Demand for Newly Certified PAs is Strong

Demand is high and the job market is strong for newly certified PAs, according to a new report by the National Commission of Certified Physician Assistants.

Demand for and the job market remain strong for newly certified PAs, according to new data released in the 2017 Statistical Profile of Recently Certified Physician Assistants by the National Commission of Certified Physician Assistants (NCCPA).

The robust report, which is based on survey responses received from 6,843 of the 8,788 PAs who obtained certification in 2017, aims to offer insight into the future of the PA workforce, as well as its current state.

Highlights from the report include:

  • On average, PAs made $95,000 as a starting salary in 2017.
  • Recently certified PAs are practicing in all 50 states and the District of Columbia.
  • The top states with the greatest number of recently Certified PAs are New York (902), Pennsylvania (699), Florida (567), California (548), North Carolina (440), and Texas (440).
  • 67.2% of respondents accepted a clinical position as a PA in 2017.
  • 77.4% of PAs who accepted a position received two or more job offers, and 79.3% of newly employed PAs indicated that they did not face any challenges when searching for a job.
  • 52.8% of recently certified PAs who have accepted a position work in a hospital setting and 29.9% are working in an office-based private practice setting.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Kim’s Blog: What If The Priority of Our Visit is Addressing Social Needs and Non-Compliance

Kim Spering encourages you to look for the real reasons patients don’t show up on time, don’t take their medications, and seem to go against medical advice.

by Kimberly Spering, MSN, FNP-BC

In my palliative care work, making home visits, we often find patients’ needs to be dire for basic necessities. What if simply being able to EAT was one of those needs? What if, for example, a patient’s reasons for not going to office visits was simply – he couldn’t afford transportation?

It was my second visit with a thin, elderly gentleman. During the first visit, he shared that his HUD housing management had sent him a written eviction notice for “multiple infractions.” I reviewed the multi-page document they sent him. Frankly, none of these so-called incidents seemed to warrant eviction.

Speaking softly, muffled due to his lack of teeth and his Parkinson’s disease, I pieced together his story.

He had been diagnosed with PD years ago, after many years with vague symptoms. He was prescribed Sinemet TID, but takes it QID on his own, as the tremors and gait freezing worsened after 3 hours of each dose. Which means… he runs out of medication before the next refill. So, he suffers more during the last week of the month. He also has subsequent cognitive short-term memory deficits as a result of the disorder.

He has had multiple mental health issues, addiction, and other social problems over the years. He sees a psychiatrist, addiction specialist, and therapist to help him through these problems.

He does not drive, and relies on public bus transportation for appointments. Guess what: now, he cannot afford the tickets. As a result, he often no-shows for appointments, thus getting him a “reputation” for “non-compliant behavior.” And let’s face it, no one looks into the details. It doesn’t matter if he can’t afford that bus pass – he is now “labeled” as “non-compliant.” He does not always know what number to call to cancel his appointments. (by the way… side bar. I loathe that term. I prefer, “non-adherent.” It’s less judgmental, in my opinion.)

In recent months, he forgot that he put pots on the stove while heating up his food. One incident led to the local fire department being dispatched. After that, his building management decided they would disconnect his stove. So now, he can’t even heat up any meals that he may get.

Also, financially, he has no extra money to pay for food, after medication co-pays. For some reason, even though he had Medical Assistance, his plan did not cover his medications. So an albuterol inhaler costs him $58… which he did not have. He has an enlarged cervical lymph node, which I presume is cancer-till-proven-otherwise, given his ETOH use/smoking, but I wrote a Rx for Keflex, hoping against hope it would help. It did, albeit marginally. He still needs evaluation for the mass. He can’t afford the bus fare to go for a visit. He also was visibly short of breath when I saw him, which likely would have improved by using that inhaler — had he been able to afford it.

