Why Nurses Leave the Bedside; A Bedside RN's perspective
The Cost of Management and The New High Elite: The Consultanting Firms
ERNST & Young,  THE HUNTER GROUP , and the climate of their ascendancy.

The Hunter Group. The Gorilla of Consulting Firms.
Never has an organization been more aptly named. Generated during the height of  "for profit" impetus in the industry, and coming of age in the Managed Care era, this expensive group is the leader of its field, creating and filling the role of consultant to CEOs themselves hired to care for the economic well being of the facilities with whom they are employed. In essense The Hunter Group is  part of a new, very expensive tier to the Health Care Industry Management team,  one notch down from the most lucrative tier [ Health Care Facility Conglomerates CEOs, and HMO CEOs] and far above the CEOs of the facilities to which they are summoned.
The Hunter Group,  now a subsidiary of the publically traded Navigant Consulting , Inc.  [a lucrative corporation whose first quarter of 2003 earnings reveal continued economic health ] describes itself  in its Homepage as "Founded in 1988, [offering]  three distinct lines of business - consulting, implementation support and interim management. We provide consulting services to help  healthcare organizations move rapidly to improve their strategic, operational and financial performance. If desired, we can provide a talented and experienced team to provide short-term implementation support to help convert a business plan into concrete results or to help with specific projects. We can also provide a high-level interim executive on a short-term basis, usually while the organization recruits a permanent replacement.".

Consultants, now with a strong niche market, [like the pharmaceutical Industry and the HMOs], further  divert funds from the beleaguered health care facility industry,  and  are a result of the enormity of confusion and economic loss feeding their niche development. Footnote one

Footnote One: Background: The CEOs of HMOs [AnthemFootnote Seven, OxfordFootnotes Six and Seven, Kaiser PermanenteFootnote Five , etc]
and the CEOs of Large Conglomerate Health Care Facilities [Tenet footnote four and Healthsouthfootnote three, etc] , continue
to enjoy enormous economic benefit for their  stewardship, often unchecked and sometimes at odds with the  entities
viability  [HMO enrollments are down, and both Tenet and  Healthsouth are much in the headlines as a result of fraud
allegations. Tenet's CFO exited late 2002 in the wake of turmoil and  her excercised111 million dollars in stock options
 in 2003. Kaiser suffered from bad press regarding patient care ratios and poor employee relations evident in the Nurses
Strikes it has endured].  The  salaries of individual hospital  CEOs and  local consortiums  of facilities on average has been
checked and appears at last  removed from the excesses of the 80s and 90s. The remark that in 2002 nurses lead hospital salary increases
which appeared in a Sept 16, 2002 article in the American Hospital Association's webpages [ "Nurses led the way with an 8.1% increase
in base salary, and incumbent hospital CEOs checked in with a 7.5% salary increase. "] , is followed immediately with its contradiction in the
same source, revealing  that base plus incentives for CEOs increased 13.4%***Footnote one. in the period being reviewed.Incentives are not
a condition of nurses incomes, except in the instance of a few Doctors Groups, the literature review of which shows a nascent  trend
among some physicians groups to  meet the need for nurses in their off hospital site practises by offering profit sharing on top of base.
In addition, the year 2001 marked the first year of NON erosion of nurses salaries nationwide in a decade, when taking into account inflation,
while hospital CEOs and management continued to receive above inflationary increases throughout that period, making their  less than usual 2002 salary
increases  soundbite self serving and non reflective of a historical precedent of continued increases among the upper tiers, and highest paid, among hospital employees .


The abuses of expense accounts by The Hunter Group has been documented, in one instance, to reflect the average cost of an individual's meals at 147$ a piece during service at one institution. Footnote Two.The industry seems to turn a blind eye to the exorbitant cost of the Hunter Group,  tauted as turning around the financial outcomes of their clients. This reputation at turn around precedes them on every introduction of their anticipated arrival given to fearful managerial and physician staff at each hospital to which they are summoned [Nurses, the largest labor sector in any hospital, representing 70% of a hospital's staff, is never privy to these announcements but learns of the arrival through the grapevine.  It is evident that the financial terms of their contracts are largely hidden from the corporation employees below highest managements tier. A quick google search can easily access these documents utilizing the keywords "Hunter Group" "Hospital" "Message" . Corporate announcements of the advent of The Hunter Group to their entities read woefully repetitive: First the, "I'm sorry but",  then the "this is the reason why" , followed by  'the terms of the contract are private" and finally "they are coming regardless"  and "please welcome them and assist them in their endeavor".

