Nursing in America and the Right to Healthcare

 

Since the debate is ongoing about healthcare, let’s think about what this is really going to affect: healthcare workers. I’m looking, specifically, at the nurses. Yes, doctors, we know that you are also over-worked, but with 10-15 minutes a patient, you can see more patients than nurses can. Given how much hands-on inpatient and outpatient care we provide, the stretch in healthcare is going to be felt most acutely by the nurses who will have to do more with less (always doing more with less).

If we are not going back to outright slavery, then we have to acknowledge that there are limits to service.  We cannot make people work in healthcare.  As things get worse, fewer and fewer people will choose this career. Why? It isn’t just the money. It’s about safety.

A nurse was recently erroneously described as “unharmed” while being held hostage. Most nurses face violence and threats on a daily basis in what is often described as a “normal day at the hospital.”

I know all of this because I face it daily. Beyond the care and concern for my patients, I have risked life and limb. I have had patients hit me, kick me, use telephones as a club, scratch me, and bite me. Luckily, it hasn’t usually broken the skin. I have also had HIV+ and Hepatitis + patients rip out IVs in my face and fling blood in my general direction.

I have never filed a report regarding a patient.

Why bother when it does nothing anyway? Nurses are to be superheroes. We are supposed to stand up to administration, doctors, other staff, and even family, all on behalf of our patients. We protect them to our own detriment, sometimes even failing our own physical and mental well-being.

I re-watched an episode of Gray’s Anatomy today. It seems counter-intuitive to bring to mind a show that is notorious for medical inconsistencies and stupid drama, but one episode always struck me as being entirely too true. Someone who assisted in this episode knew too much and it affects medical practitioners similarly. In the 11th Season, Episode 21, there is a car crash. Everyone in medicine knows these phrases: “He was trying to die on me.” “No.  Not another one.  We’re full and we’re not even trauma.”  Everyone sees it coming.  Doctors too full of themselves to answer the call. Supervising doctors uninterested in the priorities. Advocating (in futility!) for your patient’s best interests. “He needs a brain CT.”  “No, his GCS is stable.” Trying to do the right thing over and over and hitting a wall. Over. And. Over.

The episode is nearly traumatic upon viewing if you have had these experiences yourself. Watching the anguish from the outside, the poor outcomes, and the sheer frustration, is almost too much. I cried when I saw this episode. Not because I had any particular love of the characters, but because everything was wrong and it was too familiar.

The worst part is that this is just TV. It attempts to reflect the basic truth of the reality.

In real life, in hospitals every single day, nurses struggle to do right by their patients. Even if these patients bit them, kick them, slap them, or pull a knife on them, the nurses still try to do their best and to get the best possible outcome. With universal healthcare, we will be forcing nurses to neglect themselves. Even more than now, we will have to encourage nurses to think of themselves as super human or somehow subhuman because only those can possibly endure that kind of daily degradation. Only people who are superhuman are able to smile and offer jello immediately after being spat on by a patient, yelled at by a doctor, and bullied by a fellow nurse.

Universal Healthcare is another word for indentured servitude.

As long as healthcare is a matter of service, we cannot force workers to provide. We simply cannot. We cannot force nurses to neglect their physical integrity, well-being, and frankly, sanity. A right cannot exist if it violates the natural right of self-determination of another.

Healthcare never has been and should never be a right. Nurses are not super-heroes. Eventually, they will break and there will be no one to care for the masses.

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  1. Arahant Member
    Arahant
    @Arahant

    Hey, once healthcare is nationalized, you’ll be a government worker. Yeehaa!

    • #1
  2. skipsul Inactive
    skipsul
    @skipsul

    My mother recalls having full bedpans flung at her, angry families who wouldn’t let her treat her patient because they knew what was best, dealing with a traumatized juvenile rape patient, a doctor who went AWOL because he was fooling along with a nurse on the side when he was supposed to be on call, and needing security guards on more than a few occasions for transfers from the nearby prison.  It’s a brutal job.

    • #2
  3. billy Inactive
    billy
    @billy

    This inconceivable to me. Why in the hell would anyone assault his or her nurse?

    People.

    • #3
  4. Kozak Member
    Kozak
    @Kozak

    billy (View Comment):
    This inconceivable to me. Why in the hell would anyone assault his or her nurse?

    People.