I then found out that he ONLY eats when going to local soup kitchens. THREE TIMES PER WEEK, Tuesdays through Thursdays. He barely eats in-between. He had one can of tuna in the apartment. He has lost over 40 lbs… 16 lbs in the previous 6 weeks from my first visit. He is at the brink of being emaciated at this point.

Our one local food bank will deliver a food box to anyone in the apartment complex who needs it – once per month. He never got one, because he has been at the soup kitchen for his meal when the group arrives. He was told by management that they would not save a box for him, nor deliver it to his door, because “people would steal it.”

I was not only appalled, but incensed that this was the case.

So… here is a man who eats three hearty meals per WEEK, living sparingly on a can of tuna here-and-there in-between. He has no other recourse. There is minimal family involvement. He can’t access outside resources. I wanted to cry when viewing his situation.

Fortunately, he is enrolled in our Community Care Team (encompassing nurses, social workers, pharmacists, mental health specialists) through his PCP office. I sent a message to the RN on his case, detailing the grim realities of not having food. He has a community health worker at the one local church who tries to help him where possible.

On the day of my second visit, I had a palliative care fellow with me. He suggested Meals on Wheels.

On the inside, I kicked myself for not thinking of this sooner. Then I discovered that if he was frequenting soup kitchens (even only 3 days per week), he may not qualify for it. So… go to soup kitchens with a guaranteed meal three times per week… but still, he should qualify for two meals per day from MOW based on his income.

Alas, there is the logistical nightmare of trying to follow him if/once he gets evicted.

“I’ll be homeless,” he stated firmly.

“What about the Mission?” – a local resource for homeless men. They have to leave during the day, but can return for hot meals and a place to sleep in the evening, counseling, and help to get back on track.

“Nope. No way,” he said. From reading between-the-lines, and knowing he hadn’t conquered his addictions, I knew that a Christian organization would clash with his wishes for care, particularly if he used drugs.

“What about your family?”

“Eh, one daughter drops by on occasion with food. The others – they don’t call me, ever.”

What is a provider to do when faced with this scenario?

Well… for one: focus on what you can do immediately. In contacting the CCT team, I tried to enlist others in support for this patient. I fully realize… I can only do so much myself. Get the team involved.

Second: reiterate the positive issues with the patient. There may be only ONE, but try to find a positive way to reinforce great behaviors: staying clean, staying sober, calling to make and keeping appointments, etc.

Third: realize that taking these steps is truly a process… one fraught with roadblocks, challenges, and fortunately, sometimes, successes.

For every roadblock encountered, think of how you are helping that person.

Let’s broaden the perspective, shall we? This applies in my patient’s case.

For every provider who faces frequent no-shows or late patients, or patients who don’t “follow orders:” consider looking for the real reasons that patients don’t show up on time, don’t take their medications, and seem to go against medical advice. Often there is a good reason for their actions (or inactions). I admit – I used to chafe and get mad when no-shows occurred… or when patients showed up 30 minutes late, throwing the day’s schedule in disarray. It took some time and patience to dig deep, to find out the reasons. It was NOT simply that patients were inconsiderate or lazy (something I continue to hear from other providers to this day). Perhaps the bus was running late. Perhaps their ride no-showed or had other, more pressing issues. Back in the days of seeing patients in the office, I would be annoyed at the so-called lack of “consideration” of patients showing up on time.

I’ve seen a new side of the patient experience by seeing them in the home. Believe me when I say, the LEAST of many people’s concerns is getting to their office visit on time.

I’m fortunate that I finally can see things as they are for many patients. Fortunate to have the resources to try to help them any way we can.

Patients’ social history may seem like a thing to bypass, to ignore. Please… as one “in the trenches,” seeing their reality, hearing their stories – those stories are crucial to their care. Take the time to hear them. Advocate for them. Use your own resources in your practice to delegate aspects of their care.

Listen and acknowledge their social history. It’s vital to understand what patients face. But above all, please don’t label them “non-compliant,” particularly if you don’t know the whole background story.

