Providence RMC is a horribly run hospital and always has been.

It's heartbreaking, the solutions proposed by the city & county seem very reasonable. Yet here we are, with Covid, flu, and RSV cases surging just ahead of another holiday season with mass family indoor gatherings and a healthcare system that's collapsing.

I particularly liked the one point from the memo:

>Start at the top when savings need to be made, such as eliminating pay raises for high-level leadership in order to shift the focus toward competitive wages and benefits for nurses.

We are seeing this play out right now in the job market. Execs and CEOs get to demand that they won't work unless the pay, perks, and bonuses are high enough for their tastes.

Yet those same execs and CEO's seem confused when the labor side demands higher wages or they won't work unless the pay, perks, and benefits are high enough to survive on.

Sorry capitalists, you can't fuckin' have it both ways.

Sadly hospitals nationwide have been understaffed for decades. Nurses, CNA’s,Techs etc all could use a 50% pay raise!!

Nursing and NAC pay has actually grown pretty well over the last 10 years because of demand.

I know NACs in my facility make over $20/hour.

I'm paid fairly well, and giving me a 50% raise isn't going to fix the problem: we aren't, and haven't been, licensing enough nee nurses for decades.

Washington is looking at a stepped internship program, but they still need to lay it out and get the bodies in line to get it going.

Looking at executive pay at the provider level, and administration pay at the university level is one part, and then increase pay for nursing teachers so we can increase student capacity.

The work is always going to have an attrition rate, and often times bedside is a gateway to other areas of nursing.

When I advocate for people to consider nursing, that is the real seller: an RN license has damn near infinite applications, and they are all short.

Even $30/hour is not enough when WA minimum salary is $65k in 2023.

Washington State minimum wage for 2023 is $15.74/hour × 40 hours/week x 52 weeks/year = 32,739.20/year.

Now, I will argue that $20/hour isn't going to be a good pull for NACs when Walmart or McDonald's are offering the same.

But I have no idea from which orifice your number was produced.

https://www.lni.wa.gov/forms-publications/F700-207-000.pdf

Working in a hospital, especially patient facing role, is not comparable to a retail or fast food or hospitality job that one can do in their spare time during the week.

I assume the people we want as nurses and NAC are more career minded, not to mention the higher stress working environments and odd hours, nights, weekends, and holidays. So presumably, those people are weighing their options at finding a nice salaried job for $65k, or working in a hospital for $20 to $30 per hour.

And if we are not going to pay them more than a standard salaried office 8 to 5 Mon to Fri job, then watch all the better workers go do that.

That is the minimum salary threshold for employees to be exempt from overtime pay.

If you take a job that pays the exempt salary, you can damn well guarantee you will be working overtime. Positions like that have shit like 6 day requirements or 50 hour requirements.

If you are not overtime exempt, the actual minimum salary is minimum wage × 40 hours per week, and all time over 40 hours is paid as overtime.

So, for nurses, this is a DNS/DON type salary where they are on-call 24/7 for their job.

Though, smart nurses set up their contract that they get an hourly rate for covering thr floor.

> If you take a job that pays the exempt salary, you can damn well guarantee you will be working overtime. Positions like that have shit like 6 day requirements or 50 hour requirements.

Not in my experience. Lots of white collar office or government type jobs do not require more than 40 hours per week. Hell, if you count the time people spend on Reddit, they are probably 30 hour per week jobs.

Either way the lack of people jumping up and down to become nurses or nursing assistants is all the proof that whatever the pay is or was is not enough comparable to that of other options in the market.

Bah I wish is was that much. Not even close.

I would question how many of the jobs your mention here are the minimum exempt salary versus just being above the minimum salary.

"In my experience" people receiving salary are usually management or administration. Retail managers, HR, administrators, assistant administrators, etc.

These would be the majority of the workers covered by this, a lot closer to blue collar with a white clip.

It is interesting who always gets asked to make sacrifices, when times are tough... and when times are not tough. After all our beneficent overlords' record profits require record sacrifices from the lowly serfs.

