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Nurses as Housekeepers at Vanderbilt Medical Center: An Untold Story Behind the Story


by Rosemary Gibson, Senior Advisor, The Hastings Center and Author, Battle Over Health Care: What Obama’s Reform Means for America’s Future

Hospital budget cuts became viscerally visible earlier this month when Vanderbilt Medical Center announced that nurses must now perform housekeeping duties — cleaning patients’ rooms and bathrooms.

In case you missed the video of the internal announcement secretly recorded by a nurse that aired on  Nashville’s WSMV television station, here it is.

http://www.wsmv.com/story/23364976/vanderbilt-medical-center-to-have-nurses-cleaning-up?autoStart=true&topVideoCatNo=default&clipId=9280584

It is hard to think of a worse way to demoralize professionals who want to practice at the top of their license.  Invoking Florence Nightingale’s name as a spoonful of sugar to help the budget medicine go down is no salve for deep wounds of disrespect.

For patients, they are at greater risk, an inevitable outcome as nurses spend less time at the bedside.

All of this begs the question, “Where does all the money go in hospitals, who is getting it, and what are they really doing with it?”

The direction of the budget axe is being determined by an unspoken battle between labor and capital.

Nurses, pharmacists, housekeepers and increasingly, doctors, are employed labor.

Medical equipment and supplies, medical devices, drugs, computers and information technology are the products of capital investment.  Companies that manufacture these products need constantly increasing revenue to keep stock prices and earnings per share headed north.  Stockholders and other investors – their unforgiving owners – demand bigger, better, quicker returns.

Consequently, companies are programmed to take more money for themselves, which leaves less for everyone else, especially nurses.  I wrote about the uncanny parallels between the health care industry and the banking sector in Battle Over Health Care: What Obama’s Reform Means for America’s Future.  Both have price bubbles, toxic assets, too-big-to-fail syndrome, and privatized gains and socialized losses.

Implicit tradeoffs between labor and capital are made every day.

Companies have to create a stream of so-called new, innovative products every year to pump up earnings per share.  As nurses know, new is not always better.  It might be worse.  A steady torrent of new stuff: equipment, technology and a bevy of consultants causes money to trickle up.

Meanwhile, hospitals are not exactly shopping at the equivalent of Costco and getting a competitive price.  And they buy too much that ends up in landfills.  A hospital supply chain executive at a large public teaching hospital estimates that at least 10 percent of hospital purchases in inventory are expired.  Good for Wall Street investors.  Bad for people taking care of patients.

To correct the misallocation of the public’s money, transparency of billion-dollar hospital budgets would shed light on where all the money is really going.

In the meantime, we cannot let the material abundance of a few create a chasm of indifference to the plight of many.

21 Comments Post a comment
  1. I had to look up more information after reading this article. Vanderbilt states in the article post in the link below that the nurses turn over rooms that have high flow. Let’s not get our panties in a bunch quite yet. As a traveling nurse, I have worked in many hospitals. In high flow area’s, like PACU, the Emergency Dept, and Med/Surg holding units, the nurses do clean the rooms between patients. Sometimes a housekeeper cannot get there in time in between patients. In the article they also state that they are actually hiring more people for housekeeping. My point being, is that it is not uncommon to clean a room between patients by sanitizing equipment in between patients in a holding area, an ED room, or in the PACU. I think this story was perhaps blown out of proportion.

    http://news.vanderbilt.edu/perioperative-cleaning-processes/

    January 4, 2014
  2. Reblogged this on ofcourseitsaboutyou.

    January 2, 2014
  3. As a veteran nurse, how well I remember having to clean patients’ rooms while on a step down unit in a hospital in Chattanooga, TN on the 3-11 shift in the 1970′s. Not only that but we had no ward clerk and no CNA’s-we were the whole ball of wax. I had up to 10-15 patients to care for. How I hated having to do ward clerk duties squeezed in between all my patient care. Nurses do not need to be treated this way at all. If there is one thing I advocate, having worked in hospitals that did not have them, is a union to watch this type of stuff. Where I work now the CEO makes almost a million dollars-they just laid off the chaplain, some case management people who were needed desperately, and others, in a county with 17% unemployment rate. In the meantime the CEO has a membership at the local country club that is only $16,000 a year. He will retire with great benefits and a great severance package. The money in hospitals is going to people in Administration-not nurses or others who do the bulk of the work.