    Even worse, I’ve seen nurses threatened by the hospital with loss of their job if they press charges against a patient for assault.

    Not “Customer Friendly Service”.

    Dead serious on this.

    • #4
  5. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    billy (View Comment):
    This inconceivable to me. Why in the hell would anyone assault his or her nurse?

    People.

    Drugs.  Under the influence or wish they were.  Mentally unstable.  Dementia.  Sometimes just because they’re jerks.

    • #5
  6. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Kozak (View Comment):

    billy (View Comment):
    This inconceivable to me. Why in the hell would anyone assault his or her nurse?

    People.

    Even worse, I’ve seen nurses threatened by the hospital with loss of their job if they press charges against a patient for assault.

    Not “Customer Friendly Service”.

    Dead serious on this.

    This is true and real.  Most of the time, the nurses are made to feel that they are to blame for “escalating a potentially violent situation”.  The paperwork alone is prohibitive.  On the other side, if a patient accuses a nurse of a crime, the police must be called and a report filed.  I had a delightful 4oJ last year when a hallucinating patient accused our staff of assaulting her the night prior.  Cue many, many reports, a visit with the local PD, risk management and 5 hours of 1 on 1 care.

    • #6
  7. Gary McVey Contributor
    Gary McVey
    @GaryMcVey

    I shouldn’t be shocked, but…yeah, I’m shocked. How the hell could anyone behave like that to someone who’s trying to keep them alive?

    • #7
  8. Hammer, The Member
    Hammer, The
    @RyanM

    It will be a government job with a public sector union. People will be paid more for incompetence…

    • #8
  9. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Gary McVey (View Comment):
    I shouldn’t be shocked, but…yeah, I’m shocked. How the hell could anyone behave like that to someone who’s trying to keep them alive?

    Common decency goes out the window.  I can’t tell you the type of “service” requirements that have been asked of staff.  I’m lucky that I started nursing after 30 and I’m fond of lecherous oldies.  I’ll let the old guys hold my hand or kiss me on the cheek.  They get much more handsy with other nurses.  I’ll let you guess one of the places someone tried biting me.

    • #9
  10. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Hammer, The (View Comment):
    It will be a government job with a public sector union. People will be paid more for incompetence…

    Currently, I know of a few local unions were the nurses cannot be called off for low census.  That being the case, they just show up and sit there and get paid.

    • #10
  11. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Hammer, The (View Comment):
    It will be a government job with a public sector union. People will be paid more for incompetence…

    Also, I know I shouldn’t ask, but…your fist…it’s not The Hammer, is it?

    • #11
  12. Nanda Panjandrum Member
    Nanda Panjandrum
    @

    TRN, kudos to you…I’m here to type this because I was always someone’s “favorite private duty job”.  After grueling OR shifts responding to auto/industrial  accidents/hotel fires in her hometown – even a flood that happened when she was newly-graduated as an RN – she reported for duty the next day.  When a private duty patient (late in her official career) pulled a weapon and threatened suicide, she calmly disarmed her, called the home-health agency to request a police report be filed, updated her shift relief – and came home to us. She truly made use of her training, compassion, wisdom, and the armor of God. She viewed nursing as a vocation – and was distressed to see its progressive diminishment as a valued part of professional care; let alone as part of a world where one’s life might routinely be at risk…Horrific!

    • #12
  13. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Nanda Panjandrum (View Comment):
    TRN, kudos to you…I’m here to type this because I was always someone’s “favorite private duty job”. After grueling OR shifts responding to auto/industrial accidents/hotel fires in her hometown – even a flood that happened when she was newly-graduated as an RN – she reported for duty the next day. When a private duty patient (late in her official career) pulled a weapon and threatened suicide, she calmly disarmed her, called the home-health agency to request a police report be filed, updated her shift relief – and came home to us. She truly made use of her training, compassion, wisdom, and the armor of God. She viewed nursing as a vocation – and was distressed to see its progressive diminishment as a valued part of professional care; let alone as part of a world where one’s life might routinely be at risk…Horrific!

    I didn’t post it to get love or sympathy, but to get it out there that this is a daily occurrence.  The things that happen… are not okay.  They are routinely simply not okay.  My hospital is better than most, but even then the nurses are beaten down and exhausted.  They are emotionally and physically exhausted by the end of the day.  At this point, I think the person who has been here the longest has been on the unit for about 15 years.  This is legendary.  Most people cannot make it a single shift on my floor.