But after they leave, not all institutions are satisfied, and many physicians and nurses are embittered.  They have earned a  scorched earth policy evident throughout the literature, and , unfortunately for RNs like me, the nursing prey  appears too weak to combat them when they appear.  They are stalwart in pursuit and  relentless in technique. While they look globally at an organization when addressing cost containment and "improved bottom line" , The perception of the targetting of nurses is exactly because over 50% of RNs are employed in hospital settings, and 70% of a hospitals human resource pool is composed of RNs.  Because of their effect not only on layoffs and downsizing, but on the global impact on patient services and human resource...diminishing the number of RNs while expanding the job expectation of those that remain.

The enormous impact of the Hunter Group on the Health Care Industry can not be underestimated. Their contracts are not their only sphere of influence.  Providing leadership trends, as consulting giants, they are influential even in institutions that do not hire them on, and while this leader giant alone can not be held singularly accountable, it is arguable that they in fact contributed unconscionably to the current nursing shortage through their excessive downstaffing and resizing of the nursing and nursing  support staff in the nation's hospitals. While Hunter's consulting employee base crosses a broad spectrum, featured first in the list that the Hunter Group mentions among them in their webpage given above, are  "CEOs, COOs and CFOs, from all types of hospitals,   including academic medical centers, complex integrated systems, community, religious-sponsored and public hospitals ..." This in essence means they are generated from the Industry they serve, and return to its ranks when desired.

In the home care agencies in which I was employed, the demands served to create huge exodus of the survivors of the nursing layoffs and restructuring. In the hospital in which i was employed, worsening staff ratios caused an exodus to competitors.  As an aside, the two home care agencies I was an independent contracting RN with who utilized the Hunter Group are no longer solvent. One was up for sale within four years, and the other economically crippled, suffering  a reputation among the Public Health Nurse resource pool in New York upon which Home Care agencies depend as impossibly mismanaged and unreasonable in work environment to the extreme, causing the very nurse resource pool they targetted but depend upon and now wish back, to dismiss the agency as a viable option for employment.  I consider myself a Hunter's survivor by method of escape. [See account]

Real ability to evaluate the usefulness or damage to the Industry to whom they consult , and specifically in regards to Patient Care, Nursing and a facilities experience of expensive recitivism or nursing resource loyalty locally or to the profession as a whole, is only gained through review of Industry Literature and press releases in which The Hunter Group are featured. At times, as in the case of Gail Warden and the Henry Ford Health System, the gray area of this organization appears confusing.  Formerly utilized as an advisor to the Hunter group, Gail Warden is the highly regarded CEO of the Henry Ford Health System. Anxious to drive down losses, this Industry leader turned to his exorbitantly expensive former employer.

Martha Hooven, of the UCSF Dept of Medicine in her Life with the Hunter Group abstract for AIM National Meeting  Oct 14-17 2000, Washington , DC, provides a less than stellar  review of the ongoing losses  at that institution ["not as bad"] post Hunter's expensive involvement with them. Charles Idelson in his Portrait of the Hunter Group,  provides an excellent review of The Hunter Group's contracts, with interviews of Industry personnel, physicians, and nurses at the hospitals coming in contact with this entity. . Abuse of expenses and cost of their service is documented in this study.