    October 14, 2013
  4. Kathy McCardell #

    I would like to comment on Vanderbilt and their housekeeping. I am a grandmother of a infant who was born and dies on May 17, 2013. My at risk daughter wasn’t moved over to labor and deliver because the “room wasn’t clean”.. She wasn’t placed on a monitor- while she waited to be moved over- for the room to be cleaned. When I arrived to meet my 4.5 lb dead granddaughter- I had to wait to hold her- for the room to be cleaned.. When I complained the next day, in all of my grief, I was told they contracted out housekeeping..

    October 6, 2013
  5. What needs to be done Rosemary? Can we discuss this in forum? https://www.facebook.com/groups/nurseup/518201154930572/ Can devote some “Social Media” air time to this :)

    October 1, 2013
  6. Rosemary Gibson #

    I will contact ANCC and say this event should trigger a review of Magnet status and post the reply.

    What do others think? What are you willing to do?

    September 30, 2013
  7. Rosemary, if what the news has reported is true, and at this point I trust it, there will be heavy pressure to revoke or at least put on “probation” their Magnet status.

    Question is how to get their attention to do a site visit. Does anyone know if they have a Twitter account? The ANCC? Have the makings of a social media campaign in mind.

    1. Contact the provider of their Magnet Status (The ANCC), in large numbers and obtain a “Position Statement” on their use of nursing staff for housekeeping duties as a cost saving measure.

    American Nurses Credentialing Center
    8515 Georgia Ave, Suite 400, Silver Spring, MD 20910‑3492
    1.800.284.2378
    http://www.nursecredentialing.org/Magnet

    Ask if that type of cost saving, and silencing nurses is consistent with the “spirit” of the Magnet program.

    2. Contact each of the other “Magnet” hospitals, and publicly request position statements on vanderbilt’s “cost saving ideas”

    3. Make all responses and requests public, enlist help of forum moderators, tweetchat moderators, bloggers to “discuss” the issue.

    4. While we are doing this, request from Vanderbilt public updates on their “policy” and implementation of it.

    End result, after the nursing, consumer backlash and public “shaming” Vandberbilt becomes a “Cautionary” tale for any other hospital with similar “bright” ideas.

    Thoughts? I’m on Twitter or Facebook to discuss. Will lend Social Media to this campaign if we get it off the ground :)

    https://twitter.com/search?q=%23NursesCleaningToilets&src=hash

    https://www.facebook.com/groups/nurseup/permalink/511253015625386/

    September 30, 2013
  8. rosemarygibson100 #

    As to Vanderbilt’s magnet status that Andrew rightly mentions, a first step might be a site visit to the medical center to get a first-hand assessment and let senior leadership know that professional nursing care matters. Nurses who work there will be heartened to know that someone cares about them and the patients. We should “first, do no harm” to them — at least no more harm than has already been done. If the medical center no longer meets Magnet critera, let the chips fall.

    September 30, 2013
  9. Does it bother anyone else, that Vandberbilt “Touts” that it is a “Magnet” hospital to recruit nurses?

    “If you are looking for a dynamic work environment where nurses are valued and encouraged to grow, you have come to the right place. As a Magnet designated organization, Vanderbilt University Medical Center is infused with a culture that brings out the best in our staff and offers the highest quality care for our patients and their families.”
    http://www.mc.vanderbilt.edu/root/vumc.php?site=vanderbilt-nursing

    Can we start making phone calls, filing complaints and get their “Status” revoked please?

    American Nurses Credentialing Center
    8515 Georgia Ave, Suite 400, Silver Spring, MD 20910‑3492
    1.800.284.2378
    http://www.nursecredentialing.org/Magnet

    I chose option #4, spoke to Barbara and was told they are all at their conference this week and next. Was directed to leave a message for Mr. Schiferoo.

