University of Iowa hospital eyeing $95M ‘vertical expansion of inpatient tower’

cigaretteman

HR King
May 29, 2001
72,188
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Well before University of Iowa Hospitals and Clinics erects a new tower for patients — a long-term project officials revealed earlier this year as part of a 10-year master plan for the main campus — it is looking to spend $95 million adding two floors onto its existing inpatient tower.


The UI this week issued a request for proposals from prospective construction managers for a “vertical expansion of inpatient tower” project on which crews would start work next summer, according to a university timeline. The total project budget, according to the UI request, is $95 million with the construction portion accounting for $50.4 million.


A summary of the project, spelled out in the request for qualifications from interested construction managers, indicated UIHC aims to add two floors to its existing eight-floor John Pappajohn Pavilion, increasing the tower to 10 stories by adding a total of 38,000 square feet.


Advertisement

The budget also includes renovating floors seven and eight.


The new level nine will house an intensive care unit of 24-beds, and level 10 will become a “new mechanical penthouse serving the floors below.” The renovated level seven, encompassing about 33,000 square feet, and level eight, involving about 19,000 square feet, will include new delivery and postpartum OB/GYN care spaces, including inpatient beds, according to the request.


“The construction will be phased to accommodate current hospital operations,” according to the documents, which call for construction manager proposals by Aug. 23.


UI plans to notify a shortlist of finalists by Aug. 31 with selection coming after September, according to the request. UI Facilities Management records indicate it recently chose RDG Planning & Design from Des Moines for the architectural design services.


Budget, design OK still needed​


The documents report UIHC’s governing Board of Regents authorized it to enter into the pre-design and schematic design phase of the project. Board spokesman Josh Lehman said the project is part of a 10-year master plan that the UI presented to the board in January, when regents gave it “permission to proceed with planning.”


“They would need to come before the board again for approval on project design and budget,” Lehman said.


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UI’s master plan documents made public earlier this year did not specifically outline any $95 million two-story vertical expansion of the John Pappajohn Pavillion, although it did mention the work vaguely in a timeline for three main modernization projects planned through 2031. Those new projects include:


  • An 842,000-gross-square-foot inpatient tower;

  • A 320,000-gross-square-foot research and academic facility;

  • And a 709,800-gross-square-foot outpatient tower.

“Enabling projects” — paving the way for those bigger towers and research facilities — included utilities, demolitions, relocations, parking and roads, according to a UI master plan slideshow.


Among projects mentioned in a timeline for the UIHC campus modernization is “JPP Pavilion expansion (up),” emergency department expansion and internal renovations.


'Renew, right-size and improve’​


The $95 million upward expansion will add to a growing list of projects UIHC is engaged in on and off its main campus.


UI Health Care last fall begin work on a 469,000-square-foot hospital campus in North Liberty — with officials recently increasing that project’s budget 33 percent from $395 million to $525.6 million due to inflation. UIHC also is spending up to $15 million to replace windows in its relatively new 14-story Stead Family Children’s Hospital while it pursues a lawsuit against the manufacturer.


In addition to a list of more minor renovations across its main campus and hospital parking ramps — although some still topping $1 million — UIHC recently chose CMBA Architects PC of Des Moines and Miron Construction of Cedar Rapids to design and construct an emergency department expansion.


For the tower expansion at the center of UIHC’s recent request, officials are employing a “construction manager at risk” model involving a “guaranteed maximum price” for the work.


“The construction manager at risk shall assume responsibility for all costs of construction in excess of the (guaranteed maximum price),” according to the document.


In making its case for a new tower offering additional inpatient beds, UIHC in January told regents more than 44 percent of its aging hospitals beds will be obsolete 10 years from now “without renovation and modernization.” Meanwhile, Iowa’s health care needs will continue to expand.


“Iowa will need UIHC to grow by over 400 beds to satisfy complex health care needs of Iowans,” according to the university’s master plan presentation. “If UIHC runs out of capacity, UIHC’s financial stability will be threatened.”


The majority of that 400-bed need will come in “adult acute care,” with UIHC projecting it will need 279 more of those beds by 2031, plus 49 adult critical care beds, 19 pediatric beds and 77 for behavioral health.


“The large increase in the number of patients that need to be seen at UIHC is driven by the aging of the population (creating more complex care needs) and retirement of community providers,” according to the UIHC presentation.