    We are brain/spine/ortho-trauma.  This means: confused little ol’ lady on coumadin falls, cracks her head, ends up with a broken hip/spine?  That’s us.  Confused grumpy man down for 15 hours because he had a stroke and no one noticed?  Still us.  50 year old former boxer has a stroke and is withdrawing from alcohol and can do nothing else but laugh menacingly?  Oh, that’s definitely us.

    I’ve learned more ways to tie restraints than I ever thought I’d know.

    • #13
  14. Nanda Panjandrum Member
    Nanda Panjandrum
    @

    TheRightNurse (View Comment):

    Nanda Panjandrum (View Comment):
    TRN, kudos to you…I’m here to type this because I was always someone’s “favorite private duty job”. After grueling OR shifts responding to auto/industrial accidents/hotel fires in her hometown – even a flood that happened when she was newly-graduated as an RN – she reported for duty the next day. When a private duty patient (late in her official career) pulled a weapon and threatened suicide, she calmly disarmed her, called the home-health agency to request a police report be filed, updated her shift relief – and came home to us. She truly made use of her training, compassion, wisdom, and the armor of God. She viewed nursing as a vocation – and was distressed to see its progressive diminishment as a valued part of professional care; let alone as part of a world where one’s life might routinely be at risk…Horrific!

    I didn’t post it to get love or sympathy, but to get it out there that this is a daily occurrence. The things that happen… are not okay. They are routinely simply not okay. My hospital is better than most, but even then the nurses are beaten down and exhausted. They are emotionally and physically exhausted by the end of the day. At this point, I think the person who has been here the longest has been on the unit for about 15 years. This is legendary. Most people cannot make it a single shift on my floor.

    We are brain/spine/ortho-trauma. This means: confused little ol’ lady on coumadin falls, cracks her head, ends up with a broken hip/spine? That’s us. Confused grumpy man down for 15 hours because he had a stroke and no one noticed? Still us. 50 year old former boxer has a stroke and is withdrawing from alcohol and can do nothing else but laugh menacingly? Oh, that’s definitely us.

    I’ve learned more ways to tie restraints than I ever thought I’d know.

    Understood, re: sympathy; not my intent, entirely. When I was a chaplain-trainee, my site supervisor (later my boss) had me read a novel titled, “The House of God”.  Its fiction introduced me to the realities you describe,  It opened my eyes – and hurt my heart – as do your post and comment.  Is there a way back to the social – and somewhat moral – compact patients and providers once took as a given that made talk of “rights” unnecessary and/or insultingly inappropriate with respect to healthcare?  Wondering…Again, thanks for this.  (Btw, I would’ve chaplained for the folks you describe if/when they got to a physical rehabilitation unit; familiar with restraints, net-beds, alarms, cussing, thrown bedpans, and, serendipitously, a young man coping with the realities of HIV in 1990-91.)

    • #14
  15. JimGoneWild Coolidge
    JimGoneWild
    @JimGoneWild

    I delivered medication 3 days a week to a nursing home while I was in HS — Totally depressing. How the nurses handled that on a daily basis, I’ll never know.

    On the other hand, I volunteered at a children’s hospital for a number of years where for the most part things seemed happy, but you catch a nurse on her 3rd or 4th 12 hour day in a row and she would byte your head off for nothing. Or sometimes a kid would die and the volunteer staff coordinator would warn us not to go near the nurses station — both situations were understandable. A difficult profession.

    • #15
  16. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Nanda Panjandrum (View Comment):
    Is there a way back to the social – and somewhat moral – compact patients and provides once took as a given that made talk of “rights” unnecessary and/or insultingly inappropriate with respect to healthcare? Wondering…Again, thanks for this.

    I genuinely do not know.  As long as healthcare is treated as a service industry, rather than healthcare or a vocation, there is a certain amount of respect missing.  Until people remember that they have a set of responsibilities as well as a set of rights, we will all be in danger.

