Robert Bowman’s Post

The solution may need to be drastic. We need to reward 1. Hours in a week 2. Years of experience in nursing 3. Years in the same place and unit with the same patients Direct payment from some nursing controlled entity at the state level would be needed Nurses would be free to go to any hospital that supports them Nurses would be free to depart hospitals that do not support them Adequate notice would need to be supplied by nurses or hospitals for the end of employment Employers not supportive suffer Patients are moved to hospitals that have supportive employers that can get and keep nurses In areas such as primary care - all of the trainees need to be signed up MD DO NP and PA and a central entity would review and approve their environment and work contracts. Hours, experience, and continuity in specialty, practice, patients, and team members would be rewarded. You cannot trust any design to do this - fee for service, value based, etc. SHOW ME THE MONEY and the environment and conditions - TRANSPARENCY and accountability We desperately need more and better delivery team members across health care. This is best for efficient and effective practice with everyone working to their fullest capacity. We have to stop the abuses and reverse the move to toxic health care delivery environments. Everything about the way we finance hospitals and basic health access is wrong for delivery team members. DRG to value based designs are all about cost cutting designs. We are competent in this. Designers are not. This started in the 1980s when big health draining the treasury got out of control - and the managed care, micromanagement, and cost cutting designers took over control. We can have designers that are competent in health care or at least listen. This is not the case. And were 500 hospitals have been closed - the voices of those most abused have effectively been silenced. In their positions as hospital administrators, nurses, social workers, pharmacists or others delivering care, they also were locally focused health care leadership. The closures of their hospitals by the hundreds and even greater practice compromises have resulted in a worsening of awareness of the declining situations for health care across most of the US population. For nearly 40 years those such as myself have been leading locally and protesting at a number of levels - and we lost the practices, people, patients, and communities where we belonged. This is an accelerating cycle of decline across awareness, information, health access, and local organization for health care. Leaders must avoid designing an accelerating cycle of decline - but they continue to do so in health care, education, housing, government jobs, and social supports.