    Please follow on Twitter, #NursesCleaningToilets, https://twitter.com/search?q=%23NursesCleaningToilets&src=hash

    September 30, 2013
  10. JeanR92237@aol.com #

    Gerry, you are absolutely right! I remember those days, too–and now, I think nurses embrace our role as pt. advocates more fully, and will vocalize our concerns individually through our professional nursing organizations and legislators. Nurses have many other settings to practice in where our knowledge and skills are respected. And, here are some other ways we can effectively protest this decision. Since the brilliant administrators at Vanderbilt apparently did not seek the input of TJC, CDC, CMS, or ACHA as to the predictable outcome and potential cost of this plan, I hope they establish a position on this issue, and possibly pay a visit to see how the plan is working out. And, let’s not forget our pts. and families. They are participating in their own care much more than in the past. They can watch what happens in the pt. room, and protest to administrators that they do not want nurses emptying trash and cleaning toilets! They can also get the AARP behind them. Maybe our collective actions will cause this plan to be abandoned in favor of something more rational. Jean Roberson

    September 27, 2013
  11. gerry shehan #

    As a professional nurse for almost thirty years, I must say I have seen it all ( or most of it all ). If memory serves me correctly, nurses rose up in mass protest at the same tactic tried in the 70′s and early 80′s. After all, we were just nurses; what were we going to do about it. Healthcare workers unions sprung up. Professional nursing organizations took to the media, and nurses in general just started saying “NO”. I predict history will repeat itself. Professional Nurses are nurses, not housekeepers. How can the major hospital corporations pay lip service to JCAHO and CMS when it comes to decreasing the incidents of HAI and iatrogenesis, yet require nurses to perform functions inherently fraught with those same aforementioned dangers. We’ll see how this latest farce plays out…

    September 27, 2013
  12. Danielle Stanich #

    Not to mention INFECTION CONTROL! Cleaning a room appropriately is critical in the ongoing and ever present fight against hospital acquired infections. Housekeepers should have specific training and education regarding the proper take down of a room. And the time to take it down effectively. HAIs cost our health care systems millions of dollars a year.

    September 25, 2013
  13. How bad do things have to get before Americans are roused enough
    to refuse to be led off this cultural and economic cliff to the collapse
    of our American Republic???

    September 25, 2013
  14. How short-sided & sad, in this time when the need for skilled & knowledgable nurses will continue to increase as Baby boomers–still the biggest demographic goup–grow older and more in need of these nurses (unless we start taking better care of ourselves).
    It is also an insult to Vanderbilt’s nurses. I thought Vanderbilt was a well respected university, but this decision changes that belief for me. This will take the nurses away from providing quality care.
    If this decision means that the University has laid off their housekeeping staff, they could have chosen to assign these duties to CNAs, (although I do not condone that either).
    However, this is not the first time hospitals have made this decision. I remember when, in the 80′s, hospitals changed to a primary nursing model and required nurses to perform some housekeeping duties. That didn’t work, either.
    I hope that Vanderbilt nurses can choose to work at other hospitals in the area–those that respect the knowledge & skill oflicensed nurses.
    Jean

    September 25, 2013
  15. This so needed to be said, and Rosemary is the person to say it! Bravo!!!!!

    September 24, 2013
  16. Rosemary, thank you for covering this story. I will be publicizing widely :)

    As a bedside nurse, it is highly disturbing that @VUMCHealth is looking to take nurses Away from the Bedside, away from patients where we are desperately needed to save money on janitorial staff & housekeeping.

    Kindly follow the conversations, voice your comments on hashtag #NursesCleaningToilets, http://tweetchat.com/room/Nur​sesCleaningToilets

    September 24, 2013
  17. Thank you Rosemary Gibson! Yes, we need to know where the money is going. Given the very high rate of death by medical error (440,000 / year), it is critical that bedside nurses, and the ancillary staff that support nurses, are not cut. Watch the 440,000 death rate increase rapidly. How many survivors are left disabled for life, unable to return to work?

    A housekeeper does not make as much as an RN. If there is not enough money to pay a housekeeper, there is not enough money to pay an RN to do housekeeping. Except, of course, they want the RN to do housekeeping and keep the patients safe at the same time and that is not doable.

    The person making the Florence Nightengale statement reveals a major problem; the people making the cuts obviously do not even have a clue to a modern day RN’s job. RN’s have more education and responsibility today than the physicians did in Florence’s time.

    September 24, 2013
  18. Josephine, it’s great to help undergrad nurses know the big picture context in which they will be working. If you have time, can you post their reaction? Thanks!

    September 24, 2013
  19. Excellent and timely post! Thanks for writing it. Will be using it as required ‘current event’ reading tomorrow in my undergrad nursing course.
    Josephine Ensign, Seattle

    September 24, 2013

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