Kim Spering has been a nurse for over 25 years and worked as an NP over the past 15 years in Family Medicine, Women’s Health, Internal Medicine, and now Palliative Medicine. She serves as an editorial board member of Clinician 1 and submit blogs to the website, with a goal of highlighting both the clinician and patient experience in health care.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Pharma Sales Growth Tied to Price Hikes

Of the roughly $23.3 billion in sales growth seen by 45 top pharmaceutical products, $14.3 billion of that has been tied to price increases, not demand.

61% of the pharma industry’s recent sales growth was apparently, at least in part, a byproduct of price increases on top-selling drugs, according to a new report from investment firm Leerink.

From 2014 through 2017, sales for 45 top pharmaceutical products, including AbbVie’s Humira, Amgen’s Neulasta and Enbrel, and Pfizer’s Lyrica, increased by 28% (roughly $23.3 billion) in the United States. However, more than $14.3 billion of those sales was the result of price increases.

Continued price hikes from pharma companies have faced backlash and much scrutiny in recent years, including at the government level, with the Trump Administration releasing a plan to tackle the rising costs in May.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

PT Supported Opioid Bill Ready for President’s Signature

Landmark legislation to fight the opioid epidemic, supported by the APTA, is headed to the President’s desk to be signed into law.

Last week, the U.S. Senate passed legislation that aims to combat the staggering opioid epidemic that has been impacting this country at an alarming rate by a 98-1 margin, and it will now head to the White House for Donald Trump’s signature, making it law.

Being hailed as “landmark” legislation by Senate Majority Leader Mitch McConnell, it includes provisions aimed at promoting research to find alternative, less addictive medications for pain management, as well as covering treatment for opioid addiction and use disorder, and efforts to prevent foreign shipments of illegal opioids.

The legislation is supported by the APTA, as well as scores of physical therapists. “The bill now on its way to the White House represents a significant step in the right direction,” APTA congressional affairs senior specialist, Kristina Weger, is quoted as saying. “But there’s much more work to be done—there are many provisions that direct agencies to begin reviews and studies on potential changes that we may not see for years. We need to continue our advocacy and outreach to help fight this crisis.”

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

How to Ask for Referrals Without Freaking Out

Asking for referrals is a necessity to grow your practice and make it thrive, but some therapists are uncomfortable doing so.

from Evidence in Motion

Some therapists may have a little anxiety or feel uncomfortable about asking for referrals in an effort to grow their practice. However, as your practice needs clients to thrive, asking for referrals is a necessary evil. Learn how to do it right in this handy breakdown of three principles that work from Evidence in Motion.

Read More →

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Congress Bans Pharmacist ‘Gag Orders’ On Drug Prices

Pharmacists will no longer have to keep it a secret when the cash price for a prescription is less than what someone would pay using their insurance plan.

By Susan Jaffe

For years, most pharmacists couldn’t give customers even a clue about an easy way to save money on prescription drugs. But the restraints are coming off.

When the cash price for a prescription is less than what you would pay using your insurance plan, pharmacists will no longer have to keep that a secret.

President Donald Trump was expected to sign two bills Wednesday that ban “gag order” clauses in contracts between pharmacies and insurance companies or pharmacy benefit managers — those firms that negotiate prices for employers and insurers with drugstores and drugmakers. Such provisions prohibit pharmacists from telling customers when they can save money by paying the pharmacy’s lower cash price instead of the price negotiated by their insurance plan.

The bills — one for Medicare and Medicare Advantage beneficiaries and another for commercial employer-based and individual policies— were passed by Congress in nearly unanimous votes last month. A spokesman for Sen. Susan Collins (R-Maine) said her office had been told the president would sign the bills Wednesday. The White House declined to comment.

“Americans deserve to know the lowest drug price at their pharmacy, but ‘gag clauses’ prevent your pharmacist from telling you!” Trump wrote on Twitter three weeks ago, shortly before the Senate voted on the bills. “I support legislation that will remove gag clauses.” The change was one of the proposals included in Trump’s blueprint to cut prescription drug prices issued in May.

