Citing the same unprecedented financial pressures that have hurt medical centers across the country, University of Chicago Hospitals officials acknowledged Monday they are eliminating the jobs of 140 nurses’ aides.
The unexpected firings culminate a dramatic experiment undertaken by the University of Chicago–mirroring a move by thousands of other hospitals–to replace highly trained registered nurses with less costly, unlicensed assistants.
Hospital spokesman John Easton said there are no plans to hire more nurses to compensate for the fired aides. Patient care will be maintained by improved efficiency, he said.
But registered nurses and union officials fear the cutbacks will place a greater burden on existing nurses and compromise patient safety. The Tribune reported in a three-day series in September that harried and inadequately trained nurses kill and injure thousands of patients every year as hospitals sacrifice safety for an improved bottom line.
Hospitals have hired a record number of nurses’ aides–many without high school diplomas–as part of a cost-reduction strategy to provide improved care.
The announcement of the firings, effective Tuesday, underscore how the initiatives, in many cases, were veiled attempts to provide cheaper care, according to the American Nurses Association.
Easton said aides’ duties included monitoring patients, delivering meals and transporting patients. The job reductions will return fundamental, traditional nursing duties to those with the highest skills, he said.
But Philip John of Teamsters Union Local 743, which represents the majority of terminated aides, said he believes patient safety could be significantly diminished with the loss of jobs.
Aides performed essential, rudimentary tasks that allowed the hospital’s 900 registered nurses to spend more time with patients, he said. Aides provide a second pair of eyes and ears for nurses who increasingly find themselves overburdened with daily duties, he said.
“I believe nurses are going to have a difficult time,” he said. “I implored the hospital to find an alternative, but officials were determined to make the cuts.”
The move to pare away nurses’ aides at the 554-bed hospital comes at a time when many other financially strapped facilities report an increased reliance on aides or nurses employed through temporary agencies.
Nationally, hospitals are struggling to pay for staffing and to provide patient services as managed-care companies and the federal government squeeze reimbursement payments.
But teaching hospitals like the University of Chicago are hurt far more by cutbacks than their community hospital counterparts because academic health facilities’ expenses include the costs of training the nation’s future doctors and conducting cutting-edge research.
The Balanced Budget Act of 1997, for example, reduced by more than $60 million the amount of federal money University of Chicago Hospitals will get through 2002 from Medicare, the federal health insurance program for the elderly, according to hospital estimates.
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Throughout Chicago a decade ago, nearly every hospital was staffed exclusively by registered nurses. Today, registered nurses make up an average of 75 percent of the patient care staff.
At least a dozen Chicago-area hospitals have pushed aides–who earn an average $9 an hour–to perform duties beyond their training, state and federal health care records show.
At two Chicago hospitals in the last year, housekeeping staffs have donned nursing-style uniforms and were ordered to pass out medications on days when nurse staffing was leanest.
The American Hospital Association acknowledges that up to one-third of all hospitals are operating at a loss and that, in some cases, staff reductions have sunk to dangerous levels.
University of Chicago registered nurses said they fear that increased workloads caused by the absence of aides will heighten the potential for deadly medical errors.
“We don’t have enough nurses now to do the job,” said a University of Chicago nurse who asked not to be identified. “We’re one small mistake from killing somebody every day, yet the hospital wants nurses to be even more efficient, which is a euphemism to just be even quicker.”
Hospital administrators adamantly dispute nurses’ criticisms, but they were unable to document staffing trends.
A dozen nurses at the medical center have told the Tribune that university administrators have gradually been phasing in plans that require fewer nurses to care for more and sicker patients.
In the cancer treatment unit in 1994, for instance, registered nurses said they were responsible for no more than three patients. Beginning in 1995, nurses were required to care for at least five patients. The hospital compensated by hiring more nurses’ aides and employing nurses from temporary agencies.
The hospital paid one of the largest legal medical malpractice settlements in Chicago–nearly $7.9 million–involving a patient death linked to nursing error that occurred during the height of the staff transformation.
For four consecutive days from May 26, 1995, Vincent Gargano, 41, of Des Plaines, was accidentally administered massive overdoses of chemotherapy by three registered nurses. The error was discovered on the fifth day by a temporary agency nurse, but Gargano died on June 9.
Hospital officials said they have implemented numerous improvements to assure that doctors’ medication orders are properly cross-checked by nurses. Additionally, safety concerns involving a continued reliance on temporary agency nurses has been offset by enhanced training programs.
Registered nurses wonder how they will handle more work as 140 nurses’ aides are fired at the University of Chicago Hospitals.