Effective nursing care involves management of both patients and resources, so it's no surprise that nurses like Debbie Zastocki find their way into the upper echelons of health care.
For Zastocki, now president and CEO of Chilton Hospital, making the move from the nurses station to the C-suite was driven by a desire to improve education and training for fellow staff members.
"Much of what needs to occur in a hospital requires that you have very effective leadership, and I felt I was not in a position to create enough of an effect on the environment of the hospital, which at that point was a significant career change for me," she said.
Zastocki said nurses today are afforded new opportunities to affect hospital bottom lines, especially through coordinating care, without becoming active in administrative decisions. Chilton provides training to nurses and unit leaders on better preparing budgets and providing analytical reports to combine financial understanding with clinical experience.
"If I were a new careerist, and wanting to see how I could be more effective, I would want to develop an understanding — almost like my unit would be my home budget — so what is it that we need to do on our unit that would make a difference?" she said.
And there's an increasing need for nurses to make their voices heard as business decisions impact clinical care, said Jeanne Otersen, spokeswoman for the Health Professionals and Allied Employees union.
Otersen said in the past 10 years, roles have "moved from being involved in the day-to-day inside of the hospital — the patient care — into having to get involved at broader levels around staffing, around regulatory issues, things that went beyond the unit." The proliferation of for-profit owners, Otersen said, has intensified that need; she calls that "the intersection" for nurses.
"That's the intersection — when people started to see the ownership of hospitals and the changing finances directly affect them and their ability to take care of patients," Otersen said. "That was the trigger, the intersection for nurses to get involved on this level."
The HPAE, which represents roughly 4,000 nurses and other health employees in the state, was instrumental, according to Otersen, in securing passage of the Community Healthcare Assets Protection Act, which requires the attorney general's office to approve changes in hospital ownership. The group also is exerting its influencing on several ongoing ownership changes, including the bankruptcy sale of Christ Hospital, in Jersey City, and reorganization negotiations for the University of Medicine and Dentistry of New Jersey.
"We don't see it as the business side of things, we see it as the success and accountability of all hospitals to the patients they care for," said Ann Twomey, state president of the HPAE. "Sometimes there are new models that get imposed. The question is, with the scarce resources of patient care dollars, where does the money go?"
Twomey said the HPAE was vocal about Hudson Holdco LLC's 2008 purchase of Bayonne Medical Center, because the buyers had the money, but had never operated a hospital.
"We generally push for a commitment that the hospital is not just being bought for the sake of buying the building for real estate — that (they have) a commitment to services … for an extended period of time," Twomey said.
The HPAE again raised their voices when Christ Hospital in Jersey City was slated for sale to a California-based company, Prime Healthcare. This time, the union advocated for Holdco's ownership bid over Prime.
"There's a lot of questions about Prime, and we just did our research," Twomey said. "Our position was that Christ Hospital's board had a responsibility to put out a (request for proposal). They just announced their decision to sell the hospital to Prime. … Bayonne, to their credit, has a vision that they want to establish something that provides more comprehensive care for the community."
The union is also working on the UMDNJ restructuring, including extensive analysis on the Gov. Chris Christie-supported plan, "because … there's big questions that involve money in terms of what will be gained by this change?" Twomey said.
The HPAE put its reorganization analysis into a white paper breaking down the issues surrounding the merger, including the amount of charity care provided by University Hospital compared to private facilities in the area, the transition of UMDNJ's grants and clinics to Rutgers control, and the difficulty in dividing the schools' debts amongst the assets being split.
Twomey said "many of the legislators said this is the first concrete compilation of information they've seen. We know it's helped focus on some of the most important issues," such as the fate of University Hospital and preventing the people who provide services there from being "lost in the shuffle." Included in the pending legislation was a clause stating that previously bargained contracts would be honored.
Catherine Flynn, chair of the health law group at Weber Gallagher Simpson Stapleton Fires & Newby LLP, said the HPAE's white paper was "very well done" and "does set forth a lot of statistics and information that they want to get out there for consideration.
"I do believe that they are taken seriously," Flynn said.
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