Was Kentucky Spared from CHI Layoffs?

Is there still a nursing shortage in Kentucky?

Earlier this year, and following a disappointing report for the first quarter of FY 2015, Catholic Health Initiatives announced that it would cut 1500 jobs nationally by the end of January.  The positions targeted were administrative and support staff representing some 1.7% of CHI’s total 90,500-person workforce.  KentuckyOne Health (CHI’s operation in the Commonwealth) had already absorbed an previous layoff of 500 employees one year ago but remains the weakest sister financially among CHI’s regions.  Locally, concerns were shared that we might take another hit this round. Has that happened?

To be fair, CHI is not the only big system to be laying off people.  A nationwide shift from inpatient to outpatient services has even the prestigious Cleveland and Mayo clinics trimming their staffs.  Frankly, I have not heard much of anything about layoffs in Kentucky– at least in the Louisville market. Even a usually productive Google search did not reveal much for me.  The most notable activity is in Omaha where CHI’s hospital and clinical system have no current network contract with Blue Cross/Blue Shield.  The drop in patient volume there is said to have sparked layoffs of at least 156 people including physicians! Additional job cuts were anticipated through attrition and by not filling open positions.  There have been layoffs reported in Oregon too. Otherwise things seem to be quiet. Is that what happens when administrative jobs get cut?

In fact, in the usual on-line places, KentuckyOne is advertising to fill quite a few clinical positions in Louisville. I am informed that some modest hiring of clinical-support people is also occurring. I do not know what is happening in the rest of the state.  Good! Lets face it– you can’t run a hospital or medical office without doctors, nurses, and technicians.  If you terminate too many of these, people tend to notice, including accreditors and regulators.  I asked KentuckyOne how much and in what way Kentucky might have shared in CHI’s nationwide job-reduction program but did not receive a reply.

Are there nurse shortages at University Hospital?
Additionally, and what stimulated me to look into the matter, is an attempt by KentuckyOne to get more clinical hours out of existing nurse-employees at its downtown Louisville hospitals. Efficiency is good, but as reported by Laura Ungar last January, the American Nurses Association believes there is a limit to how long nurses can work before provider-fatigue presents a danger to patients.  This is the same issue that led medical residency accreditors to limit the number of hours interns and residents can work.  The nursing association now has a new research-based policy recommending that nursing shifts be limited to 12 hours per shift, a total of 40 hours per week or fewer, and elimination of mandatory overtime.

Some medical residency programs have been unhappy with the restriction on resident hours, and KentuckyOne can’t be happy about being asked to restrict nursing hours right now either. In fact, at least at University Hospital, KentuckyOne is actively soliciting its nurses to sign contracts that offer a financial bonus in exchange for a willingness to work a minimum of 48 hours and up to at least 60 hours per week.  I do not pretend that staffing hospitals 24/365 is an easy task, but it can hardly be said that KentuckyOne “discourages” its nurses from working up to 60 hours per week as was reported.  Hospitals have long hired outside contract nurses to deal with short-term staffing contingencies.  KentuckyOne seems to be reaching into its own nursing staff as an alternative to outside hiring.  The incentive program is to run from Feb 15 to April 11.  I have no information if the incentive program is planned for renewal, or if this apparent local nursing workforce shortage is related in any way to CHI’s national job-reduction initiative.

Is there a really shortage of healthcare professionals?
Teaching-hospitals and medical schools increasingly claim a physician shortage but they have a vested interest in doing so.  In my view and that of the National Academy of Science, the problem is one of maldistribution of physicians by both specialty and geography.  In that regard, what happened to the nursing shortage we heard so much about 15 years ago?  There are many more rewarding roles for nurses today with expanding clinical and administrative responsibility. The hospital-based “diploma” schools that trained so many of my high school friends seem to be going the way of the Dodo bird even though they produced an outstanding product. College and university-based programs have taken over.  One thing is for sure. Nurses provide the professional backbone of hospitals and probably do so for most of the rest of our healthcare system.  There is no question in my mind that nurses will increasingly take on responsibilities that physicians have assumed in the past.  The future will be all about teams with different kinds of knowledge and training. We need to take good care of our nurses because they take care of us!

If I have made an error of fact [I doubt it], please help me fix it.  If you can tell us how KentuckyOne employees have weathered this latest round of job cuts, please do so– the KentuckyOne system looks after of a lot of our neighbors, both nurses and non-nurses alike!  Is there a local shortage of nurses?  Comment publically or privately as instructed in the comments box below. Sign up in the sidebar if you want to be automatically informed of new articles.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
March 17, 2015