June 2002: "Last year, Gail Warden had at least two headaches he wanted to get rid of. As president and CEO of the Henry Ford Health System in Detroit he wanted to make Henry Ford Hospital profitable and drive down losses at its medical group. He decided it was time for harsh medicine: He called The Hunter Group.  The results?  'We've seen a big pickup in productivity, a reduction of $3 million a month in payroll costs and an increase in revenue," Warden says. "I'm a fan of theirs. I think there's a lot of good reasons to be concerned if you're on the receiving end of their recommendations but they get the job done.'
Warden himself has served as an adviser to The Hunter Group prior to his acceptance at the Henry Ford Health System as its President and CEO.
Those kinds of results have helped the St. Petersberg, Fla.-based healthcare management consulting firm more than double its revenues in recent years. The Hunter Group raked in revenues of $25 million in 2001-up from $10-$13 million in the mid-1990s-and grew from three employee-owners in 1987, the year of its founding, to 15 owners and about 45 full-time staff members today.  'Our reputation and our references support the magnitude of results that our clients have been able to achieve with our support...and to sustain over the long term,' says David Hunter, Hunter Group CEO.
Until recently, much of the firm's work has centered on turning around ailing hospitals. The firm has made its name by encouraging hospitals to make sometimes-drastic budgetary and staffing cutbacks, with the goal of bringing the organizations back to profitability. But looks can be deceiving, Hunter says.
It's not just patients who notice. Hospital unions break out in hives when they hear that The Hunter Group is even being considered by a hospital board. Indeed a January-February 2000 issue of Revolution magazine, a hospital union publication, devotes a nine-page feature to the firm, accusing it of a "scorched- earth" hospital turnaround philosophy where only the "bottom line matters."
Hunter readily admits that making painful decisions and cost cutting is central to his firm's turnaround philosophy."
Hospitals  Reality Check by Howard Isenstein . Health Leaders Magazine. June 2002

Gail Warden is a recognized industry leader and is listed among Modern Healthcare's May 14, 2003 100 Most Powerful List.

Sept 2002:
"COLUMBIA, Mo. University of Missouri-Columbia Chancellor Richard L. Wallace announced today that a contract with The Hunter Group has been finalized and that David B. Coats, Executive Vice President of The Hunter Group, has been named interim Executive Director for Clinical Affairs and
Chief Operating Officer of MU Health Care, effective today.
The Hunter Group, a Florida-based firm that provides interim leadership for hospitals and academic health centers, will take over management of the University's hospitals and clinics for a period not to exceed 24 months at a total cost not to exceed $94,000 per month plus expenses and up to $1 million to develop an implementation plan. The purpose of the plan will be to return MU Health Care operations to financial solvency so as to fully support excellence in patient care and medical education."
University of Missouri-Colombia, Sept. 18, 2002 news release . UNIVERSITY FINALIZES AGREEMENT WITH THE HUNTER GROUP [$94,000 is  $1, 128, 000 annually. Add the 1million implementation cost the first year will cost $2, 228,000 PLUS expenses]

April 2002:

Aug 1999:
"Last February, the Hunter Group slashed 2,000 jobs and  closed an entire hospital in Detroit. Previously, at a university medical center in Chicago Hunter Group consultants recommended a 10 percent staff cut in hospital positions and pulled  support from some of the 1,000 residents and fellows.
Closer to home, the Hunter Group closed out 1,000 positions at the California Pacific Medical  Center in San Francisco in 1994.
The trade journal Medical Economics wrote that the Hunter Group fields 'consultants that specialize in scorched-earth hospital makeovers.'
Not infrequently, some of that earth gets scorched under management's feet. At the UC-San Diego Medical School, where Hunter consultants killed 500 positions two years ago, they took over the jobs of managers who had been forced out. The same thing happened at California Pacific Medical Center.
Cost-cutting does not apply to the price of consultants for Hunter clients. The five consultants who took over UCSD's two hospitals were paid a total of about $250,000 a month, and two   others earned more than $3,500 on days when their services were required.
Since they left, UCSD has gone from a $20 million annual loss (on a budget of $300 million)  to a $24 million annual surplus. Last week, the medical school dean eliminated the position of  CEO, which the Hunter Group had created and filled with a non-physician. That marked the first time any medical center in the UC system had used the title of CEO. Critics claimed it represented a shift toward thinking about profit in a nonprofit system.
In a letter to faculty and staff, the dean said doctors would resume their leadership role at the hospital.
At UCSF Stanford, where losses for this year are projected at $60 million, the Hunter Group  was earning $400,000 a month before totally taking over the reigns." Layoff fears grip merged hospitals By Michael Dougan . San Francisco Examiner. Aug 11, 1999

The after effects of UCSD's Hunter experience is not all golden. See  Charles Idelson's  Portrait of the Hunter Group

***Footnote One: "....The median CEO base salary for 2002 is $237,000, but total cash averages paid to CEOs -- base plus incentives -- increased 13.4%. All  data were gathered and analyzed by the Hay Group, in cooperation with the America Society for Healthcare Human Resources  Administration. For more information go to  http://www.hhnmag.com"  Survey: Nurses lead hospital salary increases September 16, 2002. From the American
                        Hospital Association webpages at AHANews.com.

