NurseWeek: Change of heart

Change of heart
Traditional hospitals could lose nurses to luxury, specialty centers that pay healthier salaries

By Heather Stringer
January 22, 2001
Photo: Heart Hospital of Austin

Since opening in 1994, the Heart Hospital of Austin has become a leading cardiovascular care provider to the Greater Austin area. Nurses such as these see patients throughout their hospital visit.


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A new strain of hospitals is cropping up around the country, and at least two nurses who staff these facilities agree on one thing: They couldn’t go back to traditional hospitals.

These new facilities are for-profit ventures that specialize in specific, usually high-revenue, procedures. Some nurses say these "specialty hospitals" are a boon for RNs weary of the staffing shortages and bureaucratic mazes that can plague conventional hospitals. These new hospitals hire a minimal number of administrators to allow employees more of a say in policy decisions, and nurses are cross-trained to handle a wider variety of responsibilities.

Heart hospitals are the most popular manifestation of this new philosophy, but orthopedic versions are not far behind. Heart hospitals offer everything from bypass surgery to angioplasty to pacemaker procedures. Sometimes called luxury hospitals, these facilities are known for patient perks such as gourmet meals concocted by top chefs and rooms painted in snazzy colors – all for the same price of a procedure at a traditional hospital and covered by insurance. By offering only certain high revenue procedures, specialty hospitals can minimize overhead costs and pour profits back into patient comfort.

These hospitals may be attractive to patients and nurses, but opponents of the new trend argue that these luxury facilities are siphoning off the highest revenue procedures from public hospitals that need the money to pay for less lucrative programs, such as burn units or trauma centers.

Nurses in the specialty facilities contend that competition forces hospitals to offer better patient care. Heart hospitals are bucking the traditional systems with a model called patient-focused care. Patients stay in one room throughout their stay instead of waiting for beds to open as they move from one unit to another.

At The Heart Hospital in Rancho Mirage, Calif., each room is equipped for all stages: preop, recovery, ICU and telemetry.

(In December, The Heart Hospital was purchased by Eisenhower Medical Center and will be converted to a cancer center. According to the Chamber of Commerce in Rancho Mirage, the doctor who had founded The Heart Hospital was ready to retire.)

The one-room approach also cuts down on time spent in the hospital. The Heart Hospital, which is equipped with 12 beds, usually sends patients home in three days, compared to five to seven days in a conventional hospital, said Kathy Smith, RN, director of nursing at The Heart Hospital.

This system also is popular with nurses, who are cross-trained to offer care at different stages of recovery. Smith said this minimizes monotony. Nurses also see patients throughout the hospital visit, instead of losing contact when people move from the ICU to telemetry units.

"Nurses love working here because they see the patient the whole stay," Smith said. "It’s rewarding because you meet them and they know you because you see them from beginning to end."

Smith also is pleased with the higher salaries at The Heart Hospital. Nurses earn between $5 and $7 more per hour than their counterparts in traditional hospitals, Smith said. She also doesn’t miss the staffing shortages. In her previous job, she remembers the quality of patient care slipping as nurses without adequate training filled in on understaffed floors.

"I could never go back to that," said Smith, who has been a nurse for 12 years.

Although her hospital may be draining business from the nearby medical centers, Smith said she doesn’t feel guilty.

"There’s enough to go around, and ultimately the patient gets better care," she said. "It could make hospitals offer better care."

But conventional hospitals face stiff competition. The Heart Hospital hired a gourmet chef who visits patients individually to learn meal preferences. The staff aims to create a hotel- or resortlike decor with rooms painted in teal and fuchsia, and medical machines are hidden to give the room a homey feel. In fact, employees avoid the term "room" and instead call it a "guest suite."

A study by health care research firm HCIA.com in Maryland suggests that the comforts of specialty hospitals are winning over more and more patients. The study found that two public hospitals performed between 25 percent and 35 percent fewer heart procedures on Medicare patients in 1997 than in 1996, the same year a heart hospital opened in the vicinity.

Losing patients isn’t the only problem traditional hospitals are battling. Specialty hospitals are luring away the most experienced caregivers, said Pauli Marr, MS, RN, senior nursing officer at University Health Partners in Oklahoma City, Okla. A heart hospital is scheduled to open in her town in the fall.

"I asked them to please not steal my good nurses," Marr said. "They are handpicking people, and I know a handful will leave."

The ICU nurses are in greatest demand, and she expects to lose more than a dozen when the heart hospital opens.

Rick Wade, senior vice president of the American Hospital Association, argues that traditional hospitals also are handicapped because overhead costs are so much higher. Specialty hospitals save money by hiring minimal management staff.

Hospitals associated with MedCath Inc., a group with heart hospitals in seven states – including California, Texas and Arkansas – do not hire secretaries to assist managers. Administrators do their own scheduling, and employees call them directly to discuss any problems.

In this system, more than 60 percent of the staff cares for patients, compared to 40 percent in the average conventional hospital, said Vivian Austin, vice president of clinical services for MedCath.

Kim Meharg, RN, a nurse with a MedCath hospital in Austin, Texas, said she was able to start a new training program much faster under this management structure. She was a nurse at Brackenridge Hospital in Austin for 11 years when she took the job at The Heart Hospital of Austin. She, too, has never looked back.

"The regular hospital was more day in and day out," Meharg said. "After 11 years, you get very hungry. This keeps me stimulated."