Ronna Hauser, vice president of payment policy and regulatory affairs at the National Community Pharmacists Association, said many members of her group “say a pharmacy benefit manager will call them with a warning if they are telling patients it’s less expensive” without insurance. She said pharmacists could be fined for violating their contracts and even dropped from insurance networks.

According to research published in JAMA in March, people with Medicare Part D drug insurance overpaid for prescriptions by $135 million in 2013. Copayments in those plans were higher than the cash price for nearly 1 in 4 drugs purchased in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33 percent.

Yet some critics say eliminating gag orders doesn’t address the causes of high drug prices. “As a country, we’re spending about $450 billion on prescription drugs annually,” said Steven Knievel, who works on drug price issues for Public Citizen, a consumer advocacy group. The modest savings gained by paying the cash price “is far short of what needs to happen to actually deliver the relief people need.”

After the president signs the legislation affecting commercial insurance contracts, gag order provisions will immediately be prohibited, said a spokesman for Collins, who co-authored the bill. The bill affecting Medicare beneficiaries wouldn’t take effect until Jan. 1, 2020.

But there’s a catch: Under the new legislation, pharmacists will not be required to tell patients about the lower cost option. If they don’t, it’s up to the customer to ask.

The Pharmaceutical Care Management Association, a trade group representing pharmacy benefit managers, said gag orders are increasingly rare. The association supported the legislation. Some insurers have also said their contracts don’t include these provisions. Yet two members of Congress have encountered them at the pharmacy counter.

At a hearing on the gag order ban, Collins said she watched a couple leave a Bangor, Maine, pharmacy without their prescription because they couldn’t afford the $111 copayment and the pharmacist did not advise them about saving money by paying directly for the medicine. When she asked him how often that happens, he said every day.

“Banning gag clauses will make it easier for more Americans to afford their prescription drugs because pharmacists will be able to proactively notify consumers if a less expensive option may be available,” she said last week.

When Rep. Debbie Dingell (D-Mich.) went to a Michigan pharmacy to pick up a prescription recently, she was told it would cost $1,300. “After you peeled me off the ceiling, I called the doctor and screamed and talked to the pharmacist,” she recalled during a hearing last month. “I’m much more aggressive than many in asking questions,” she admitted, and ended up saving $1,260 after she learned she could get an equivalent drug for $40.

While the legislation removes gag orders, it doesn’t address how patients who pay the cash price outside their insurance plan can apply that expense toward meeting their policy’s deductible.

But for Medicare beneficiaries there is a little-known rule — not found in the “Medicare & You” handbook or on its website —that helps people with Medicare Part D or Medicare Advantage coverage. If they pay the lower cash price for a covered drug at a pharmacy that participates in their insurance plan and then submit the proper documentation to their plan, insurers must count it toward patients’ out-of-pocket expenses.

The total of those expenses are important because that amount affects the drug coverage gap commonly called the “doughnut hole.” (This year, the gap begins after the plan and beneficiary spend $3,750 and ends once the beneficiary has spent a total of $5,000.)

And beneficiaries don’t have to wait until the gag order ban takes effect in two years.

The Medicare rule also says that if a senior asks about a lower price for a prescription, the pharmacist can answer.

Rep. Buddy Carter (R-Ga.), a pharmacist who sponsored the Medicare gag order bill, said he wasn’t surprised by the bipartisan support for the legislation. “High prescription drug costs affect everyone,” he said.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Healthcare Continues Adding Jobs; Unemployment Hits 49 Year Low

The unemployment rate is at a 49 year low, and healthcare’s steady and consistent job growth is one factor as to why.

Healthcare added 26,000 jobs in September, including 12,000 in hospitals, 10,300 in ambulatory care, and 3,400 in nursing care facilities, according to numbers released by the U.S. Bureau of Labor Statistics on Friday.