Hospital officials said they’re committed to partnering with community hospitals and finding new efficiencies on campus — saving them from adding 196 beds to their 400-bed need.


Across its campuses, UIHC’s proposed growth over the next decade is expected to increase its inpatient bed days from 256,653 to 302,113; emergency visits from 52,987 to 69,338; surgical cases from 33,764 to 47,912; and clinic visits from 1.2 million to 1.8 million.


“The 10-year facilities plan, for both the UI and UIHC, intends to renew, right-size and improve our campus, for students, faculty, staff and visitors and for citizens of the State of Iowa who rely on highest quality health care,” according to the UI presentation.

 
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GOHOX69

HR Legend
Sep 26, 2009
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Well before University of Iowa Hospitals and Clinics erects a new tower for patients — a long-term project officials revealed earlier this year as part of a 10-year master plan for the main campus — it is looking to spend $95 million adding two floors onto its existing inpatient tower.


The UI this week issued a request for proposals from prospective construction managers for a “vertical expansion of inpatient tower” project on which crews would start work next summer, according to a university timeline. The total project budget, according to the UI request, is $95 million with the construction portion accounting for $50.4 million.


A summary of the project, spelled out in the request for qualifications from interested construction managers, indicated UIHC aims to add two floors to its existing eight-floor John Pappajohn Pavilion, increasing the tower to 10 stories by adding a total of 38,000 square feet.


Advertisement

The budget also includes renovating floors seven and eight.


The new level nine will house an intensive care unit of 24-beds, and level 10 will become a “new mechanical penthouse serving the floors below.” The renovated level seven, encompassing about 33,000 square feet, and level eight, involving about 19,000 square feet, will include new delivery and postpartum OB/GYN care spaces, including inpatient beds, according to the request.


“The construction will be phased to accommodate current hospital operations,” according to the documents, which call for construction manager proposals by Aug. 23.


UI plans to notify a shortlist of finalists by Aug. 31 with selection coming after September, according to the request. UI Facilities Management records indicate it recently chose RDG Planning & Design from Des Moines for the architectural design services.


Budget, design OK still needed​


The documents report UIHC’s governing Board of Regents authorized it to enter into the pre-design and schematic design phase of the project. Board spokesman Josh Lehman said the project is part of a 10-year master plan that the UI presented to the board in January, when regents gave it “permission to proceed with planning.”


“They would need to come before the board again for approval on project design and budget,” Lehman said.


Daily News​


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checkmark-yellow.png
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UI’s master plan documents made public earlier this year did not specifically outline any $95 million two-story vertical expansion of the John Pappajohn Pavillion, although it did mention the work vaguely in a timeline for three main modernization projects planned through 2031. Those new projects include:


  • An 842,000-gross-square-foot inpatient tower;

  • A 320,000-gross-square-foot research and academic facility;

  • And a 709,800-gross-square-foot outpatient tower.

“Enabling projects” — paving the way for those bigger towers and research facilities — included utilities, demolitions, relocations, parking and roads, according to a UI master plan slideshow.


Among projects mentioned in a timeline for the UIHC campus modernization is “JPP Pavilion expansion (up),” emergency department expansion and internal renovations.


'Renew, right-size and improve’​


The $95 million upward expansion will add to a growing list of projects UIHC is engaged in on and off its main campus.


UI Health Care last fall begin work on a 469,000-square-foot hospital campus in North Liberty — with officials recently increasing that project’s budget 33 percent from $395 million to $525.6 million due to inflation. UIHC also is spending up to $15 million to replace windows in its relatively new 14-story Stead Family Children’s Hospital while it pursues a lawsuit against the manufacturer.


In addition to a list of more minor renovations across its main campus and hospital parking ramps — although some still topping $1 million — UIHC recently chose CMBA Architects PC of Des Moines and Miron Construction of Cedar Rapids to design and construct an emergency department expansion.


For the tower expansion at the center of UIHC’s recent request, officials are employing a “construction manager at risk” model involving a “guaranteed maximum price” for the work.


“The construction manager at risk shall assume responsibility for all costs of construction in excess of the (guaranteed maximum price),” according to the document.


In making its case for a new tower offering additional inpatient beds, UIHC in January told regents more than 44 percent of its aging hospitals beds will be obsolete 10 years from now “without renovation and modernization.” Meanwhile, Iowa’s health care needs will continue to expand.


