Hospitals average 100% staff turnover every 5 years — Here's what that costs

 Hospitals have been paying astronomical prices for staff turnover, according to the "2022 NSI National Health Care Retention & RN Staffing Report."

It covers 589,901 healthcare workers and 166,087 registered nurses from 272 facilities and 32 states. Participants were asked to report data on turnover, retention, vacancy rates, recruitment metrics and staffing strategies from January to December 2021. 

The survey found a wide range of helpful figures for understanding the financial fallout of one of healthcare's hardest labor disruptions:

• The average hospital lost $7.1 million in 2021 to higher turnover rates.

• The average hospital loses $5.2 to $9 million on RN turnover yearly.

• The average turnover cost for a staff RN is $46,100, up more than 15 percent from the 2020 average.

• The average hospital can save $262,300 per year for each percentage point it drops from its RN turnover rate.

• To improve margins, hospitals need to control labor costs by decreasing dependence on travel and agency staff, but only 22.7 percent anticipate being able to do so.

• For every 20 travel RNs eliminated, a hospital can save $4.2 million on average.

In the past 5 years, the average hospital turned over 100.5 percent of its workforce:

• In 2021, hospitals set a goal of reducing turnover by 4.8 percent. Instead, it increased 6.4 percent and ranged from 5.1 percent to 40.8 percent. The current average hospital turnover rate nationally is 25.9 percent, according to the report.

• While 72.6 percent of hospitals have a formal nurse retention strategy, less than half of those (44.5 percent) have a measurable goal.

• Overall, 55.5 percent of hospitals do not have a measurable nurse retention goal.

• Retirement is the number four reason staff RNs leave, and it is expected to remain a primary driver through 2030. More than half (52.8 percent) of hospitals today have a strategy to retain senior nurses. In 2018, only 21.6 percent had one.

Historically, RN turnover has trended below the hospital average across all staff. For the first time since conducting the survey, this is no longer true: 

• In the past five years, the average hospital turned over 95.7 percent of its RN workforce.

• Close to a third (31.0 percent) of all newly hired RNs left within a year, with first year turnover accounting for 27.7 percent of all RN separations. Given the projected surge in retirements, expect to see the more tenured groups edge up creating an inverted bell curve.

• Operating room RNs continue to be the toughest to recruit, while labor and delivery RNs are trending easier to recruit than in the year prior.

• Hospitals are experiencing a dramatically higher RN vacancy rate (17 percent) compared to last year's rate of 9.9 percent.

• The vast majority (81.3 percent) reported a vacancy rate higher than 10 percent.

https://www.beckershospitalreview.com/finance/hospitals-average-100-percent-staff-turnover-every-5-years-heres-what-that-costs.html

The U.S. Government’s Woke Training

 The Department of Veterans Affairs has a gender gingerbread person. NASA says beware of micro-inequities. And if U.S. Army servicewomen express “discomfort showering with a female who has male genitalia,” what’s the brass’s reply? Talk to your commanding officer, but toughen up.

These are details from hundreds of pages of diversity and inclusion training materials used by the federal government in 2021 and obtained under the Freedom of Information Act (FOIA). Everyone in corporate life knows such training, lampooned in the second episode of the TV show “The Office.” Yet taxpayers might be curious how their money is being spent to instruct the federal workforce these days.

Documents obtained via FOIA often lack context, so it’s hard to know the audience for any specific training and whether participation was voluntary or not-so-politely encouraged. With those caveats, press ahead.

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Asked for its diversity training, the U.S. Army offered three modules on transgender policy, one for “Commanders at all levels,” another for “Special Staff,” and a third for “Units and Soldiers.” Notable is a series of vignettes that cover pronoun usage, urinalysis observation, and a serviceman who wants “to discuss his newly confirmed pregnancy.” With respect to showers, schedules can be adjusted or curtains installed. But a soldier’s gender in the Army’s system governs which facilities are used. Accommodating only a transgender soldier is prohibited.