The constant and steady growth of jobs in the healthcare sector has contributed to what is now the lowest unemployment rate (3.7%) in 49 years.

Over the year, healthcare has added 302,000 jobs.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Nursing Jobs, Cost of Living, & Where to Hang Your Hat

Making decisions about your work-style and lifestyle can be fraught with anxiety and concern about the future—let’s unpack that conundrum.

From Nurse Keith’s Digital Doorway

In my work as a career coach for nurses and healthcare professionals, I frequently witness those who work in nursing struggling with decisions related to finding work and the relative cost of living in terms of where they live or where they might move.

Making decisions about your work-style and lifestyle can be fraught with anxiety and concern about the future — let’s unpack that conundrum.

Workstyle and Lifestyle

Figuring out where to live and work can be a difficult choice. On the one hand, you want to earn up to your potential and receive the highest possible wage according to your level of experience and expertise. On the other hand, the highest salaries are generally in large popular metropolitan areas where the cost of living is through the roof and the relatively high salary will just barely (if at all) make up the difference when compared to more moderately priced cities or towns.

A single working professional may have much more freedom of movement than one who is married, but finding a way to afford single life in more expensive areas can be a challenge.

Choosing a new domicile becomes even more complicated when children are in the picture. Whereas a single person may simply look at nightlife, cultural amenities, cost of living, safety, etc, the nursing professional with children must also consider school quality and everything that comes with the needs of growing children.

Choosing an underserved rural area may offer a quiet place to live and low cost of living for someone who loves the outdoors, but for a nurse with a regular habit of going out to movies, theater, and other nightlife activities, the flip side will be discovering how to have those amenities in the city without breaking the bank.

Your chosen lifestyle and workstyle need to be fairly aligned; if you have a spouse and kids, these decisions are more complex but not impossible to overcome. And while work can sometimes take up a third or more of your life, it can’t always be the sole factor that determines where you rest your head at night.

The Best Places to Live

Here in the United States, there is a wide diversity of choices related to climate, safety, way of life, economics, diversity, educational opportunities, housing costs, crime, and culture. And we all know that one person’s paradise can be another’s purgatory.

Money Magazine and Realtor.com crunched the numbers for 2018, creating a list of the 50 best places to live in the United States. The communities were examined using a methodology that looked at areas with populations over 50,000; the rankings were compiled based on the examination of over 70 types of data, including those mentioned in the preceding paragraph.

Somewhat surprisingly (or not), the 50 winners aren’t all household names like San Francisco, Boulder, or Dallas. Here are the top 10:

  1. Frisco, Texas
  2. Ashburn, Virginia
  3. Carmel, Indiana
  4. Ellicott City, Maryland
  5. Cary, North Carolina
  6. Franklin, Tennessee
  7. Dublin, California
  8. Highlands Ranch, Colorado
  9. Sammamish, Washington
  10. Woodbury, Minnesota

Two small cities within the metropolitan halo of Boston made the cut: Newton and Brookline. In relation to the New York City region, only Union and Parsipanny/Troy Hills, NJ were on the list. Near Atlanta, we find the suburb of Alpharetta as a highly prized location (my mother lived there very happily in the last few years of her life). And the only selections in the entire state of California are Dublin, a city of 60,000 located 30 miles east of Oakland, and Eastvale, a city an hour east of downtown LA. Sorry, Hawaii and Alaska — you didn’t even make the top 50.

Anyway, here’s Money Magazine’s list of the best places to live in each state.

We can’t entirely live our lives according to the results from this kind of research, but such information can serve as a jumping off point for further exploration and can support us in doing our due diligence and making prudent choices.

