HMOs Don’t Squeeze Only Doctors
Nurses all over the nation are watching the California Legislature’s debate of a bill that would mandate safe nurse-patient ratios. California has the dubious honor of having the lowest nurse-patient ratio in the country but hospitals throughout the United States are close behind.
Cutbacks in the number of professional nurses who provide inpatient hospital care have led to a point of crisis. Nurses like myself live with the results of this crisis every day. We are running as fast as we can. Sometimes, at the end of my shift, I realize that I have had almost no interaction with people who are in the hospital precisely because they need me, a professional nurse. They need me to teach them how to cope with their illness, to manage their pain, to take their medications. They need me to watch carefully, to pick up on small changes that can herald a complication or a new problem. But how can I do this when I am being asked to take care of a larger and larger patient load?
Feeling guilty but, at the same time, helpless to change the situation has become an everyday reality for many of the nation’s nurses. Sadly, many have chosen to leave their profession rather than to provide inadequate care, and bright young people are steering clear of a profession plagued by inadequate staffing and layoffs.
Recently, my experiences as a family member have brought home to me in a deeply personal way the impact of a decade’s slow erosion of nursing care.
My mother-in-law, whose cancer had spread to her bones, was admitted to the hospital because her pain had grown so severe she could no longer walk. I had hoped that she now would have nurses to evaluate her and plan for care that would minimize her pain. She needed to have her pain medications carefully timed, to have assistance with simple activities, to be moved carefully, to have somebody pay attention to whether she was eating.
Over the course of a three-week hospitalization, she received all the high-tech care that we could hope for, including radiation therapy to slow painful tumor growth and consultations from medical experts to suggest additional strategies. But the nursing care that would have made the crucial difference to her was seldom in evidence.
Speaking to her on the phone, she was often in tears, brought on by pain, exhaustion and helplessness. “The only thing I see of them is their backs as they are leaving,” she commented about the nurses.
In fact, I saw a nurse take the time to carefully evaluate her pain only once. When I asked the nurses caring for her to find a minute to discuss her pain management plan with me, they admitted, with embarrassment, that there was no real plan--and this despite the fact that she had been admitted primarily for the purpose of pain control. Faced with the reality of this understaffed hospital unit, I was seriously considering taking a leave of absence from my own job so that I could care for her myself at home when she unexpectedly died from complications of the immobility enforced by her uncontrolled pain. At her memorial service, when friends and relatives expressed relief that her suffering was over, I carried the burden of knowing that, with good nursing care, much of her suffering could have been alleviated while she was alive.
Like most nurses, I went into the profession to help others. I do my best for patients, even with limited resources, and have tried not to complain as more and more is expected from fewer and fewer professionals. But I, along with other nurses, am complaining now. We have ample research to show that good nurse-to-patient ratios lead to better outcomes, and virtually none to suggest that limiting nursing care and substituting low-skill workers is safe for patients.
Hospitals point to sophisticated monitoring systems, stating that these allow nurses to care for more patients. But this is an illusion. Monitors cannot save your life unless there is a professional nurse available to recognize and respond to impending catastrophe.
Insurers are squeezing hospitals to cut the cost of inpatient care. To survive, hospitals are gambling that you or your family member will not suffer a complication, because there are often not enough nurses available to pick up the symptoms if you do. And too little attention is paid to the comfort, teaching and emotional support that acutely ill patients need in a health care environment that increasingly devalues basic dignity.
Nurses and patients are powerless to fight giant insurance companies and hospital systems. Government must act to protect patients and to preserve the nursing care that their lives depend on. California has led us into this wilderness, now nurses like myself look to the California Legislature to lead the public back to safety.