Also, stiff upper lip: “Anyone may encounter individuals in barracks, bathrooms, or shower facilities with physical characteristics of the opposite sex.” Transgender soldiers aren’t “required or expected to modify or adjust their behavior based on the fact that they do not ‘match’ other Soldiers.”

The VA’s “Managing Gender Diversity” training has sections on pronouns and embracing “gender-expansiveness.” One slide lists terms, including “gender fluid” and “pansexual,” while instructing: “List your personal ‘biases’ in the BIAS box.” A game of “PRIVILEGE BINGO” includes such items as “NO CRIMINAL RECORD,” “MILITARY EXPERIENCE,” and “MARRIED.”

A NASA training on “Allyship for Executives” says that the term “African American” is “utilized heavily in white spaces,” and it “can make Black people feel excluded as the term tends to ‘other.’” Another NASA slide series explains that inclusive leaders “are willing to be ‘uncomfortable’” in exploring “race, gender, sexual orientation” and so forth. “We have been taught to act as if we are colorblind and gender-neutral,” it adds, but “these efforts actually limit us.”

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A NASA tip sheet on microaggressions gives examples that include, “Asking an Asian person to help with a Math or Science problem,” as well as saying, “America is a melting pot.” A slide deck on inclusive language suggests nixing “the poor” and substituting “people dealing with economic hardship.” A talk to a NASA center by Janice Underwood, then the state of Virginia’s chief diversity officer, urges: “Walk toward the discomfort—when patterns of white supremacy are named or questioned, predictable defensive responses will emerge.” Ms. Underwood now leads the diversity bureau at the federal Office of Personnel Management.

A Department of Homeland Security presentation on “Inclusive Diversity” says that micro-inequities can be fought by micro-affirmations. “Social and Physical Pain Produce Similar Brain Responses,” it argues, using a cartoon rendition of two brain scans.

A National Science Foundation seminar presents data about the race and gender of the NSF’s workforce, before sending participants to breakout rooms to discuss. A National Endowment for the Arts program offers definitions for terms such as “White Fragility,” “Heterosexism,” and “Misogynoir.”

Some government bodies refused to release training materials created by outside vendors, citing a FOIA exemption for “confidential” commercial information. But contracts and lists of courses can shed a little light.

The Centers for Disease Control and Prevention provided training orders of about $313,000 for a slew of courses, such as “8 Tactics for Courageous Workplace Conversations About Race,” “Let’s Talk About Systemic Racism, Unconscious Bias and Privilege,” and “Silence is a Statement: Understanding Race in the Workplace.”

The Environmental Protection Agency’s course lists feature “Everyday Anti-Racism” and “Psychological Safety: Building a Culture of Inclusion and Innovation.” The Food and Drug Administration’s menu offers a two-hour seminar, “Checking Your Blindspot: Ways to Find and Fix Unconscious Bias.”

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These examples are, well, non-inclusive. Many of the materials are dull recitations of anti-retaliation policies or polite reminders, for example, not to pet somebody’s service dog. But one lesson is that there is now a conveyor belt from academia to the diversity-industrial complex. The portmanteau “misogynoir” was coined in 2010 on a blog called Crunk Feminist Collective. Eleven years later it’s in a training for government workers.

This type of re-education was accelerated by President Biden’s 2021 executive order directing agencies to “increase the availability and use of diversity, equity, inclusion, and accessibility training.” It’s a form of political indoctrination intended to impose woke values on the vast federal bureaucracy and U.S. military.

You’d think the agencies would be proud to post all of these materials online, where it doesn’t require a long wait and a records request to read them. But since they don’t, we thought readers might like to see their taxpayer dollars and government values at work.

https://www.wsj.com/articles/the-u-s-governments-woke-training-federal-employees-diversity-equity-inclusion-11672251764

Jonathan Haidt on the ‘National Crisis’ of Gen Z

 The phrase “generation gap” became popular in the late 1960s, as baby boomers were coming of age. To hear social psychologist Jonathan Haidt tell it, today’s generation gap has widened into a chasm. “We have a whole generation that’s doing terribly,” he says in an interview at his professorial office, book-lined and hushed, at New York University’s Stern School of Business. He calls it a “national crisis.”

