Even as the "Great Recession" took hold of the country, hospitals and healthcare professionals had reason to be optimistic. With the aging of the baby boomer population, it seemed that the market for healthcare would stay strong, and those who have dedicated their careers to helping others would continue to have jobs.

In the past year, however, this certainty has grown a bit shaky. Hospitals are reporting a downturn in elective procedures that tend to be paid for in full by the patient or his or her insurer, which means that some ORs are standing empty, waiting for the economy to rebound. This is particularly serious, as these most-profitable procedures are tailing off while hospitals are simultaneously serving a higher number of uninsured patients, with procedures that tend to lack the favorable margins hospitals need. At the same time, hospitals are realizing losses in their investment portfolios.

Even patients who have health insurance are dealing with higher deductibles, which means that they’re assessing their healthcare spending based on price as well as need. Without a doubt, this is a change for an industry in which the insured consumer didn’t always have to contemplate a high contribution for their own care. And, with the future of governmental involvement in healthcare uncertain, it appears that this industry, which was once a safe harbor in an economic storm, has been hit with the same tumult as other sectors.

It seems that the recession has hit healthcare, directly affecting OR nurses.

The Impact on Jobs
Adam Rubinstein, MD, has been a plastic surgeon in Miami for nearly 20 years; and, as such, he has seen the economy impact the work he and his OR nurses do. “There are fewer surgeries, in general, so there’s less need for OR nurses,” he says. This has caused a number of effects on the job market for these nurses. While Rubinstein finds that “busy facilities can cherry-pick” the top nurses, other nurses “are just trying to hold on to the positions they have.”

This cutback in demand for OR nurses comes on the heels of a nursing shortage. So, simple economics would indicate that a short supply would balance out the diminished demand, resulting in a lower equilibrium point in the market for nurses. Indeed, Rubinstein expects that “if we continue as we are, we will hit an equilibrium.” However, this balance point may leave some non-hospital surgical centers scrambling for the top nursing talent. “In office ORs, it’s tough to find quality people, [because the work] generally doesn’t come with [as many] perks,” he says.

For some hospitals, however, the recession has enabled OR nurses to really gel as a team. “In the past year, we’ve had a high level of retention,” says Megan Graham, vice president of workforce strategy and planning for Children’s Healthcare of Atlanta. “We have just under 70 nurses, and we’ve only hired four nurses – we usually hire 10 or 12,” she says. She notes that most of the attrition has come from nurses leaving due to spousal job moves.

This doesn’t mean that Children’s Healthcare of Atlanta hasn’t dealt with cutbacks from lower patient traffic during the recession. “Our census was lower in the summer, so we had to flex people off,” Graham reveals, acknowledging that this did affect nurse morale.

However, they’ve made scheduling changes, such as moving from eight-hour shifts to 12-hour shifts, which meant that scheduling could be juggled to allow cutbacks without affecting nurses so dramatically. Plus, with the recession contributing to a certain increased stability among the staff, Children’s Healthcare of Atlanta has been able to take advantage of this to ensure their professionals are well-trained to serve their target population. “We’ve been able to grow our own quite a bit,” Graham says.

Saving Money
Most of the economies that have come about as a result of the recession have affected staffing and benefits, not the actual patient-care work of OR nurses. “You really can’t scrimp in the OR that much,” says Rubinstein. Graham concurs, noting that although some economies can result from “product standardization,” there’s a limit to the cost savings that can go on in the operating suite itself.

However, Rubinstein does note that “on the floor, [nurse/patient] ratios have gotten worse and worse.” What’s more, other hospitals have reported changes that make the healthcare profession a less stable one than ever before.

Case in point: In an April 2009 article in the Wall Street Journal, Beth Israel Deaconess Medical Center, a teaching hospital in Boston, reported 140 job cuts, salary freezes, reductions in vacation allowances, and reductions in retirement fund contributions. All of these moves were meant to address a $20 million budget shortfall. In the same article, it was reported that the Rochester, Minn.-based Mayo Clinic had instituted salary freezes, reduced travel and overtime expenses, and cut capital spending. Although most of these cuts hit doctors and senior administrators, they illustrate how serious cost-cutting has become for hospitals nationwide.

This doesn’t ring true for all hospitals, however, and some institutions are using the recession as a time to make improvements. Discussing the situation at Children’s Healthcare of Atlanta, Graham remarks, “There are good things about the economy forcing us to look at [certain elements] closer.” For example, she explains that the recession “didn’t change the level of patient interaction” her nurses have, but “we had to be smarter about patient scheduling.”

This comes along with a trend toward more serious surgeries, as procedures that are considered elective or postponable are delayed, waiting for better economic fortunes. “Surgeries are changing,” says Graham. The traffic she sees in the OR these days is “higher acuity, more serious.” And her facility is poised to expand when the need arises. “We do have some ORs we could open, and we plan to open some this year,” she reveals. “It is a growth initiative in spite of the economy.”

Ultimately, it’s clear that OR nurses are dedicated to working together to provide high-quality care to their patients in spite of the dismal economic forecast. “As a surgeon, I’ve been very impressed and happy with the team effort,” says Rubinstein. “Kudos to nurses for picking up the flag.”

Jennifer Patterson Lorenzetti is an Ohio-based freelancer.