Wow $20 whole dollars per hour!? Does that come with a top hat and monocle or do they have to provide their own?

That's not enough for Everett, but that's pretty good in rural areas. You can't really judge salary if there's not context of where you are. It's like teacher and cop salaries are pretty good in Seattle but Texas is a whole other world.

It really depends. Usually there are busy times and slack times. In tech, if you're only doing 30, that just means you're a slacker.

When the state changed what are exempt roles, some of my dad's colleagues became hourly and made absolute bank in overtime. Overtime is how cops make so much money (some over $300k)

Nurse: I want 25$ an hour or I quit

Hospital: Best I can do is 20$

Nurse: puts on hat I'm a traveling nurse

Hospital: We can pay you 150$ an hour

> That's not enough for Everett, but that's pretty good in rural areas.

That is awful anywhere in the nation. Any person doing any job in any area whatsoever.

Did they also go to a (nursing) school in a cheaper, rural area?

I have mixed feelings about the travelers. I have family that works in the medical field and I am constantly told how muc more they make above the regular staff. Not only that, paying them so much more is draining the budgets of hospital departments. At some point the hospitals will need to end the use of travelers or, at least, cut down on the amount of time they are used. It simply isn't sustainable to employee such people at high rates.

I have friends who work in the ED at PRMC and it is grim right now… don’t get me wrong it’s bad at almost ever ED but Prov especially is struggling. Their administrators brilliant idea to respond to this event? Make floor nurses cover 7-8 patients instead of 4-5. They are not doing anything to retain their current staff and are having problems getting new staff. I attended a nursing school that was basically a direct pipeline to work at PRMC but after spending all their clinicals at that hospital is it any surprise that the nursing students are now looking at other hospitals in the area for their first job? I know I did. Most of the other hospitals pay better too…

> Not only that, paying them so much more is draining the budgets of hospital departments.

I agree, it's not ideal. But it's a very not ideal situation that the hospitals are 100% responsible for. I would be fine with ending travel nursing if they also ended stupidly low pay caps. But I don't know why there are any nurses who aren't travel nurses at this point. Those are the ones being rewarded by the hospitals.

> make over $20/hour.

Well since the minimum wage is over 19 in parts of the state, 20 or so is pretty sad.

There are those staff members who have family and therefore cannot travel. You can't do that if you have kids and a partner who also works.

Every single hospital system in the area uses travel RNs, and I myself do local travel. If we’re going to be understaffed and overworked wherever we go (and still in a pandemic), I’m not going to pick a job that’s $39 vs $69/hour

Which is your right. And, yes, I am well aware of the use of travelers. That doesn't change the financial impact on the medical in system. It still isn't sustainable.

NACs don't go to nursing school.

I agree that it’s not sustainable at all, and until hospital admins start paying their regular staff more, there’s just going to be more travel positions everywhere. Unfortunately most of their heads are up their own asses and they continue to give themselves bonuses while refusing to increase wages. At my last job we got a 4% raise in 2 years (when inflation in one year was 8%) and 2% of the raise was from our union bargaining :(

You can't clue in the clueless.

Oh I agree with you about the management issues. More often than not management, especially middle management, is oblivious to anything that is not staring them directly in the face (and even then that's not always the case).

$3200/month when you can get an apartment for $1100/month is right about on par.

And overtime exempt salary positions is how you bilk the same people out of tons of overtime pay.

At a minimum wage of $15.74/hour a person would have to work over 26 hours a week in overtime to meet the exempt rate.

Yeah OK, I should have put another question mark.

The point still stands, I think, at least sometimes.

I'm not sure on specifics, so maybe I'm wrong and it doesn't stand! I can admit that I'm wrong, if so. :)

Fact on facts

Private hospitals like Providence will never “do the right thing” on their own. They need to be regulated far more aggressively.

I don't care, I just like you.

Yeah. School for these positions is pretty cheap. At least I know my self-described trailer trash ex's mom went into nursing on the cheap without leaving that cheap town.