    • #16
  17. Johnnie Alum 13 Inactive
    Johnnie Alum 13
    @JohnnieAlum13

    My mom was nurse.  She mostly worked in nursing homes.  When she was a young nurse she worked at a children’s hospital with heroin addicts.  She loved it, but after about 3 years she was burned out and couldn’t do that any longer.  She went back to nursing homes.  For a brief time, about 2 1/2 years, she worked at a prison.  She hated it.  Because she was forced to care for the absolute worst in society.  It is hard to feign compassion in that setting.  I am convinced that if we get Universal Healthcare that nurses will no longer be able to feign compassion.  Her final job, for the last 15 years of her life, was in a Veterans Home.  For a brief time she was on the Alzheimer’s unit.  One of the residents broke her arm with his walker, she left to go to the emergency room had her arm put in a cast and returned to finish her shift.  One resident said he had a “gift” for her and put a pile of poop on the counter of the nurses station.  She had several terrible patients over her years as a nurse.  I remember asking her once how she could continue on.  She said, “Even though there are the bad patients that could ruin your day if you let them, there are the great patients that brighten it. There are the times that you must tell a family that their father or mother died. They see that also experience that loss.  There are times when a resident tells you that he is praying for your safety.  I can’t tell you how many tears I’ve shed during my career for my patients.”  For my Mom, nursing was her vocation and she knew it.  As healthcare moves in the direction of a “right” the nurses that see it as a vocation will leave, and those are the ones that the system cannot afford to lose.

    • #17
  18. DocJay Inactive
    DocJay
    @DocJay

    Nice article.   I see indifference now and commonly where it used to be rare.

    Subhuman will win the day.

    • #18
  19. Jules PA Member
    Jules PA
    @JulesPA

    Kozak (View Comment):
    Even worse, I’ve seen nurses threatened by the hospital with loss of their job if they press charges against a patient for assault.

    Not “Customer Friendly Service”.

    Dead serious on this.

    This comment is not likable.

    Hate. This is the hate button.

    • #19
  20. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    DocJay (View Comment):
    Nice article. I see indifference now and commonly where it used to be rare.

    Subhuman will win the day.

    I worry about that.

    I worry about it all of the time, actually.  I’m in a unique position that I’m surrounded by neuro patients all day, every day (my mom being one of them).  I’m getting burned out.  It’s only been about 7.5 years of work, 14 years with my mom.  I feel subhuman sometimes.  I feel like we just can’t have emotions.  We don’t get to be upset.  We don’t get to feel upset for our patients.  If you do, you’re being “dramatic” and need to be talked down.  I’m an excitable person, sure, but when my incoming patient has a bleed and is being brought to sub with uncontrolled blood pressure and only “fair” breathing (with a decent chance of intubation in the next 12-24 hours), that’s not a stable patient.  I hate that in order to advocate, I have to become cold and calculating and manipulate things, rather than use human emotion, compassion AND statistics in order to get the best care.

    I worry because I’m getting exhausted and everyone else is too.  I love my job.  I love my patient population because I can excuse a lot of the behavior (brain damage! pain! Yay!).  Even then, there’s a limit and we all get there.  There simply is not enough PTO to compensate for the emotional and physical wear and tear.  3 12-hour shifts back to back is physically and emotionally exhausting.  The next day, it takes me a while to become human.

    • #20
  21. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Johnnie Alum 13 (View Comment):
    For my Mom, nursing was her vocation and she knew it. As healthcare moves in the direction of a “right” the nurses that see it as a vocation will leave, and those are the ones that the system cannot afford to lose.

    Those left are the ones that were involved in this sort of thing.

    • #21
  22. Aaron Miller Member
    Aaron Miller
    @AaronMiller

    TheRightNurse: Healthcare never has been and should never be a right.

    Amen. I wish we could convince more people of that. But I know plenty of Republican voters who willfully believe otherwise simply because the truth is so harsh.

    As with communism, advocates can endlessly claim it just has to be done right. The dream is immune from experience.

    I have dipped my toes in nursing of a sort. It’s tolerable or just plain misery depending on the patient, but in any case someone has to do it. Do career nurses all start with a passion for it, even if they are eventually beaten down or have bad times? Do you (nurses) think the career requires personal traits, not merely knowledge and discipline?

    • #22
  23. I Walton Member
    I Walton
    @IWalton

    The reason there are professional associations is the same reason there were guilds, unions, etc.  Their purpose is to restrict entry and raise incomes.   Unfortunately the AMA got out of hand had too much power and they and other health care professionals, and patients  are now paying the price.  When we say we need more market reforms, that includes investment in human capital.  Indeed that is probably the most important investment of all.  When we socialize it, the government will attempt to drive down costs by making it easier to become a health care professional.  We don’t want them doing that either, but it’s coming.