Footnote Two:
The Hunter Group raked in revenues of $25 million in 2001-up from $10-$13 million in the mid-1990s-and grew from three employee-owners in 1987, the year of its founding, to 15 owners and about 45 full-time staff members today. Hospitals  Reality Check by Howard Isenstein . Health Leaders Magazine. June 2002
The Hunter Group is part of Navigant Consulting.
** CHICAGO--(BUSINESS WIRE)--April 7, 2003--Navigant Consulting, Inc. (NYSE:NCI), prior to the Company's presentation at the Sidoti &   Company Institutional Investor Forum in New York  City on April 9, 2003, today released preliminary results for the first quarter of 2003. All results are unaudited and subject to review. Revenues for the  2003 first quarter are expected to be between $72  million and $74 million, an increase of 19 to 22 percent compared to the first quarter 2002. EBITDA  is expected to be between $7.5 million and $8.2 million, an increase of 45 to 60 percent compared to the first quarter 2002. Resulting net income is expected to be between $3.0 million and $3.6  million, reflecting a significant improvement of 65 to 100 percent compared to the first quarter of 2002. Earnings per share on a fully diluted basis will range from $0.06 to $0.08 per share, reflecting an increase of 50 to 100 percent year over year."Navigant Consulting Announces Preliminary First  Quarter Results: From pages of Navigant Consulting

Footnote Three
Ernst & Young
"In 1998 -- around the time HealthSouth's alleged $1.4 billion earnings fraud started to ramp up -- Scrushy scored  himself a sweetened employment contract from the company he'd founded and built into an outpatient empire.  Scrushy would receive a base salary of at least $1.2 million, regardless of the company's performance. But he could triple his compensation if the company hit its monthly performance targets. Even if HealthSouth fell short on certain months, Scrushy could still collect the entire $2.4 million extra if the company made up for the shortfall and  met all performance goals by year's end. ....
"Mr. Scrushy's leadership has been essential to  HealthSouth's success and growth," the April 2002 proxy states. "The committee believes that it is important to ensure that, if Mr. Scrushy is successful in leading HealthSouth to achieve the goals set forth by the board of directors, his compensation will  be [competitive] ."

But Scrushy apparently needed even more. He also took out a $25 million company loan, which he repaid this year by selling half his HealthSouth shares shortly before a questionable earnings warning sent the stock into a  tailspin.

 Oddly enough, the chairman of the compensation committee -- which approved both Scrushy's salary and his loan-- also serves on the company's audit committee. Financial experts now view this rare arrangement as problematic, since the two committees are supposed to have clearly separate goals

Still, the audit committee -- comprising two longtime friends of Scrushy and the CEO of a glass company -- wasn't alone in conducting potentially poor police work. HealthSouth's independent auditor, Ernst & Young, apparently never detected any signs of the rampant fraud regulators now allege took place. In a formal response last week, Ernst & Young threw up its hands in innocence, declaring: "When individuals are  determined to commit a crime, a financial audit cannot by expected to detect that crime."