“Iowa will need UIHC to grow by over 400 beds to satisfy complex health care needs of Iowans,” according to the university’s master plan presentation. “If UIHC runs out of capacity, UIHC’s financial stability will be threatened.”


The majority of that 400-bed need will come in “adult acute care,” with UIHC projecting it will need 279 more of those beds by 2031, plus 49 adult critical care beds, 19 pediatric beds and 77 for behavioral health.


“The large increase in the number of patients that need to be seen at UIHC is driven by the aging of the population (creating more complex care needs) and retirement of community providers,” according to the UIHC presentation.


Hospital officials said they’re committed to partnering with community hospitals and finding new efficiencies on campus — saving them from adding 196 beds to their 400-bed need.


Across its campuses, UIHC’s proposed growth over the next decade is expected to increase its inpatient bed days from 256,653 to 302,113; emergency visits from 52,987 to 69,338; surgical cases from 33,764 to 47,912; and clinic visits from 1.2 million to 1.8 million.


“The 10-year facilities plan, for both the UI and UIHC, intends to renew, right-size and improve our campus, for students, faculty, staff and visitors and for citizens of the State of Iowa who rely on highest quality health care,” according to the UI presentation.

Maybe they can stop hiring 3'rd rate physicians first and prevent a free fall in their ratings. Nyah, why would they do that?
 

Fair Child

HR All-State
Gold Member
Oct 21, 2019
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Maybe they can stop hiring 3'rd rate physicians first and prevent a free fall in their ratings. Nyah, why would they do that?
Funny story— my husband was in UIHC with gallbladder issues and tests. I had just left for the drive back to CR when he calls and say I better come back,got some bad news. Some foreign dr whom he could hardly understand came in and told him his x ray showed he had spots on his lung. Holy crap!I raced back only to find out that about 1/2 hr later he came back in and said: “Sorry Mr, I gave you another guy’s results. Wasn’t funny then,but fortunately got to breathe a sigh of relief.
 
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Huey Grey

HR Legend
Jan 15, 2013
49,308
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It's insane how routinely the hospital drops coin on stuff like this. $100 mill, $500 mill, it doesn't matter.
 
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GOHOX69

HR Legend
Sep 26, 2009
14,493
18,177
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Funny story— my husband was in UIHC with gallbladder issues and tests. I had just left for the drive back to CR when he calls and say I better come back,got some bad news. Some foreign dr whom he could hardly understand came in and told him his x ray showed he had spots on his lung. Holy crap!I raced back only to find out that about 1/2 hr later he came back in and said: “Sorry Mr, I gave you another guy’s results. Wasn’t funny then,but fortunately got to breathe a sigh of relief.
That's nuts.
 

theiacowtipper

HR Legend
Gold Member
Feb 17, 2004
14,532
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Rumor is you will be able to see Keokuk from rooftop.
I see what you did here. This is the future of healthcare. Regional hospitals that you will go to for admissions. Referrals. This is where you’ll have to go to see any specialist. Dermatology neurology cardiology obstetrics etc. Probably supplemented by mid level practitioners outreaching to local hospitals.

The only thing that small hospitals will have is outpatient services like radiology and lab. Maybe an emergency department in larger communities. There may be a few mid size hospitals that admit patients. Now, in iowa, you have a few healthcare systems dominating. Unity Point, Mercy, and of course UIHC.

Selfishly, in EMS, it puts a huge strain in the system. Unless reimbursement for transport to urgent is a thing, pipe dream, there’s going to be a lot more 30-50 mile trips in an ambulance. Will the second caller even se a truck?
 

BioHawk

HR Legend
Sep 21, 2005
39,354
40,910
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I see what you did here. This is the future of healthcare. Regional hospitals that you will go to for admissions. Referrals. This is where you’ll have to go to see any specialist. Dermatology neurology cardiology obstetrics etc. Probably supplemented by mid level practitioners outreaching to local hospitals.

The only thing that small hospitals will have is outpatient services like radiology and lab. Maybe an emergency department in larger communities. There may be a few mid size hospitals that admit patients. Now, in iowa, you have a few healthcare systems dominating. Unity Point, Mercy, and of course UIHC.

Selfishly, in EMS, it puts a huge strain in the system. Unless reimbursement for transport to urgent is a thing, pipe dream, there’s going to be a lot more 30-50 mile trips in an ambulance. Will the second caller even se a truck?
This is what exists where I live. Had it existed when my second daughter was born I probably would have been pulled over on the side of the road helping my wife give birth.
 

