelmed. Many times the 'perceived' acuity level is determined by the experience of the nurse. This is something that needs to be addressed more closely as you mentioned. I will try to do this better on the days when I'm charge.

Respectfully,
Russ