At 59, Mr. Haidt is a young boomer, and he isn’t talking about millennials, some of whom are in their 40s by now. Rather, he has in mind the younger cohort, Generation Z, usually defined as those born between 1997 and 2012. “When you look at Americans born after 1995,” Mr. Haidt says, “what you find is that they have extraordinarily high rates of anxiety, depression, self-harm, suicide and fragility.” There has “never been a generation this depressed, anxious and fragile.”

He attributes this to the combination of social media and a culture that emphasizes victimhood. The latter was the subject of his most recent book, “The Coddling of the American Mind: How Good Intentions and Bad Ideas Are Setting Up a Generation for Failure” (2018), with co-author Greg Lukianoff. Social media is Mr. Haidt’s present obsession. He’s working on two books that address its harmful impact on American society: “Kids in Space: Why Teen Mental Health Is Collapsing” and “Life After Babel: Adapting to a World We Can No Longer Share.”

The former title is a metaphor. Mr. Haidt imagines “literally launching our children into outer space” and letting their bodies grow there: “They would come out deformed and broken. Their limbs wouldn’t be right. You can’t physically grow up in outer space. Human bodies can’t do that.” Yet “we basically do that to them socially. We launched them into outer space around the year 2012,” he says, “and then we expect that they will grow up normally without having normal human experiences.”

Mr. Haidt’s research, confirmed by that of others, shows that depression rates started to rise “all of a sudden” around 2013, “especially for teen girls,” but “it’s only Gen Z, not the older generations.” If you’d stopped collecting data in 2011, he says, you’d see little change from previous years. “By 2015 it’s an epidemic.” (His data are available in an open-source document.)

What happened in 2012, when the oldest Gen-Z babies were in their middle teens? That was the year Facebook acquired Instagram and young people flocked to the latter site. It was also “the beginning of the selfie era.” Apple’s iPhone 4, released in 2010, had the first front-facing camera, which was much improved in the iPhone 5, introduced two years later. Social media and selfies hit a generation that had led an overprotected childhood, in which the age at which children were allowed outside on their own by parents had risen from the norm of previous generations, 7 or 8, to between 10 and 12.

That meant the first social-media generation was one of “weakened kids” who “hadn’t practiced the skills of adulthood in a low-stakes environment” with other children. They were deprived of “the normal toughening, the normal strengthening, the normal anti-fragility.” Before 2010, teenagers had flip phones. “They’d text each other and say, ‘Let’s meet down at the mall.’ They would do things together.” Now, their childhood “is largely just through the phone. They no longer even hang out together.” Teenagers even drive less than earlier generations did.

Mr. Haidt especially worries about girls. By 2020 more than 25% of female teenagers had “a major depression.” The comparable number for boys was just under 9%. The comparable numbers for millennials at the same age registered at half the Gen-Z rate: about 13% for girls and 5% for boys. “Kids are on their devices all the time,” he says, but boys play videogames, often in groups: “Boys thrive if they have a group of boys competing against another group of boys.”

Most girls, by contrast, are drawn to “visual platforms,” Instagram and TikTok in particular. “Those are about display and performance. You post your perfect life, and then you flip through the photos of other girls who have a more perfect life, and you feel depressed.” He calls this phenomenon “compare and despair” and says: “It seems social because you’re communicating with people. But it’s performative. You don’t actually get social relationships. You get weak, fake social links.”

Mr. Haidt says he has no antipathy toward the young, and he calls millennials “amazing.” Older folks make fun of them, “but that’s the normal teasing across generations that you get going back to Plato.” To illustrate his point about Gen Z, Mr. Haidt challenges people to name young people today who are “really changing the world, who are doing big things that have an impact beyond their closed ecosystem.” He can think of only two, neither of them American: Greta Thunberg, 19, the Swedish climate militant, and Malala Yousafzai, 25, the Pakistani advocate for female education. By contrast, he says millennials remade the “entire world”—though not necessarily for the better. Mark Zuckerberg, born in 1984, founded Facebook when he was 20.