Joes Place

HR King
Aug 28, 2003
125,187
121,220
113
Well before University of Iowa Hospitals and Clinics erects a new tower for patients — a long-term project officials revealed earlier this year as part of a 10-year master plan for the main campus — it is looking to spend $95 million adding two floors onto its existing inpatient tower.


The UI this week issued a request for proposals from prospective construction managers for a “vertical expansion of inpatient tower” project on which crews would start work next summer, according to a university timeline. The total project budget, according to the UI request, is $95 million with the construction portion accounting for $50.4 million.


A summary of the project, spelled out in the request for qualifications from interested construction managers, indicated UIHC aims to add two floors to its existing eight-floor John Pappajohn Pavilion, increasing the tower to 10 stories by adding a total of 38,000 square feet.


Advertisement

The budget also includes renovating floors seven and eight.


The new level nine will house an intensive care unit of 24-beds, and level 10 will become a “new mechanical penthouse serving the floors below.” The renovated level seven, encompassing about 33,000 square feet, and level eight, involving about 19,000 square feet, will include new delivery and postpartum OB/GYN care spaces, including inpatient beds, according to the request.


“The construction will be phased to accommodate current hospital operations,” according to the documents, which call for construction manager proposals by Aug. 23.


UI plans to notify a shortlist of finalists by Aug. 31 with selection coming after September, according to the request. UI Facilities Management records indicate it recently chose RDG Planning & Design from Des Moines for the architectural design services.


Budget, design OK still needed​


The documents report UIHC’s governing Board of Regents authorized it to enter into the pre-design and schematic design phase of the project. Board spokesman Josh Lehman said the project is part of a 10-year master plan that the UI presented to the board in January, when regents gave it “permission to proceed with planning.”


“They would need to come before the board again for approval on project design and budget,” Lehman said.


Daily News​


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checkmark-yellow.png
Delivered to your inbox every day







UI’s master plan documents made public earlier this year did not specifically outline any $95 million two-story vertical expansion of the John Pappajohn Pavillion, although it did mention the work vaguely in a timeline for three main modernization projects planned through 2031. Those new projects include:


  • An 842,000-gross-square-foot inpatient tower;

  • A 320,000-gross-square-foot research and academic facility;

  • And a 709,800-gross-square-foot outpatient tower.

“Enabling projects” — paving the way for those bigger towers and research facilities — included utilities, demolitions, relocations, parking and roads, according to a UI master plan slideshow.


Among projects mentioned in a timeline for the UIHC campus modernization is “JPP Pavilion expansion (up),” emergency department expansion and internal renovations.


'Renew, right-size and improve’​


The $95 million upward expansion will add to a growing list of projects UIHC is engaged in on and off its main campus.


UI Health Care last fall begin work on a 469,000-square-foot hospital campus in North Liberty — with officials recently increasing that project’s budget 33 percent from $395 million to $525.6 million due to inflation. UIHC also is spending up to $15 million to replace windows in its relatively new 14-story Stead Family Children’s Hospital while it pursues a lawsuit against the manufacturer.


In addition to a list of more minor renovations across its main campus and hospital parking ramps — although some still topping $1 million — UIHC recently chose CMBA Architects PC of Des Moines and Miron Construction of Cedar Rapids to design and construct an emergency department expansion.


For the tower expansion at the center of UIHC’s recent request, officials are employing a “construction manager at risk” model involving a “guaranteed maximum price” for the work.


“The construction manager at risk shall assume responsibility for all costs of construction in excess of the (guaranteed maximum price),” according to the document.


In making its case for a new tower offering additional inpatient beds, UIHC in January told regents more than 44 percent of its aging hospitals beds will be obsolete 10 years from now “without renovation and modernization.” Meanwhile, Iowa’s health care needs will continue to expand.


“Iowa will need UIHC to grow by over 400 beds to satisfy complex health care needs of Iowans,” according to the university’s master plan presentation. “If UIHC runs out of capacity, UIHC’s financial stability will be threatened.”


The majority of that 400-bed need will come in “adult acute care,” with UIHC projecting it will need 279 more of those beds by 2031, plus 49 adult critical care beds, 19 pediatric beds and 77 for behavioral health.


“The large increase in the number of patients that need to be seen at UIHC is driven by the aging of the population (creating more complex care needs) and retirement of community providers,” according to the UIHC presentation.