Interesting, thanks.

I was asking a real question. I kind of guess that there were cheaper, more local options, but wasn't sure.

Ya travelers often aren’t ready to work from day 1 need an orientation period at no fault of their own, they are just new to a job. It is frustrating when the person needing to be trained makes 3x the trainer and more than the provider writing the orders tho. Gets old fast for the permanent staff who either can’t travel (life, kids, house, etc) or like their job. Traveling needs to end as it drains the budgets and perpetuates…. More traveling and lower and lower morale at work.

I know some health care workers who quit the industry because of harassment over asking patients to wear a mask during peak Covid. I don't know if that contributed a lot to being understaffed overall, but it's stupid that patients and visitors did not want to comply to a very simple request and instead verbally and physically harassed workers.

Exactly. This is what my family members have told me.

This may seem odd give the unfortunate circumstances here. Tort reform.

Having worked as an er nurse I know that through-put is complicated. Some things you have to consider are obvious:

1. Not enough staff: nurses, doctors, techs, radiology support.

2. No inpatient beds: the doctor has ordered the patient be admitted for treatment, though the hospital has no beds available—possibly physically occupied or no staff to work them.

3. Shotgun workups: due to no tort reforms (the doc doesn’t want to get sued for missing something). So the provider may feel more inclined to order likely unnecessary and burdensome labs, imaging, and other tests (all the tests have so many compounding time wasting variables, think about backlog for imaging, labs, transporters, staff to carry out lab draws, etc). Yes! The provider shouldn’t act with negligence and should know their stuff! But the fact medical malpractice insurance costs a fortune, and they have to protect themselves and their livelihood. Tort reform would help ease the fear of lawsuits.

4. No primary care: patients that don’t need life saving treatment visit the ER for seasonal cough and cold, stomach aches, etc. The law (EMTALA) requires the ER sees the patient and provides care.

5. Psych patients and drugs: no treatment facilities, patients backlog in the ER and don’t receive any treatment that will ultimately help them get well while they wait hours to days (sometimes sedated or strapped down) for the right treatment.

Side rant on this one: you think safe injection sites enable? This is where they help! They pass out clean needles (preventing infection and abscesses that result in er visits for treatment and usually discharge). Added benefit for having connection to social services and getting patients the right care (maybe not every patient, or the first time, but some do end up seeking treatment).

I’m probably missing something. But I feel a big one is tort reform. If providers didn’t feel obligated to order every test under the sun to avoid a lawsuit they wouldn’t.

Not providence but I was at a different ER in the area today and it was terrifying how obviously understaffed they were and how burnt out the staff that was there was. Everything was in disarray, waited hours, they missed absolutely critical medical information that I told to three different people, etc etc. Our healthcare system is truly fucked and it’s pretty scary to see it up close when you need help. We have got to do something.

Since Providence is clearly overwhelmed, how can the region divert some of this patient load to other hospitals?

I know location and insurance are important factors in choosing where to go for ER care, but it doesn't make sense if Providence is consistently overwhelmed for such large numbers of patients to keep going there.

One issue is Prov Everett is a level 2 trauma center and there aren’t a ton around (two other closest are Bellingham and Tacoma and they’re also pretty swamped). Only level 1 trauma center is Harborview which is the only one in WA ID AK and MT so it’s swamped. Lesser injuries could be seen at other hospitals but almost every hospital is swamped. Why are they swamped? Higher acuity patients (not reallyfixable unless we completely revamp our primary care system and make it more accessible so it can be more focused on preventative healthcare) and short staffing. Everywhere is short staffed because nurses are being underpaid, treated poorly and leaving bedside. Quickest fix would be to pay nurses more and enact safe staffing laws so they feel more supported. Longer term fix is to expand nursing school spots but that would require more educators, paying them more, and making sure there are enough nurses in the hospital to train the students. It’s honestly a mess and I don’t have good solutions. My hope is that we will eventually completely revamp our for profit healthcare system and go towards universal healthcare.

