Today, in America, we as a nation are suffering from a
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individual who deserved to be treated as a whole person was no longer valid.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.
early 1990s came MCOs (Managed Care Organizations) with the original
intent to save money, by practicing preventative medicine, rather than
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
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
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
trained to perform phlebotomy. The goal: the bottom line, the motivation,
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.
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?
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
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
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
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
Decades ago medication errors were thought to be
remedied with the Unit Dose System, and the pharmacist took on a greater
level of liability.
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
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!
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.