Hospital officials said they’re committed to partnering with community hospitals and finding new efficiencies on campus — saving them from adding 196 beds to their 400-bed need.


Across its campuses, UIHC’s proposed growth over the next decade is expected to increase its inpatient bed days from 256,653 to 302,113; emergency visits from 52,987 to 69,338; surgical cases from 33,764 to 47,912; and clinic visits from 1.2 million to 1.8 million.


“The 10-year facilities plan, for both the UI and UIHC, intends to renew, right-size and improve our campus, for students, faculty, staff and visitors and for citizens of the State of Iowa who rely on highest quality health care,” according to the UI presentation.


UNPOSSIBLE


ObamaCare was going to put them all out of business....
 

Joes Place

HR King
Aug 28, 2003
125,187
121,220
113
Well before University of Iowa Hospitals and Clinics erects a new tower for patients — a long-term project officials revealed earlier this year as part of a 10-year master plan for the main campus — it is looking to spend $95 million adding two floors onto its existing inpatient tower.


The UI this week issued a request for proposals from prospective construction managers for a “vertical expansion of inpatient tower” project on which crews would start work next summer, according to a university timeline. The total project budget, according to the UI request, is $95 million with the construction portion accounting for $50.4 million.


A summary of the project, spelled out in the request for qualifications from interested construction managers, indicated UIHC aims to add two floors to its existing eight-floor John Pappajohn Pavilion, increasing the tower to 10 stories by adding a total of 38,000 square feet.


Advertisement

The budget also includes renovating floors seven and eight.


The new level nine will house an intensive care unit of 24-beds, and level 10 will become a “new mechanical penthouse serving the floors below.” The renovated level seven, encompassing about 33,000 square feet, and level eight, involving about 19,000 square feet, will include new delivery and postpartum OB/GYN care spaces, including inpatient beds, according to the request.


“The construction will be phased to accommodate current hospital operations,” according to the documents, which call for construction manager proposals by Aug. 23.


UI plans to notify a shortlist of finalists by Aug. 31 with selection coming after September, according to the request. UI Facilities Management records indicate it recently chose RDG Planning & Design from Des Moines for the architectural design services.


Budget, design OK still needed​


The documents report UIHC’s governing Board of Regents authorized it to enter into the pre-design and schematic design phase of the project. Board spokesman Josh Lehman said the project is part of a 10-year master plan that the UI presented to the board in January, when regents gave it “permission to proceed with planning.”


“They would need to come before the board again for approval on project design and budget,” Lehman said.


Daily News​


Newsletter Signup
checkmark-yellow.png
Delivered to your inbox every day







UI’s master plan documents made public earlier this year did not specifically outline any $95 million two-story vertical expansion of the John Pappajohn Pavillion, although it did mention the work vaguely in a timeline for three main modernization projects planned through 2031. Those new projects include:


  • An 842,000-gross-square-foot inpatient tower;

  • A 320,000-gross-square-foot research and academic facility;

  • And a 709,800-gross-square-foot outpatient tower.

“Enabling projects” — paving the way for those bigger towers and research facilities — included utilities, demolitions, relocations, parking and roads, according to a UI master plan slideshow.


Among projects mentioned in a timeline for the UIHC campus modernization is “JPP Pavilion expansion (up),” emergency department expansion and internal renovations.


'Renew, right-size and improve’​


The $95 million upward expansion will add to a growing list of projects UIHC is engaged in on and off its main campus.


UI Health Care last fall begin work on a 469,000-square-foot hospital campus in North Liberty — with officials recently increasing that project’s budget 33 percent from $395 million to $525.6 million due to inflation. UIHC also is spending up to $15 million to replace windows in its relatively new 14-story Stead Family Children’s Hospital while it pursues a lawsuit against the manufacturer.


In addition to a list of more minor renovations across its main campus and hospital parking ramps — although some still topping $1 million — UIHC recently chose CMBA Architects PC of Des Moines and Miron Construction of Cedar Rapids to design and construct an emergency department expansion.


For the tower expansion at the center of UIHC’s recent request, officials are employing a “construction manager at risk” model involving a “guaranteed maximum price” for the work.


“The construction manager at risk shall assume responsibility for all costs of construction in excess of the (guaranteed maximum price),” according to the document.


In making its case for a new tower offering additional inpatient beds, UIHC in January told regents more than 44 percent of its aging hospitals beds will be obsolete 10 years from now “without renovation and modernization.” Meanwhile, Iowa’s health care needs will continue to expand.


