As nurses we are all feeling the ever tightening belt of fiscal allotment in the budgets for staffing our units, whatever they may be. The acute and long term care sectors, the home health care sectors, the government health care sectors...every one of us has a small bite out of tails in this area. Some moreso than others. I feel fortunate that I am working in a non-profit hospital, the almighty dollar is present, but there still is some tempering of it because of the nature of the beast. but it is there, and over the years it has come more to the forefront. I really am not sure if it is because the non profit area has become more business astute, and has been changing systems to accomodate the financial fray in which it is involved...actually probably more like survive in the fray, or if it because the old guard had retired and the new guard had taken over.

  I work in a corporation that has multiple facilities, and I would imagine it has become quite a juggernaut. Reversal of direction is not a small effort, so I would think that raising awareness of financial responsibility makes us all more conscious of our day to day actions and their effects on the bottom line. Nurses don't really like that sort of thing. If we did, perhaps we would have chosen another profession. We are all conscious of the fact that the care we deliver is expensive, and we do make efforts to minimize that when we can. But we also strive to deliver the very best care we can in the environment we are in. And I think this is an across the board statement.

  Are we part of the problem? Some say we make too much money, that we are lazy and want to do as little as possible for our money. That, my friends, is a bunch of crap. Granted, my salary must be figured in to the mix when budgeting and planning, so it is a factor.  We still pay the certified car mechanic more to fix our cars than we do those who stay at the bedside and save our lives. We pay the timber worker more, the steel worker more, the computer geek more( no offense intended),the construction worker and pipe fitter more. There are the priorities of this society, in things not people. And they say that we are greedy and materialistic. Some rapper gets paid astronomically for whatever it is that they do, but that is okay. Just don't raise those salaries much of the nurses. Okay, maybe that was a bit extreme, but there was a point to be made.

  Money rules the staffing. There are multiple models and systems all trying to achieve the purpose of adequacy in staffing. But they don't live and breathe like the flow of a nursing unit. They can't stretch minute to minute to accomadate turnover. They don't take into account radical jumps in patient needs over the period of just a few minutes. We all work within inflexible walls and strive to make them stretchy and pliable. We must look at the systems we use, scrap them for new ones if they don't work. Keep trying to solve the problem.