Here we go again!


Few things make people grouchier than change, which may well explain why so many people working in healthcare delivery today are so crabby. Just ask any patient. Change has come so fast and so furiously; it literally came in one era and out another.

“These are changing times,” we are told. Not true. Time doesn’t change, people do. Events do. Circumstances do. And not always for the better. Some ideas, some values, some ways of doing things really ought not to be put to death before their time just to make room for change, especially since change is not always motivated by some great cause, or brought about as a natural evolution. Sometimes “change” actually may be regressive rather than progressive.

At any rate, I think these changes are decidedly regressive, especially in the face of full implementation of the Accountable Care Act. According to recent Bureau of Labor Statistics (BLS) data, there were 13 hospital mass layoffs (defined as involving 50 or more employees) in August, resulting in 1,085 initial unemployment benefit claims. If this layoff pace continues, BLS analysts say hospitals will post 127 mass layoffs this year involving 8,257 people, giving 2011 the third-highest number of mass layoff incidents in the last decade.i  Meanwhile, earlier this month the American Hospital Association (AHA) said hospitals would lose $41 billion from 2013 to 2021 if Medicare payments were cut by 2%. According to AHA, the 2% cut would cost 92,866 jobs in 2013 and 194,522 jobs by 2021.ii  How stunningly stupid!

How might one distinguish between regressive and progressive change? Regressive change offers simple, quick “solutions” and nothing more: a method with an end, so to speak. It gains most of its momentum by proclaiming what’s wrong with what is (in this case, reduced Medicare payments). It doesn’t look at what’s about to happen, such as full implementation of healthcare reform, dramatic changes, and dramatic increases in demand for services.

Progressive change arises out of what is and moves one into the future. Progress has deep roots—in technology and science, in demographics and social mores, in economics, in law—and in the successful performance of predecessors and peers. Progress builds on strengths. And nursing has a lot of those.

iBureau of Statistics. Economic News Release. Mass Layoffs Summary. September 22, 2011. Accessed October 6, 2011.

iiStagg Elliott V. Economic pressures prompt increase in hospital mass layoffs. American Medical News. September 29, 2011.

The views and opinions expressed by Perspectives contributors are those of the author and do not necessarily reflect the opinions or recommendations of the American Nurses Association, the Editorial Advisory Board members, or the Publisher, Editors and staff of American Nurse Journal. These are opinion pieces and are not peer reviewed.


  • I for one would rather agree to a paycut than to job loss. As a matter of fact in our facility the employees all agreed to give back 5% of our salary to help with funding our health plan. No one likes as pay cut but the alternative is worse

  • Nursing does have a lot of strengths – especially when you consider that we can cut health care costs by providing care as advanced practice nurses. We can meet the health care needs of our communities, providing increased access to care at lower costs than physician-provided care.

  • Nursing, at least in NYC, is operating with an extreme shortage of RN’S and a current hiring freeze …yet we ALL NEED OUR JOBS AND INCOME…although I would not like a pay cut…I feel this is a better option for ourselves and our glad you have a job..I doubt you are making the minimum wage….disgusted, frightened but hopeful…..An RN working for what I signed up for..HELPING ….:)

  • Dear Julie,
    No one likes a cut in pay, but most prefer it to lay-offs. In fact during the great depression, the employees of AT&T voted to reduce their work-week to 4 days to avoid both lay-offs and cuts in hoursly pay. In our case, we should look to redployment of personnel according to what will be funded under the ACA of 2010!

  • Okay, so we souldn’t have lay-offs. OK…How do you think people would like a cut in pay instead?

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