“Iowa will need UIHC to grow by over 400 beds to satisfy complex health care needs of Iowans,” according to the university’s master plan presentation. “If UIHC runs out of capacity, UIHC’s financial stability will be threatened.”


The majority of that 400-bed need will come in “adult acute care,” with UIHC projecting it will need 279 more of those beds by 2031, plus 49 adult critical care beds, 19 pediatric beds and 77 for behavioral health.


“The large increase in the number of patients that need to be seen at UIHC is driven by the aging of the population (creating more complex care needs) and retirement of community providers,” according to the UIHC presentation.


Hospital officials said they’re committed to partnering with community hospitals and finding new efficiencies on campus — saving them from adding 196 beds to their 400-bed need.


Across its campuses, UIHC’s proposed growth over the next decade is expected to increase its inpatient bed days from 256,653 to 302,113; emergency visits from 52,987 to 69,338; surgical cases from 33,764 to 47,912; and clinic visits from 1.2 million to 1.8 million.


“The 10-year facilities plan, for both the UI and UIHC, intends to renew, right-size and improve our campus, for students, faculty, staff and visitors and for citizens of the State of Iowa who rely on highest quality health care,” according to the UI presentation.


Goddamn Children's hospital blocked their weekend views of FB games.

Must.Build.Higher!!!!
 

theiacowtipper

HR Legend
Gold Member
Feb 17, 2004
14,532
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113
Mrs. Lucas is curious as to how they will staff this addition when they are so understaffed as it is? Especially the nursing positions.
Nurses like to work in cutting edge new facilities they are counting on nursing coming for that kind of thing. UIHC is also doing some things with the nursing program to get more of the grads to stay. thats becoming really common.

The local hospital charitable board is investing something like 10 million dollars in our community college to enroll more nursing students, paid internships, and guaranteed employment.
 

lucas80

HR King
Gold Member
Jan 30, 2008
97,168
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Nurses like to work in cutting edge new facilities they are counting on nursing coming for that kind of thing. UIHC is also doing some things with the nursing program to get more of the grads to stay. thats becoming really common.

The local hospital charitable board is investing something like 10 million dollars in our community college to enroll more nursing students, paid internships, and guaranteed employment.
UI is hemorrhaging nurses right now, especially young nurses. They are losing bunches to the temp agencies purely over money. Some of the hope is that as things settle the ones who want some stability in their lives, and those entering a point in their lives where they want to have kids, will return.
 

jberesford

HR MVP
Dec 1, 2001
1,893
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Get a job where you interact with them at their contract hospitals.
Lots of them like to drink and party
As someone who works a bar gig on the side, I can completely attest to that. Nurses in general are a party crew, but the traveling ones are well more funded to get weird with it. They come to town and generally don't know anyone in the area and rampage when they're not at work.
 

theiacowtipper

HR Legend
Gold Member
Feb 17, 2004
14,532
12,879
113
UI is hemorrhaging nurses right now, especially young nurses. They are losing bunches to the temp agencies purely over money. Some of the hope is that as things settle the ones who want some stability in their lives, and those entering a point in their lives where they want to have kids, will return.
The tide seems to be turning a bit on this. At least anecdotally. I know of three hospitals in iowa that have sworn of travelers.
 

Joes Place

HR King
Aug 28, 2003
125,187
121,220
113
No, you misremember. We were going to be able to close up all the ERs

Why would ERs no longer be necessary due to insurance coverage?

Obamacare was going to eliminate all accidents and car crashes, too? Man, I don't recall that whopper of a promise...

(maybe hospitals made more $$ BECAUSE of a lower intake of uninsureds to ERs..... 🤔 )
 
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Chewback

HR Legend
Feb 14, 2002
22,105
5,024
113
Maybe they can stop hiring 3'rd rate physicians first and prevent a free fall in their ratings. Nyah, why would they do that?
I was a pharmacy tech in the unit dose substations 70-74, 3rd shift. Some of the residents were real pips. One in particular in urology had no concept of dosages.

Around midnight one night a nurse brought a med order to the substation and as she handed it to me she said, "We've already argued with him." The order was for 1 mg of phenobarbital IM. I said, "We're going to argue with him some more." Phenobarb injectable was 100mg/cc.

The pharmacist went to the ward and argued with him for about 10 minutes before the resident said, "OK, make it a 100 then." One of many such events with this guy.
 

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