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A more perfect union

Mergers have the potential to bring positive change for RNs

Monday October 21, 2013
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Nurses deal with constant changes in their professional settings, and now many are facing a whole new set of challenges with the growing number of hospital mergers and acquisitions. Nurses can feel threatened or uncertain about the future of their facility, its identity and their job security when another hospital or organization takes over or consolidates with theirs. However, there also is much to be gained when a facility is bought or merges with another.

In 2012, 94 hospital/healthcare system mergers and acquisitions took place, according the American Hospital Association’s website. That was a slight increase from 92 in 2011. The trend will continue into 2014 because of the implementation of the Affordable Care Act, predicted researchers in a June 2013 article on the American Medical Association’s news website.

As healthcare systems acquire stand-alone hospitals or link up with other systems, patients and the nursing profession stand to gain, say healthcare analysts. Several CNOs and staff nurses whose organizations have been involved in mergers and acquisitions agree.


Joanne Reich, RN
A stronger bottomline

Joanne Reich, RN, MA, NEA-BC, CNO at Chilton Hospital in Pompton Plains, N.J. , said Chilton has been in the merger process with Atlantic Health System, a large not-for-profit healthcare system, since last year. She said the merger of her 260-bed community hospital with AHS’s four hospitals benefits Chilton by solidifying access for their patients into a tertiary system of care. “Chilton serves 33 communities over 250 square miles,” Reich said, “so this is a tremendous extension of the service area.”

Likewise, when Mountainside Hospital in Montclair, N.J., became part of Hackensack University Medical Center in 2012, nurses could see the benefit of becoming part of a larger system, said Mountainside’s vice president and CNO Bonnie Michaels, RN, MA, NEA-BC, FACHE.

Michaels said Mountainside experienced a previous acquisition by another healthcare system in 2007 and many staff, herself included, found the results favorable and the process manageable and necessary. “Nationally, due to the prolonged economic downturn and a decline in hospital admissions with uncompensated care on the increase, every healthcare facility is faced with healthcare challenges,” she said. “Joint ventures between not-for-profit and for-profit facilities are emerging throughout the country. Being affiliated with a larger healthcare system provides for increased integration and greater operating efficiencies, while providing market share growth and a better position in approaching commercial payer contracting. A facility that has a strong financial base and positive margin provides security to all its employees.”

Increased job security

When a community hospital joins with a larger healthcare system in the same region, both the community and the employees can benefit. Patients have access to more services and specialized providers through the larger organization. With predicted growth in services and patient population, job security is increased.


Bonnie Michaels, RN
Ann Mueller, RN, a critical care coordinator at Mountainside, said nurses in the surgical ICU are looking forward to having more physicians associated with the hospital, which will help increase the unit’s census. Her colleagues also are pleased with wider job opportunities, such as the potential to work in the open heart surgical program at Hackensack UMC.

Nurses at smaller or independent hospitals see mergers as a chance to access a clinical ladder or to advance their education. “The educational opportunities are phenomenal [with the larger organization],” said Donna Kruse, RN, MSN, CCRN-CMC-CFC, a clinical educator at Advocate Sherman Hospital in Elgin, Ill., part of Advocate Health Care, a 12-hospital system in Illinois. “Advocate Health Care has a large calendar of courses and review classes for certification exams. These can be costly to take on your own. We already have nurses who have started signing up because they’re excited about this rich resource that’s now available.”

Another advantage for nurses is being associated with a Magnet hospital or a health system with a favorable reputation. Nurses at Mountainside experienced a surge in public perception when the Hackensack UMC name was attached to their facility. “To have that alliance [with Hackensack] made everyone feel good,” Mueller said. “Joining with a great medical center boosted us in the eyes of the community.”
While some expanded healthcare networks offer cross-training for nurses to work among their facilities, that potential depends on the distance between sites and the physical continuity between settings. Michaels said one hospital in their new affiliation might offer cross-training, but the hurdle of a different system for documentation must be faced first. “Eventually, when those of us at the older hospital get the new documentation systems, it will be easier to share with staff,” she said.

Besides sharing everything from payroll systems and benefits to technology, the facilities must agree on shared cultures and values. “Advocate and Sherman cultures are very similar, so the transition has been very transparent,” said Susan Campbell, RN, DNP, senior vice president and CNO for Advocate. Campbell said having similar cultures is key to a smooth transition. Both organizations must provide opportunities for nurses to learn the other’s culture.


Susan Campbell, RN
Overcoming fear of change

“There is a natural tendency to respond to a [merger] announcement with fear of loss of identity and security, fear of giving up known relationships and expectations and the fear of losing what is familiar,” Michaels said.

Reich advises nurses to appreciate the change as a benefit for the hospital which ultimately will be a benefit for the community it serves. “As a nurse, work to understand that your services become even more valuable as the emphasis is on quality care,” she said. “Keeping current about change theory is an excellent way to keep yourself mentally prepared for our rapidly changing healthcare landscape.”

The myriad concerns nurses have about job security and potential changes after a merger can be allayed by nursing leaders who communicate openly and transparently, Reich said. Fear of losing seniority or benefits, or being forced into undesired changes, can be diminished if nurse leaders share changes in advance. In many instances, as Michaels said, “being affiliated with large healthcare system provides for growth and a strong financial base for all employees.”

While change is inevitable, nursing leaders such as Michaels and Reich, invite dialogue with their staffs and offer the following suggestions for easing growing pains:
* Don’t let the fear of the unknown overtake you.
* Rather than dwell on rumors, find out the facts. Seek accurate information from leadership.
* Attend open forums and meetings.
*Anticipate and grow with the change that comes from a merger, whether the change is to schedules, dress code or job titles.
* Watch for opportunities to get involved in the process.

“Nursing care at the bedside is still essential,” Michaels said. “As best practices are implemented, changes will benefit patient care and nurses.”

Reich concluded, “Support each other, and see the strength in working collaboratively.”


Karen Schmidt, RN, is a freelance writer. Post a comment below or email editor@nurse.com.