But some experts aren't buying that claim. They fully expect regulators to broaden their net to include  HealthSouth's outside auditors -- and perhaps even the company's longtime banker. ". HealthSouth Watchers Had Their Doubts By Melissa Davis  Staff Reporter . 03/27/2003 TheStreet.com

Footnote Four:
"Tenet Healthcare Foundation, established in 1998, is a not-for-profit charitable foundation sponsored by Tenet Healthcare Corporation." [Homepage for the Corporation] "Tenet is the second-largest investor-owned health care services company in the United States. Tenet's key profit center was and is Redding Medical Center ("RMC"), a 238-bed, general hospital located at 1100  Butte Street, Redding, California 96001." [Weiss and Yourman, Attorneys for the plaintiff ]  . Currently the corporation faces litigation from Heart Surgery patients and its stockholders, with Tenet and its CEO and CFO Barbakow and Mackey  named in fraud and deceit by members of their Stockholding community. Both men were dismissed in Nov, 2002, but the dismissal did not impact their bank accounts, apparantly, at least at present. "Thomas B. Mackey, Tenet's chief operating officer, and David L. Dennis, chief financial officer... were dismissed last month. Neither responded to requests for comment.   A month before leaving, Mackey exercised $10 million in Tenet stock options. Barbakow this year  cashed in stock options worth $111 million, on top of his $5.5-million salary and bonus for fiscal  2002."[ Tenet's Aggressive Corporate Culture Fed   Crisis, Insiders Say The hospital operator's business practices, profit-based pay incentives come under scrutiny By Don Lee, Times Staff Writer. Dec 12 2002]
Nurses working for Tenet have long complained about their salaries, patient care, and the use of Mandatory overtime. Letters from Tenet Nurses reporting their concerns leading to Strike from across the nation are also available on line. Use of Mandatory Overtime is frequently commented upon in those letters.
The financial report of the corporation for the three month periods ended August 31, 2001 and 2002 , published Oct 2 2002  is present online at  Financial data for the Corporation  Online, where its worth, and its cost , including for Salaries and Benefits  2001 / 2002 is reviewed.
Tenet recently faced a nurse's strike.
"After years of bitter squabbling, Tenet Healthcare Corp. has reached a national labor agreement with its major nurses' unions that includes pay raises of up to 29 percent  over the next four years. ....Tenet has been under constant attack from the nurses' unions which have claimed the company's hospitals have too few nurses and require employees to operate in difficult working conditions. Tenet struck the deal while under investigation for overbilling Medicare; its stock has plunged 70 percent in the past year. " Tenet, nurse's union reach agreement. From  allnurses.com, Friday May 2, 2003 

Footnote Five :
Kaiser Permanente, is a managed care entity with its own hospitals and clinics. It  is the "country's largest nonprofit managed care health plan" and their webpagesinform they are a not-for-profit health care organization, serving 8.1 million members in 9 states and the District of Columbia.
Currently Kaiser is receiving magnate hospital status as a result of its "Voluntary" innovations regarding nursing involvement in decision making and contractural agreements to maintain RN wage scales above the local norm. These "voluntary" actions gained in the first years of the new millenuim, follow 5 years of fierce RN action and were, in fact, not voluntary at all.
Kaiser's current CEO is George C. Halvorson, its last, David M Lawrence, MD having made his plan to retire in Dec December  2002 by July 23, 2001. [Health Plan CEO to retire Dec 2002  from Kaiser Permanente's own News Release pages].
" David M. Lawrence, MD, made 2.2 million in 2000.... The Star Tribune.... reports that Halvorson made $814,000 a year at HealthPartners; his Kaiser salary has not been disclosed.  " Meet George C. Halvorson" by Frank Diamond. From Managed Care Magazine; June 2002. George Halvorson also serves on the Board of Directors of The American Asoociation of Health Plans 

