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This page was last updated 09/29/09

 

 

  

Today, in America, we as a nation are suffering from a healthcare emergency.

We as a nation are blessed with the minds and technology to have the greatest healthcare system in the world. However, in the past two decades medicine and nursing has been taken over by corporate interests.

The slide downward began in the 1980s with the implementation of DRGs. (Diagnosis Related Groups) where hospitals were paid a set amount of monies for a diagnosis.  And, so began the era of 'billing codes. '

As a staff nurse in the ICU at the time, I noticed how my ideals of each patient as an individual who deserved to be treated as a whole person was no longer valid. The view was that each patient encompassed the whole. The patient's mind, body and spirit, as well as their socioeconomic status affected how they responded to their disease process.

The early 1990s  came MCOs (Managed Care Organizations) with the original intent to save money, by practicing preventative medicine, rather than interventional medicine.

Additionally, the intent of the hospital alliances  was meant to consolidate and avoid duplication of services. The desired outcome being the ability to provide a more economical plan of care without compromising quality.

The ideal was to work cooperatively rather than competitively to provide the best each facility had to offer while serving the community at large.

Physicians were approached by MCOs and motivated to join in group practices. Several incentives were offered, with one of the biggest lures being that the physician would have more time to spend with family, since a larger practice meant more physicians to rotate being on call.

Sounds like a great idea doesn't it?

However, the outcome has resulted in The Hippocratic Oath, and The Nightingale Pledge taking a backseat to the bottom line.

The number one cause of medical mistakes is the lack of nurses. 195,000 people die each year due to medical mistakes.

The number one reason for increased complications, infections and falls, is nurses being short staffed and working long hours.

In the early 1990s the hospitals consolidated their services; the corporate entities, decided to cut costs by replacing nurses with staff from departments such as housekeeping, laundry, and kitchen.

These individuals were trained for eight (8) weeks to take vitals signs and perform other bedside nursing duties. Some of these individuals were trained to perform phlebotomy. The goal: the bottom line, the motivation, profit.

As the manager of a department and overseeing budgets, I am well aware that the first place the finance people cut is, staffing.

Nurse salaries were approximately $30,000/annually. The housekeeping and janitorial staff could be paid half amount.

Of course, this idea looked great on paper. And, the finance people were simply incapable of fathoming the outcome, with no thought to how the staffing shortages would result in more mistakes and complications, with lives devastated and more lives lost.

The mindset of the bottomline dictating the scenario is at the heart of the matter. The reality is that there is no savings in the long run, and this 'business' is life and death situations!

Nurses being the one pivotal variable was removed from the scenario. Why? Merely economics? Is greed truly that blind?

Nurses as patient advocates who coordinate the patient's care. They see to it that the physician's orders are carried out. The nurse collaborates with the entire healthcare team, to coordinate the patient's care. The nurse checks, double checks, and triple checks, and not to avoid liability, but rather to protect her patient.

Nurses in adequate staffing, trained appropriately to handle the acuity of their patient population, results in across the board less mistakes and complications.

When I hear about a case where the wrong limb was amputated, I wonder the details. Staffing ratios and if a nurse was involved.

The nurse sees to it that the X-ray has been performed, the IVs are hung on time, the IV solution and rate of infusion is appropriate to the patient being treated. Makes sure the patient is ready and on time for surgery, having been prepared for that specific operation.

The nurse makes sure the medications ordered are the approved dose, the appropriate route of administration, and appropriate to the disease being treated. The nurse makes sure the patient is not allergic to the medication, nor is taking any medications that would contradict.

The nurse educates the patient and family about the medications, why they need them. Additionally, she educates patient and family to the correct time to take the medications and any special precautions or side effects associated with the mediation.

The nurse documents all of these details in the patient's medical record, while performing all of these duties.

Decades ago medication errors were thought to be remedied with the Unit Dose System, and the pharmacist took on a greater level of liability.

However, nurses are responsible for the medications and treatments they administer. In the incidence of a medication error there are many things to consider.

Was the wrong dose sent up by pharmacy? Was the physician's order unclear? Did the error occur at the transcription phase? Did the nurse make the mistake? What period in the process did the error occur?

The nurse as patient advocate knows, regardless of medical diagnosis, all patients have a psychological, socio-economic, and spiritual component, and that all of these components affect outcomes, and cannot be captured on pathways nor by using formulas.

Caring and compassion cannot be objectively measured, nor legislated which is precisely why the plan to manufacture medicine from a calling to a business has been a dismal failure, that has cost us billions of dollars and devastated lives.

Nurses have always been overworked, and underpaid, but today is different, the reason nurses are in short supply is because they have been driven out of the profession.

Frustrated at being prevented at every turn to give their patients the quality of care they know they deserve. Nurses being altruistic in nature, were taken advantage of by the administration who used their very attributes against them.

Working long hours due to short staffing, and in some states, nurses are actually forced to work overtime.

Nurses leave the field because they are being prevented from being the one thing they devoted their lives to being, NURSES!

The moment a patient hits the door, the discharge planning begins. A patient's care is dictated by a regimented protocol called a critical pathway.

The LOS (length of Stay) is the determining factor when MCO's shop for hospitals. Deviations (variances) serve not only to educate and improve quality, but also cost the provider more money.

Medicine has been around as a science, an art, a calling for centuries, and business people have destroyed it in less than a decade.

Get informed, get involved, start petitions and take a stand, and put medical care back into the hands of the dedicated professionals, our nurses and physicians.

It's not too late

Avoiding Medical Mistakes With Children

Causes of Medical Mistakes - WrongDiagnosis.com

 

 

 

 

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