Not long ago St. Michaels on Kitsap had their ED charge nurse call in the local EMTs to help staff their department they were so overwhelmed. It’s a mess out there.

So, I asked an acquaintance of mine who worked as a hospital admin why they keep getting travelers instead of paying core staff more and their response was that after considering all the benefits they have to pay for their core staff, travelers are actually cheaper (short term). I don’t know how true this is or if I was getting smoke blown up my @ss, but that was what I was told. Issue is, travelers aren’t really temporary anymore, they seem like they’re here to stay unless they can actually keep core staff, which they won’t be able to unless they pay them more.

I find that very suspect, but admittedly I don't know. Also, each hospital may be different in terms of where they stand with a budget. As far as travelers being more than just temporary I would also doubt that from what I have been told. Again, this could be a hospital by hospital basis.

Yeah, it probably def depends on the individual hospital or system. I am also suspect. The ED I used to work at brought in a ton of travelers during COVID, supposed to be temporary to “get us through” but now, according to my friends who are still there, they’re still hiring majority travelers. An inpatient floor I was recently at at Prov had maybe 50% travelers for day shift and nights was 90% travelers. Though supposedly they are trying to get rid of travelers, which should be interesting considering they’re hemorrhaging core staff right now. Not sure who will be left to care for patients.

And this is my concern as well. If a hospital can't afford with regular staff and/or travelers then what will it do?

That’s the million dollar question.

I mean, I’d happily volunteer to teach an overpaid administrator how to insert a foley cath, hang IV meds, calm down a pt in the middle of a mental health crisis, etc. if they think it’s such an easy job. Hell, I’d PAY to teach them how to care for a pt with a leaky rectal tube.

Yeah, I wouldn't get your hopes up on that! 😂

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I have a friend who is about to quit at a local Seattle hospital. He barely makes enough. It’s absolutely sad the amount of training he had to do and schooling just to be severely underpaid.

But city council will never have authority to do anything. They shouldn't have even sent the "disappointment" letter at all. Has nothing to do with them. Heartbreaking to have happened but headline is stupid.

I hear you all. I understand all of you. But I'm a mom who needs 24 hour care at home for her daughter. We've been doing this for 37 years, and each year the availability of nurses gets thinner. Yes, the pay isn't quite Hospital pay but it's a break. It's a supplement if you need a bit of extra money. Please consider picking up one or two shifts a month in home health care. And you'll love your patients.

I also kno a nurse that quit cause of the changes in the industry after covid

Right it’s crazy, cause hospital bills are crazy high, I was in providence for less than a week broke my leg had surgery and my bill was over 500,000$

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What I've seen posted in r/nursing and other Healthcare subs has echoed staffing problems nationwide. Doesn't really seem to bode well without some major business decision shifts.

I know several that quit over mandates. I thinks that's a majority of it along with exhaustion from dealing with covid.

Older workers retired in droves when the pandemic hit. They were the most at risk to the virus and didn't want to risk their health working in the industry. Now there's a shortage.

Yeah, here in chehalis, the ER is a joke. You can come in on the verge of death, and look forward to AT LEAST a 5 hour wait in the lobby. Plus most of the staff are rude for seemingly no reason at all. Worst hospital I've ever been to.

Regulated by who tho? The state run hospitals are just as awful

Take the vaccine or get fired. And now they are disappointed that the hospitals are under staffed. The government made the problem.

Federal mandate for a 1-to-4 nurse-to-patient ratio. https://www.trustednursestaffing.com/nurse-patient-ratios-by-state/#nurse-patient-ratios-by-state-1

True, but what they can do is bring media attention to the issue. Next step is to direct that media attention towards a useful solution (like a federal mandate for 1:4 nurse:patient ratios).

FFS. They had the fucking answer and they fucking tabled and killed it in the fucking state senate.

Two things will draw in nurses and make WA a nursing Mecca.