Footnote Six  [See also Footnote Seven]
"HMO executives have piled up truly extraordinary sums of money for themselves. Even if we accept the industry's argument that executive compensation is a result of stunning new  management techniques and the elimination of inefficiencies, the money in the executives' pockets formerly was spent on health care. " The Robber Barons of Health Care found in Chapter 4  [ The Financial Sting Paying More For Less] in  the Book " Making a Killing "  by Jamie Court & Francis Smith (With a foreward by Ralph Nader)
Table 2 in source shows  that Stephen Wiggins,  CEO of Oxford Health Care earned $30,735,093  in 1997  , the year his company crumbled.  See Table 1 and 2 in source above for more outrageous figures of other HMO CEOs.
Footnote Seven
"HMO enrollment dropped for the second straight year in 2001. The number of people  enrolled in HMOs dropped to 78 million in July 2001 from 78.9 million in July 2000, representing a 1.1% drop in enrollment, according to InterStudy Publications.
That decline, however, was a slowdown from the 2% decrease in enrollment that occurred the previous year.
The number of HMOs in the United State also shrank last year. There are 531 HMOs in the United States, down from 560 in July 2000.
Top executives at Anthem and Oxford Health Plans saw massive rewards in 2001.
Anthem went public in the fall of 2001, which landed $15.2 million into the pockets of Larry Glasscock, chief financial officer. On top of that, Glasscock got a salary of $900,000 for 2001, up from $800,000 in 2000. For 2001, he was paid a maximum bonus of $2.16 million, compared with $1.6 million in 2000, according to a Securities and Exchange Commission filing.
Oxford paid out $2.96 million to its chief executive, Norman Payson, with stock options worth $8.3 million. Oxford raised Payson's pay to be more closely in line with what other companies offer, according to a filing with the Securities and Exchange Commission.
Payson was originally paid a 2000 bonus of $350,000, then increased it to $2.5 million in "light of his contributions and accomplishments," the filing said. His annual salary was raised to $1 million as of January 2002, compared with his 1999 salary of  $350,000. "
 Business: News in Brief. May 6, 2002.   AmedNews.com "the Newspapers for America's Physicians"[Part of the AMA]
[Anthem's homepage informs they are " one of the nation's leading heaalth care benefits companies, providing innovative health benefit plans, dental, vision and behavioral health benefits, pharmacy benefits management services, and life insurance. As the Blue Cross and Blue Shield licenssee in nine state, we touch the lives of more than 10million people"

April 15, 2002
"St. Mary's Medical Center in San Francisco is violating state law by placing its nursing services under an executive with the  notorious Hunter Group who does not have a California registered nurse license, the California Nurses Association charged today. In late February, St. Mary's announced the appointment of Gloria Kunze, "RN," a senior vice president with the Hunter Group, as Interim Chief Nurse Executive. However, Kunze, a Florida resident, does not have a California RN license. California law governing nursing care specifically mandates that the administrator of nursing services be a Registered Nurse licensed by the BRN.
The reason for that requirement is rigorous California standards to protect patient safety. Before granting a California license to a nurse from another state, the BRN is expected to verify the candidate's record, including assurances that  charges or complaints under the nurse's license are not pending in another state.
Shortly after Kunze was hired, the hospital implemented a RN hiring freeze, despite previous postings of large numbers of RN vacancies, and informed the nurses of increases in work assignments as a result of the staffing shortfall. Problems with  safe nursing care are persistent throughout the hospital.
"We feel we can't do everything we need to do for our patients in an 8-hour shift," says Allen Fitzpatrick, an Intensive Care Unit RN at St. Mary's. "It's a demoralizing situation and has compromised our ability to provide the best patient care."

Costly expenditures
The Hunter Group, a controversial consulting firm that specializes in slashing patient services to cut costs, was hired by St.Mary's last year to reduce budgetary expenditures. Across the country, the Hunter Group has inspired hospital closures, deep cuts in nursing staff and other employees, replacement of RNs with lesser skilled personnel, higher ratios of nurses to patients, and reductions in indigent care.

 San Francisco is still reeling from the effects of a Hunter Group stewardship of the failed merger between the University of California San Francisco and Stanford University Medical Center. Among the consequences was the closure of Mt. Zion Medical Center's emergency room and in-patient services.

But while polishing its "slash and burn" reputation, the Hunter Group is also noted for its expensive charges. While the Hunter Group or its hospital employers rarely disclose its hefty bills, the price tag frequently runs in the millions of dollars even while the hospital says it is employing the Hunter Group to cut expenses elsewhere in hospital operations. For example, it was believed that UCSF-Stanford paid the Hunter Group over $3.5 million between January 1998 and August

Those charges at times include lavish expense accounts, such as costly travel expenditures for Hunter Group executives.