He concedes that his judgment of Gen Z may be premature: “It could be that you’ll see some impact in three or four years, by the time they’re 30. But I’m predicting that they will be less effective, less impactful, than previous generations.” Why? “You should always keep your eye on whether people are in ‘discover mode’ or ‘defend mode.’ ” In the former mode, you seize opportunities to be creative. In the latter, “you’re not creative, you’re not future-thinking, you’re focused on threats in the present.”

https://www.wsj.com/articles/the-national-crisis-of-generation-z-jonathan-haidt-social-media-performance-anxiety-fragility-gap-childhood-11672401345

Our immigration courts have a 2,023,441 case backlog

 The Border Patrol had more than 2.2 million encounters with illegal crossers between ports of entry on the Southwest border in fiscal 2022.   

A recent report from the DHS Inspector General indicates that most of the illegal crossers are not put in detention facilities or expelled under Title 42, but rather are processed for outcomes allowing them to be released into the United States to wait for immigration hearings. This has overwhelmed the immigration courts.  

The immigration court backlog was 1,262,765 cases at the end of fiscal 2020, which was the last full fiscal year of the previous administration. Under the current administration, it has risen to 2,023,441 cases as of the end of November 2022.  

Almost 800,000 of them have submitted asylum applications and are waiting for an asylum hearing. The average wait from when an application is filed to when an applicant’s case will be heard is 1,572 days, or 4.3 years.  

DHS Secretary Alejandro Mayorkas has been criticized for lack of border enforcement. (AP Photo/Jose Luis Magana)

Moreover, many others have been allowed to enter the United States to wait for an asylum hearing but have not filed an asylum application yet. And the number of asylum seekers is likely to increase greatly when Title 42 is terminated. 

The administration seems to want to deal with this problem by finding faster ways to adjudicate the applications instead of admitting fewer asylum seekers to give the immigration court a chance to catch up. 

For instance, on May 28, 2021, the administration announced a new Dedicated Docket which is supposed to expeditiously and fairly make decisions on the immigration cases of newly arrived families who are apprehended between ports of entry at the Southwest Border. INA §1325(a) provides that such entries are crimes subject to imprisonment for up to two years. 

DHS Secretary Alejandro Mayorkas says in the announcement that, "Families who have recently arrived should not languish in a multi-year backlog; today’s announcement is an important step for both justice and border security."  

He is referring to newly arriving families, not the families who already are languishing in the multi-year backlog. 

The announcement concludes that while "the goal of this process is to decide cases expeditiously, fairness will not be compromised." 

Dedicated Dockets are not new or fair. 

The Obama and Trump administrations also had Dedicated Dockets for newly arriving migrants to prevent them from having to wait a long time for a hearing. 

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The Vera Institute of Justice claims that as prior efforts to use expedited dockets have demonstrated, Dedicated Dockets do not provide due process. Court records for a two-year period during the Obama administration show that it was rare for an unrepresented family in Dedicated Docket proceedings to file the papers needed to seek asylum or other forms of relief from deportation. Only 1 in 15 (6.5 percent) managed to do this without representation. 

According to a recent TRAC report, more than 110,000 cases have been assigned to the current administration’s Dedicated Docket, and nearly 40,000 of them have been completed. The vast majority (83%) of the completed cases were closed within 300 days from the date of receiving a Notice to Appear in removal proceedings.  

But a price must be paid for doing this. Georgetown Law School Professor Paul Schmidt points out that when Dedicated Docket judges are not available to hear cases on the general docket, it places extra burdens on their judicial colleagues who are handling the general docket cases. 

And taking judges away from the general docket to serve on the Dedicated Docket also reduces the number of judges who are available for doing cases that would reduce the backlog.  

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TRAC found that only 34% of the families whose cases have been completed had representation, and few families without representation have been able to complete the paperwork required for filing an asylum application.  

Overall, only 2,894 out of 39,187 families who had hearings in fiscal 2022 were granted asylum. The cases in which asylum was granted represent just 7.4% of the completed cases. 