Now For the Jobs per U.S. News

When considering relocation and where to settle down, other tools also come in handy. U.S. News & World Report’s “The 25 Best Jobs of 2018” can help us to piece the puzzle together. While software developer clinched the #1 spot for 2018, rest assured that healthcare jobs dominate the list, with the following health-related careers making appearances:

#2: Dentist
#3: Physician Assistant
#4: Nurse Practitioner
#5: Orthodontist
#7: Pediatrician
#8: A tie between Obstetrician/Gynecologist; Oral and Maxillofacial Surgeon; & Physician
#11: Occupational Therapist
#12: Physical Therapist
#13: A tie between Anesthesiologist & Surgeon
#15: Psychiatrist
#16: Prosthodontist
#17: Dental Hygienist
#18: Registered Nurse
#20: Physical Therapy Assistant
#21: Respiratory Therapist
#22: Nurse Anesthetist
#23: Optometrist

If you’re thinking of switching out of healthcare entirely, see the list for the details, but rest assured that you’d do well as an actuary, marketing manager, statistician, or mathematician.

If you’re wondering about the difference between NPs, nurse anesthetists, and RNs, look no further:

Nurse Anesthetist
Median salary: $160,270
Unemployment rate: 2.7 percent

Nurse Practitioner
Median salary: $100,910
Unemployment rate: 0.7 percent

Registered Nurse
Median salary: $68,450
Unemployment rate: 1.2 percent

One thing we have no reliable data on is how much nurses are earning when they reach the PhD or DNP level, so the operative question remains whether pursuing those terminal nursing degrees repay the earnest (and highly indebted) nurse with high salaries and low unemployment.

Similarly, the Bureau of Labor Statistics also does nothing to parse these differences either. Don’t get me wrong, BLS data is a useful resource but doesn’t give us the full breakdown we truly need (likely because those BLS folks have no idea what a DNP is, and it’s even less likely that they even know what DNPs are capable of.)

The 25 Best Nursing Jobs

According to an article posted on TopRNtoBSN.com, nursing jobs of course have their own hierarchy of popularity and career mojo. Unfortunately, no methodology is shared, thus we’re left in the dark as to how they arrived at these conclusions. While the only hard statistics we’re given are median salaries, the list includes:

  1. Ambulatory Care Nurse
  2. Camp Nurse
  3. Case Management Nurse
  4. Correctional Nurse
  5. Flight Nurse
  6. Forensic Nurse
  7. Home Health Nurse
  8. Hospice Nurse
  9. Informatics Nurse
  10. IV Therapy Nurse
  11. International Nurse
  12. Long-Term Care Nurse
  13. Medical Supplies or Pharmaceutical Rep
  14. Nurse Advocate
  15. Nurse Educator
  16. Nurse Manager
  17. Nurse Researcher
  18. Psychiatric Nurse
  19. Public Health Nurse
  20. School Nurse
  21. Substance Abuse Nurse
  22. Telephone Triage Nurse
  23. Transplant Nurse
  24. Travel Nurse
  25. Wound, Ostomy, & Continence Nurse

You likely already noticed that many of the listed nursing jobs are removed from acute care, demonstrating to curious nurses that there is indeed life beyond the hospital (I’ve known this for decades, myself, but so many nurses seem unaware that any potential for work exists outside of the hospital milieu. Don’t get me started about those who say real nurses only work in hospitals!).

And remember that nurse entrepreneurs and other outside-the-box nurses (like myself) never get air time on mainstream healthcare and career websites.

Choose Your Own Adventure

Nursing offers varying entry points into the profession, with some students now choosing an entry-level MSN as their starting place, especially when coming from another professional career. That said, RN and BSN programs are still robust in terms of how many people are clamoring for admission, as are the many types of MSN and NP programs.

In essence, nursing is a “choose your own adventure” undertaking, with as yet many unknowns for each individual. Those unknowns may include the twists and turns of the economy; potential changes in healthcare reform and the Affordable Care Act (ACA) and the number of insured Americans; student loan program changes; as well as cost of living and other factors covered in the first half of this post.