1. Pass HB1868 and the nurses will simply materialize. There is no nursing shortage, especially here, with all of the many nursing schools churning out grads each year.

What there is, is a shortage of nurses willing to work bedside. New grads who nope right out fairly quickly thinking they made a mistake. Vets going on hiatus or traveling. Retiring early. Taking that desk job. Working in insurance. Etc.

2. Zero LEGAL tolerance for violence or sexually inappropriate behavior toward health care workers. Hospitals will never do this. Never. It might upset patients and family. Also, the current state of pressing charges means your home address will be on the report. The aggressor gets a copy. Encourages everyone to press charges, amiright? (I’m not talking about TBIs and Alzheimer’s, I’m talking patients and family who are of sound mind but choose to be assholes).

You politically savvy folks could get some ballot measures going that could fix this shit right up. Clearly our present lawmakers aren’t doing shit. Maybe playing cards with the clueless senator who thinks that is what we do all day.

Mandate ratios. The state doesn’t run the hospital. They pass a regulation that says nurses can’t have more than x patients, now go figure out how to do that.

Travelers get health insurance. 401k is payed by the agency.

The other issue is many contracts pay less than staff so there’s no reason to go. Especially out here. Stipends for Seattle Metro / west side if the sound do NOT cover rentals and the taxed pay isn’t worth it.

They are rude because they are overworked and traumatized from working in a system that values money over patients. They see multiple deaths a week. People that see their children die in front of them and instead of grieving have to worry about how this will bankrupt them. Violent patients that abuse them day in and day out. How would that affect you and how you treat people?

I’m not saying it’s ok, I’m saying there are reasons why ER nursing staff are emotionally burnt out.

Part of the issue is working conditions. Violence. Hospitals really should do weapons screenings at the door. Few if any want to. It will take a state mandate.

Ratios. Oregon is golden. California is golden. Washington is flailing.

The language needs to be stated correctly. There isn’t a nursing shortage. There’s a shortage of nurses willing to work bedside.

Sure, OR takes 9-10% in state income tax. But I’ll happily pay it on those contracts for the better, safer working conditions.

Np, I found this link. I was thinking of the associate's degree version. The different levels of education might cloud the picture here. I think the person I was talking about went to community college for it because the neighboring town had one. https://simplenursing.com/nursing-school-cost/

Out of curiosity, I looked up housing costs. A home there has increased a lot lately - I'm betting because they started catering to retirees. But a good sized house is about $500k now, on redfin, which is anywhere from $800-1200k in the greater Seattle area. Rough estimate.

I would quit the morning after they gave me 7-8. I can travel to OR and do 5. Or do a Midwest PCU I like, that likes me back, with 4.

7-8 isn’t safe.

That’s nuts. What do you even do about that?

But this is all on admin. Pay your staff well, boom-no need for travelers. Admin is promoting staff cannibalizing travelers. Keeps the poo off of them. Keep the serfs infighting, give themselves another raise.

For any job you had to get training for that's a pretty pathetic wage. Don't care where it is in the country.

In my post history is my life story. I've been through hell for 30 years of my life. I'm not a prick to anyone. I don't disrespect people or judge them off talking to them for 2 minutes. I agree, that medical care is all about money over health and wellness. That doesn't give anyone the right to take it out on me though.

Oh mannnn that would be great. I saw that in Cali and thought it was great

There is a huge difference between regulation and state-operation.

Mid 20s with no insurance... honestly it is nuts, I felt so ripped off, I don’t kno what to do about it...

Declare bankruptcy?

I get it, I hope things get better for you.

It’s cheaper than raising wages permanently for all staff. They will do anything to continue screwing healthcare workers over. The joke is on them too though. They have fucked us all into a corner and we will never hire enough non contract staff to sustain the workload.

St Michaels in Silverdale has had nurses call 911 twice now due to short staffing in the ED. The fire chief arranged his workers to help them. They are no holding a no confidence vote demanding administration step down. My long term care facility is bordering on neglect constantly. While administration blames everyone but themselves.

Thanks.