The Vera Institute of Justice would address this problem by providing representation for every migrant in Dedicated Docket proceedings.  According to the Institute, "No immigrant should be forced to go through immigration court proceedings without legal defense."  

Is that even possible?  And if it is possible, who is going to pay for it?  INA §1229a(b)(4), which provides that migrants have the "privilege of being represented" in removal proceedings, specifies that it must be "at no expense to the Government." 

Frankly, I think the main problem is that the administration is flooding our already overwhelmed immigration court with a tsunami of illegal crossers who claim that they are asylum seekers. 

The attempt to relieve the immigration court's backlog crisis with a Dedicated Docket didn’t work for the Obama administration and it isn’t working for the current administration either.

Nolan Rappaport was detailed to the House Judiciary Committee as an executive branch immigration law expert for three years. He subsequently served as an immigration counsel for the Subcommittee on Immigration, Border Security and Claims for four years. Prior to working on the Judiciary Committee, he wrote decisions for the Board of Immigration Appeals for 20 years. Follow him at: https://nolanhillop-eds.blogspot.com 

https://www.foxnews.com/opinion/bidens-border-crisis-immigration-courts-have-2023441-case-backlog-more-handle

Biden Department of Justice looks the other way as judges targeted

 In 2022, a California resident was arrested in U.S. Supreme Court Justice Brett Kavanaugh’s Maryland neighborhood after transporting weapons across state lines to allegedly assassinate him. This attempt followed weeks of potentially unlawful demonstrations outside the homes of the conservative justices after a leaked, draft opinion showed that Roe v. Wade would be overturned.

If this incident had happened to a Democrat-appointed justice, there would have been universal outrage from both sides of the aisle and swift passage of federal legislation to protect members of the judiciary. 

However, an attempted assassination on a Republican-appointed justice was met with almost no coverage on subsequent Sunday political shows and a delayed vote in the Democrat-controlled House of Representatives on a bill to extend greater protections to Supreme Court Justices and their families.

The Kavanaugh episode may be one of the most egregious against our judges in recent memory, but it is not isolated. According to the National Judicial College, "71% of judges have received an inappropriate communication related to their position, and 56% have received a threat." 

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As someone who has sued the federal government many times and been on both sides of judicial decisions in very controversial cases, I see the concerning rise in tone and rhetoric against our independent judiciary on both sides of the aisle – but especially from the left.

For example, after Judge Aileen Cannon, from the U.S. District Court for the Southern District of Florida, ruled in favor of a Special Master in the case involving former-President Trump and the Biden-led Department of Justice, the left’s outrage was dangerously close to inciting violence against the American judicial system. 

We look no further than a Sept. 6 tweet from Keith Olbermann that called for Judge Cannon to be "indicted and arrested" if she did not "vacate her order for a Special Master."

This issue is personal for my family. My wife is a federal judge, and as a member of the judiciary, she is entitled to a protected address. We could never imagine dozens of demonstrators outside of our home in a last-ditch effort to influence or intimidate her before or after one of her rulings. Judges’ families should not have to live in fear because of lawful decisions handed down from the judicial benches around this country.

There is no room for any intimidation of our federal judiciary, and yet we have seen the Biden Department of Justice continually look the other way when Republican-appointed justices or judges are targeted for potentially illegal protests. 

The path we are on now has been forged by every tin-horn dictator and Marxist revolutionary around the world and throughout history. It has been said that where the law ends, tyranny begins. But likewise, where an independent judiciary ends, Marxism begins.

An independent judiciary is the bulwark of a functioning and representative democracy. Our Founding Fathers set up a system of government where the judicial branch interprets the law. That responsibility demands that federal judges have no fear of reprisals from any disgruntled whims and that they remain true only to the U.S. Constitution and our laws. An assault on our judiciary is an assault on our entire system of government.

This doesn’t mean that, from inception, America’s judicial branch has been perfect. Judges on the federal branch – all the way to the Supreme Court – have at times disappointed Americans with their rulings across the entire political spectrum. There are many cases that have been decided wrongly and have been reversed, or have yet to be overturned. Such is life in the Constitutional Republic in which we live. Justice may take time, but it ultimately prevails.