Kunze, for example, maintains her residence in Florida while working four days a week in San Francisco. Reportedly, Kunze is flown home from San Francisco to Florida every weekend."
April 15, 2002  CNA Press Releases. St. Mary's, San Francisco, Violating State Law in Nursing Care Hunter Group Nursing Executive Operating Without California License as Serious Staffing Problems Persist Throughout Hospital

My own Experience of The Hunter Group
I was a staff RN in a home care agency in 1996 when I had my first of four experiences with the Hunter Group. This was an era when each staff meeting we were told "there will be no discussion. This is a fact dessimating meeting. There will be some additional changes" but, not content not to speak up when the changes were so overwhelmingly job destructive, when i did, or one of my colleagues did, we were  told "If any of you nurses are unhappy, or any of your colleagues are, then go somewhere else to work. But I don't see any nurses positions being advertised, so good luck. You get plenty of money for what you do. The choice is yours" Despite this atmosphere of unrelenting stress in the office and unbelievable work load to the day, the Hunter group was called in to demand further efficiencies and cut backs.
As a result of their additional restructuring of my patient daily seen mandate and the mantra after their arrival  at each management contact of "overtime, what overtime?" when I requested to be paid for the extra time required to meet the increased day's paper/ patient visit/ and coordinating work, I became numb and embittered. But the final nail was when I requested  reimbursement for taxi  to an "out of area" patient when one of my own patients in my own assigned  area had been cancelled for the da. This  6$ taxi cost was refused. I was told to take the bus. I pointed out that I would gladly take the bus, but that this would entail 45 minutes of overtime, and a 34$ cost. That also was refused.  I contacted the union, i was told there were so many incident reports and pending arbitrations that the issue of overtime pay could not be  met in a reasonable time frame; I  I was encouraged to keep filling our reams of paper documenting the abuses and flagrant disregard for fair labour practise [just what i wanted after doing the paperwork required of home care all day and half the night].
That was it. I quit the next day,  after 9 years full time employment, and with the Hunter Group consultant sitting in our home care offices establishing the mandates and policies regarding nursing salaries, expenditures,  the stance on refusal to admit overtime was required to meet the days work load, and the policy to refuse any   taxi fare no matter if it was a noreaster, a blizzard ,  110 degrees or up to Harlem from Chelsea on a dime.
In the meantime, these consultants were holed up in , not modest apartments, but luxurious, penthouse apartments at a cost equal to several staff nurses monthly salaries. The piciyune refusal to pay for the cost of doing business, overtime or occasional taxi fare, was only the final nail in the coffin. I left pleasantly and quite contentedly, for this was all i needed to quell my fear about independent contracting. I continued working for that agency happily only on weekends as an independent contractor unable to be their puppet, and unwilling to take m-f patients from that agency as their morale and support in the office was too thread bare and morale depleted and weekend work did not require interaction with non existent support staff. That agency went up for sale within three years after the Hunter group arrived.
I also established contracts with two other hospital home care agencies for during the week, being able to control my own work flow and consolidate further my territory into a nice little chelsea and west village packet. I enjoyed holiday and vacation time for which i was not paid, but over which i had complete control. But the Hunter group presented at one of these agencies as well. Within three months, not ONE of the staff nurses in the office with whom i had worked for three years remained. The destruction to the support staff of both nursing middle tier supervisors and the staff RNs and private contractors like myself was entire. That agency suffers now a reputation so apalling among New York City's public health nurses that they can not hire nurses to their ranks to see their patients, and continually must turn away business. I understand it too, faces possible closure.
Tired of the paperwork in homecare, and the erosion of my pay over time [see Home Care and the Nursing Shortage], and the terrible condition of work for the visiting RN in New York City worsening monthly, after 14 years in Home Care  I decided to return to the hospital setting as long as I could have 12 hour shifts, flow sheets,  and a garaunteed patient ratio. This meant that I would have to look at ICUs, and I elected to return to a first love, the Neonatal ICU, and to a hospital known for its quality nurse/patient ratios in a state mandating patient/ nurse ratios although they were not yet in effect.  Within 4 months of my change, the Hunter group presented at THAT hospital, having followed me across the country,  and the ratio has changed for the worse, the morale is poor, and the union discussing a possible strike, while I am considering Law School, primarily to engage in nurse advocacy. This is my legacy  from the Hunter Group.