Chic Boutiques
Despite concerns about the effect on community facilities, specialty hospitals continue to grow, offering nurses and patients a more personalized
care experience

By Linda Childers
April 6, 2004

Recovering from quadruple bypass surgery, a woman rested in the critical care unit at Edward Heart Hospital in Naperville, Ill. She admired her spacious surroundings—cherry wood floors and furnishings that gave the room the ambiance of an upscale hotel. Even the medical equipment was discreetly concealed behind custom cabinets.

Christine Michaels, RN, had cared for the patient since the woman’s release from surgery. Although it was late in the evening, the woman’s family remained by her side.

Because Edward has no set visiting hours, family members could come and go as they pleased and even spend the night at her side.

The patient was in a specialty, or “boutique,” hospital, one of the newest and fastest-growing trends in health care. These new medical centers are for-profit ventures that specialize in specific high-revenue procedures including cardiac, cancer and orthopedic care. The federal government estimates that about 100 specialty hospitals are in operation nationwide.

For nurses such as Michaels, specialty hospitals offer more favorable staffing ratios than larger hospitals, increased job satisfaction and the ability to offer personalized care to a smaller number of patients.

“I love working in a specialty hospital,” said Michaels, who has been on staff at Edward since it first opened a year ago. “I truly feel my job allows me to give my patients the best possible care.”

After graduating from nursing school, Michaels conducted an internship at Edward and liked the way the specialty hospital operated. She was given six months of training, compared to the six weeks that many of her fellow graduates received at other hospitals, and she continues to gain extensive on-the-job experience as new equipment is introduced in the cardiac field.

At Edward, patients are brought directly from surgery to the CCU rather than to a recovery room. As with many specialty hospitals, Edward offers low staffing ratios with nurses typically caring for only one or two patients on any given shift.

Most boutique hospitals allow patients to remain in one room throughout their hospital stay and to see the same nurses daily. As a result, the hospital stay for patients at a specialty hospital is often shorter than that of a standard hospital.

“I think working in a specialty hospital allows nurses to be more in tune with the needs of patients and their families,” Michaels said. “Patients are always telling us how pleased they are with the care they receive here.”

Source of debate

Although many nurses and patients praise the concept of boutique hospitals, the trend has received criticism from some nonprofit organizations and community hospitals.

These organizations argue that because boutique hospitals specialize in high-volume inpatient procedures including cardiac and orthopedic surgery, they are taking revenue from general hospitals that rely on these surgeries to cover the cost of critical services including emergency rooms and burn units.

At Butler (Pa.) Memorial Hospital, nurses are disputing plans to build a separate for-profit specialty outpatient surgery center. They argue that the new facility could affect the existing hospital’s finances, patient safety and nursing jobs.

About 300 registered nurses at Butler are members of the Pennsylvania Independent Nurses union, and have spoken out to have the proposed specialty center remain under the ownership of the hospital.

“We’re worried the new specialty surgery center would threaten the financial health of Butler Memorial,” said Tammy Kaufman, RN, a staff nurse at Butler and vice president of the Pennsylvania Association of Staff Nurses and Allied Professionals. “Since ambulatory surgical procedures are one of the most profitable services performed at a hospital, we feel that Butler’s patient care services would be dramatically impacted if these services are removed from our community hospital.”

Kaufman and her colleagues also have concerns regarding patient safety at the new surgery center.

“Right now, there is talk of building the facility on a separate site, which could put patients at greater risk if an emergency occurred during a surgical procedure,” Kaufman said.

Nurses at Butler also have expressed concern about their jobs. Staff likely to be transferred to the new outpatient surgical center would have an average of 25 years’ experience, but could lose seniority if they were transferred to the specialty hospital where they would be considered new employees.

Higher chance of survival

Despite the controversy, many patients, physicians and nurses remain sold on the concept of boutique hospitals. They say specialty facilities offer patients not only more focused care, but also a better chance of survival.

At Fox Chase Cancer Center in Philadelphia, researchers and health care professionals work side by side to develop and participate in clinical trials that broaden their knowledge of cancer treatments.

Cliff Speer, RN, works in the hospital’s phase one clinical trial unit that specializes in clinical trials that use medications that are not yet available to the general patient population.

Before joining the staff at Fox Chase last year, Speer worked at a pediatric medical center where he became burned out on the myriad social and domestic abuse issues he encountered daily.