Members of the Supreme Court pose for a group photo at the Supreme Court in Washington, DC on April 23, 2021. Seated from left: Associate Justice Samuel Alito, Associate Justice Clarence Thomas, Chief Justice John Roberts, Associate Justice Stephen Breyer and Associate Justice Sonia Sotomayor, Standing from left: Associate Justice Brett Kavanaugh, Associate Justice Elena Kagan, Associate Justice Neil Gorsuch and Associate Justice Amy Coney Barrett.  (Erin Schaff-Pool/Getty Images)

However, no one in public office should ever fear for their lives or livelihoods – or that of their families – for simply attempting to uphold their constitutional duties. 

That’s why, in 2021, I co-led a bipartisan coalition of attorneys general who urged Congress to pass legislation to protect the safety of federal judges and their families. I have also called on U.S. Attorney General Merrick Garland to enforce existing federal laws to stop attempts to intimidate Supreme Court Justices.

Yet unfortunately, this is becoming our new normal across America. The far-left has undermined our institutions and values for decades and has set its sights on coercing landmark Supreme Court opinions to sustain its radical agenda. This will not end well for the men and women who serve on our nation’s highest court, which is why Congress and the U.S. Attorney General must act immediately to prevent a catastrophic tragedy from occurring.

Everyone in our society, from the media to elected officials, should soundly and immediately condemn any attempts to subvert our democracy with intimidation tactics or violence against federal judges or Justices on the U.S. Supreme Court. Regardless of the issue being deliberated, all Americans must stand together to protect and preserve our independent judiciary.

https://www.foxnews.com/opinion/2023-cannot-tolerate-intimidation-judiciary

Analysts Predict 1 Million Bpd Drop in Russian Crude Output

 By Charles Kennedy of OilPrice.com

• UBS' Giovanni Staunovo: The European Union’s ban on Russian oil products set to come into force on February 5 could lead to a 1 million barrel per day drop in Russian crude oil output for the New Year.
• Moscow has also warned it could cut production by up to 700,000 bpd as it responds to the $60/barrel price cap on its oil implemented by the G7 in December.
• According to Energy Intelligence, Russian refineries are already struggling with a labor shortage due to conscription for Putin’s war on Ukraine.

The European Union’s ban on Russian oil products set to come into force on February 5 could lead to a 1 million barrel per day drop in Russian crude oil output for the New Year, commodity analysts for UBS told Insider on Monday.

"We expect the European ban on seaborne Russian crude and refined products (to come into force on February 5) to result in a drop of Russian production of at least 1 million barrels per day in 2023, with Russia having difficulties in finding alternative markets," UBS’ Giovanni Staunovo, told Insider.

While Russia has been rerouting crude volumes to Asia, traders are finding it increasingly challenging to secure the necessary insured vessels to carry sanctioned Russian crude. As of the first week of December, Moscow was sending nearly 90% of its crude to Asia. 

Moscow has also warned it could cut production by up to 700,000 bpd as it responds to the $60/barrel price cap on its oil implemented by the G7 in December.

Another analyst, Saxo Bank’s Ole Hansen, told Insider that global supplies will experience more tightness, leading oil prices to top $100 bpd this year, once Chinese demand improves. 

"Following a soft first quarter, I see the price of Brent returning to a $90-100 dollar range. What happens later will depend on the strength of an incoming economic slowdown," Saxo told Insider. 

Russia boasts the world’s third-largest refining industry, and the EU ban that goes into effect on February 5 is expected to have a fairly significant impact. 

According to Energy Intelligence, Russian refineries are already struggling with a labor shortage due to conscription for Putin’s war on Ukraine. Energy Intel analysts expect to see a further decline in Russian refining margins this year as they pay more for tankers to export further, predicting a 600,000-bpd drop in refining throughput in 2023, year-on-year.

https://www.zerohedge.com/markets/analysts-predict-1-million-bpd-drop-russian-crude-output