Between cost of living, your family’s needs, potential salaries, and the lifestyle you prefer to lead, your choice of a nursing specialty and a place to put down roots is truly up to you. If you’re single or otherwise able to explore the country as a travel nurse, that could be one way of doing your research. Otherwise, networking, conversations, informational interviews, and deeper research is called for.

The possibilities are endless, nurses — do your due diligence and see what the roulette wheel of life and career hold in store for you.

Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is co-host of RNFMRadio.com, a wildly popular nursing podcast; he also hosts The Nurse Keith Show, his own podcast focused on career advice and inspiration for nurses.

A widely published nurse writer, Keith is the author of “Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century,” and has contributed chapters to a number of books related to the nursing profession. Keith has written for Nurse.com, Nurse.org, MultiViews News Service, LPNtoBSNOnline, StaffGarden, AusMed, American Sentinel University, the ANA blog, Working Nurse Magazine, and other online publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, online nurse personality, podcaster, holistic career coach, writer, and well-known successful nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

$949M: Possible Cost of Mass. Nurse Staffing Ratio Mandate

The debate around the proposed nurse staffing ratio mandate on the ballot in Massachusetts rages on, with new figures estimating it could cost up to $949M.

The total annual costs of a ballot question in Massachusetts that aims to limit the number of patients assigned to each nurse is estimated to cost between $676 million and $949 million, if put into action, according to a new state analysis. The Health Policy Commission, who released the numbers along with other findings on October 4th, also cautioned that it is likely a conservative estimate of the possible cost.

Stuart Altman, Health Policy Commission Chairman, told reporters that passing the initiative could “force a lot of other changes” to health care in Massachusetts in relation to associated costs and the way hospitals choose to respond to the mandate, if it passes.

The Health Policy Commission’s study found that an additional 2,286 to 3,101 full-time nurses would need to be hired to meet the proposed staffing mandates, and that the greatest need would be at community hospitals and for night shifts.

It was also noted by the Health Policy Commission implementing the staffing ratios could save an estimated $34 million to $47 million as a result of shorter hospital stays and fewer adverse events associated with the hiring of a greater number of RNs.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Physicians Say Mandatory Nurse Staffing Ratios Will Hinder ED Care

In an op-ed published last week, three emergency medicine physicians strongly opposed a proposed ballot initiative to mandate nurse-to-patient ratios.

There is a battle brewing in Massachusetts over nurse-to-patient staffing ratios, which will be decided at the ballot box this November. Question 1, also known as the Nurse-Patient Assignment Limits Initiative, was proposed by the Massachusetts Nurses Association, and is part of a larger fight nurses nationwide have been waging for years in an effort to secure safer staffing ratios. However, an op-ed written by three emergency medicine physicians and published last week in SouthCoast Today, says the mandated nurse staffing ratios could hinder quality of care and patient safety efforts.

The physicians—Jennifer Pope, MD, Chair of the Emergency Department at St. Luke’s Hospital, Brian Tsang, MD, Chair of the Emergency Departments at Charlton Memorial Hospital and Tobey Hospital, and Matt Bivens, MD, EMS Medical Director of Southcoast Health hospitals—called the state’s ballot initiative for mandated nurse staffing ratios “a disaster-in-waiting for Massachusetts, especially for emergency departments,” in their op-ed.

“Question One on the November ballot to mandate a government-set nursing-patient ratio invites us to discard what already works, and instead adopt the California model — in fact, a far more extreme version of that model, because of the aggressive proposed timeline. What would happen in the emergency departments?” the op-ed asks.

The physicians postulate what would come next—hospitals will let go of support staff, patients will be rushed in and out of the hospital more aggressively, emergency department waiting room times will soar.

The physicians said, in conclusion, “We worry this will cost jobs of ancillary staff, burden nurses with more low-skilled work, block patients in waiting rooms, rush patients out of the hospitals early, and break systems across the state that are already known for high-quality patient safety and care. We will vote no on Question One.”

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.