“Coming to Fox Chase is the best thing I’ve ever done in my career,” Speer said. “It totally changed my outlook on nursing. I don’t feel as if this is a job, but rather an opportunity to connect with patients who need both physical and emotional care.”

On a typical day, Speer works with both patients involved in clinical trials and oncology patients who have been admitted with medical problems. If the protocol patient is particularly time-consuming, he or she will be the only patient Speer cares for during his shift.

“The environment here at Fox Chase is one of total support and focused patient care,” Speer said. “Specialty hospitals give nurses the chance to have multiple resources within easy grasp to help us give patients proper care.”

Speer also praises the staffing ratio, which is never higher than two patients to one nurse during day shifts, and 4-to-1 during the evenings.

“I’m often able to take a half hour at any given time just to sit and talk with patients to see how they and their family are coping with the disease,” he said. “This is a luxury that most nurses don’t have.”

Speer said the only downside in working in a specialty cancer center is learning to deal with the deaths of patients and helping their families cope with the loss.

“We become close to the protocol patients because we are often their last hope for treatment and in some cases, we offer a delay in the inevitable,” Speer said. “We also experience all of the highs and lows of cancer treatment with patients and their families.”

Texas has seen one of the most rapidly expanding markets for specialty hospitals because of its population growth. Also, Texas is one of several states that doesn’t require investors in a new hospital to prove it’s needed and won’t financially harm existing facilities.

Patty Walker, RN, BSN, is director of pain management at Texas Orthopedic Hospital in Houston. The medical center is the brainchild of several physicians who wanted to devote their practice to caring for patients with joint, spine and shoulder injuries as well as those needing hip and knee replacement surgery.

The hospital has 45 inpatient beds, which are usually at capacity, and also treats patients on an outpatient basis.

“It’s extremely gratifying to work in an environment where you can make an impact on the daily life of a patient,” Walker said. “We have patients who come into our pain management clinic scoring their pain as a seven, but rate it as a zero after undergoing treatment.”

Walker, who has a background in trauma care, says that working in a specialty hospital allows her to spend more quality time caring for her patients.

“Our patients often comment that our staff is more understanding and compassionate about their pain,” Walker said. “We get to know our pain patients very well since we often work with them over a two-week or two-year period.”

The staff’s personalized approach to care is reflected in their patient satisfaction surveys. Patients at specialty hospitals such as Texas Orthopedic praise the time and follow-up care they are given by nurses.

“It means a lot to patients when we are able to identify them by name and ask about their specific condition,” Walker said. “They know they aren’t just a number here, and they have greater confidence in us and in the system.”

Janet Kaiser, RN, became intrigued with the idea of working in a specialty hospital five years ago. She heard that a cardiac specialty hospital was set to open in Wichita, Kan., and she quickly applied to become part of their team.

Today, Kaiser is celebrating her fifth year at Kansas Heart Hospital where she works as the manager of the ICU.

“Five years ago, specialty hospitals were a new concept and I was excited at the prospect of building something new,” she said.

No regrets

Kaiser has no regrets about leaving her job at a Midwest hospital to transfer to Kansas Heart. She enjoys being part of an all-RN staff and the close-knit atmosphere of working in a 54-bed hospital.

Despite its size, Kansas Heart conducts more than 700 open-heart surgeries a year, a statistic comparable to many 500-bed medical centers.

“We have a nursing ratio of one nurse to every two patients and only a 2 percent to 3 percent turnover rate among nurses at our facility,” Kaiser said. “Since all we provide is cardiac care, we can focus on meeting the individual needs of our patients.”

Kim Harris, RN, transferred to Kansas Heart Hospital seeking a slower pace and the opportunity to offer patients the best care experience possible.

“In my previous job, I was providing care for approximately three cardiac intensive patients each shift,” she said. “I never felt as if I could give them all the individual care they needed.”

At Kansas Heart, Harris has found her niche. She enjoys the close, supportive camaraderie of her nursing colleagues and the ability to have her concerns or questions on patient care heard by administrators.

“Middle management at our hospital consists of two people,” Harris said. “It’s much easier to facilitate change in this kind of environment. I believe that our managers listen to us and are more accessible than administrators in a large hospital.”

Contact Linda Childers at eastbaypr@aol.com.