Replacing RNs With LVNs

Replacing RNs With LVNs

The shortsighted way for hospitals to save money

By Christine Contillo, RN, BSN
to Save

When the economy took a turn for the worse, I did what most of my colleagues continue to do, which was look for the most painless ways to save money. Small actions add up, such as bringing a container of coffee with me instead of spending a few dollars at Starbucks (coffee is never enough, I always need a Danish to go with it), or reading the sale flyer before entering the grocery store and planning my weekly meals accordingly. It’s no surprise that hospital management is doing the very same thing. After all, hospitals are big business and looking to cut all the corners they can. Soon enough I found that all overtime was canceled by my employer, even though it takes us the same amount of time to get our work done and we’re still working through our lunch period.

All supply requests are now being scrutinized carefully. Thus, even though the scissors disappeared off my desk while I was off, they had only been purchased this year and another would be on my dime. Professional memberships became our own responsibility and educational day spending reduced.

What surprised me though was a small headline I saw in a local paper. It announced that one city hospital would be filling vacant RN positions with LVNs. I wasn’t surprised that hospitals would undertake this as a cost-saving measure; I was surprised by how shortsighted management could be in the current healthcare world. Clearly hospital officials are not looking at the same evidence-based research that I’ve been reading.

In their own report JCAHO reveals that there are “positive impacts on quality cost and health outcomes when staffing levels are compromised.” In other words, fewer nurses have a direct impact on patient care.

LVNs generally have a 12- to 18-month training period that emphasizes technical skills. RNs, on the other hand, study two to four years with an educational curriculum that includes critical thinking. Both types of nursing are vital for good patient outcomes, but even quality technical skills can only be stretched so far without insight into their use.

In a review of evidence-based studies, the Agency for Healthcare Research and Quality, an agency within the U.S. Department of Health and Human Services, found significant association between the lower level of nurse staffing and adverse outcome events, including higher rates of pneumonia, upper GI bleeds, shock/cardiac arrest, UTIs and failure to rescue. While replacing RNs with LVNs may save hospital costs, those costs will be borne by the patient and shown by an increase of poor outcomes, something that none of us want.

Hospital administrators can fail to look beyond their bottom line. If your facility will be taking a close look at expenses, form a nursing committee and lobby to have your efforts and recommendations included. Help your management find a way to contain costs while preserving positions and maintaining patient care. Don’t sit back and assume that your job is safe, don’t lose benefits that you’ve enjoyed, and don’t allow yourself to be forced into unhealthy working conditions. Just as you worry about saving money at home, help your employer weather tough economic times.

For more information about the AHRQ report, go to their website and search for “nurse staffing.” Additional research reports are available on a variety of patient care issues.   

Agency for Healthcare Research and Quality

Christine Contillo, RN, BSN, has worked as a nurse since 1979 and has written extensively for various nursing publications, as well as The New York Times.

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