    • #23
  24. Front Seat Cat Member
    Front Seat Cat
    @FrontSeatCat

    I mirror the other comments that said shocking, had no idea this went on! If you can’t have control, respect, and safety in a hospital, what does that say about the rest of our country? When did this actually start Nurse? I’ve heard terrible stories about overflowing waiting rooms locally where seriously sick people are made to wait a long time to even be seen. My mother in law doesn’t want any doctors or hospital affiliation in Panama City Beach, but wants to come to Sacred Heart the next town over where we are, our local Catholic hospital for doctors. It’s like night and day. Her doctor is retiring. My sister said hospitals have gone out of business or merged in her area since Obamacare, and she is now seen by a PA for checkups. Something needs to be done about all of it – it is life and death!  Thank you for being a nurse and caring for others!

    • #24
  25. Jeff Peterson Member
    Jeff Peterson
    @PatJefferson

    TheRightNurse (View Comment):

    3 12-hour shifts back to back is physically and emotionally exhausting. The next day, it takes me a while to become human.

    I’ve never understood why such long shifts are the norm in hospital staffing — and often thought that if I’m sent to the ER with something life-threatening or tricky, it’s nearer the beginning of my doctors’ and nurses’ shifts than the end.

    So picky little question off a thread raising much bigger issues: Is there a benefit to someone besides the scheduler in having people to work three consecutive 12-hour shifts?

     

    • #25
  26. Nancy Inactive
    Nancy
    @Nancy

    Why is it in California the nurses union the biggest supporter of single payer heath care?  I would have thought they would be very much against it.  Is it just a union leader thing?

    • #26
  27. civil westman Inactive
    civil westman
    @user_646399

    The management of healthcare employees offers a deep insight into the ethos of our “one size fits none,” coercive government. It also shows how its can end up by incrementally resulting in systematic inhuman actions.

    When it comes to medical care, layer upon layer of regulators blow through hospitals, each ignorant of the others’ latest rules which are always additive – none are ever eliminated. The result is that nurses, particularly, are loaded with more tasks per unit tie than can possibly be accomplished, especially with the level of perfection expected. The first job of doctors and nurses is now data entry, not patient care. There is barely time to look at a patient; only the keyboard and screen of the COW (computer on wheels).

    Government has assumed the role of scripting every word uttered and choreographing every move in hospitals and medical offices. It is stifling. All the humanity and actual human caring has been squeezed out. Administrators and administrative nurses have been coopted into “compliance” officers. That is, they are given the latest rules by regulators and then force compliance on those in the front lines. This mechanism offers insight into just how mass murder became a banal administrative matter perpetrated by Germans and their accomplices in WWII. Lots of little coerced steps with no accountability at the top.

    It can’t happen here? Consider the worldview of those who comprise the unaccountable “deep state” within our government. Ask yourselves, given the ethos of governance here, today, just what limits such people are likely to respect in enforcing their utopian plans. Who has the “right to treatment” and who does not – like who is prosecuted and who is not –  will rapidly become a matter of political favor and connections.

    • #27
  28. Henry Castaigne Member
    Henry Castaigne
    @HenryCastaigne

    Unless we give abusive people sub-par healthcare they will continue to be abusive. The only way for decency to flourish is to let some folks get sick and die.

    A man once said, “To govern is to choose.” I would say, “To be decent is to discriminate.” Giving the same healthcare to an someone who assaults a nurse ruins the healthcare of decent people.

    • #28
  29. EJHill Podcaster
    EJHill
    @EJHill

    You know what the worst thing about hospitals? They’re filled with some really sick individuals. They’re grumpy, don’t feel good, have health problems, some are addicts and others are old and suffer from dementia.

    Now, if we could only find a way to give them the hammer of an oppressive government agency to get them to think they had a right to make all sorts of demands…

    • #29
  30. James Gawron Thatcher
    James Gawron
    @JamesGawron

    Dear Right Nurse,

    During my recent extended visit to the ICU (heart attack), I had a very different experience than you are describing. The nurses both male & female almost 100% were dedicated and hard working. I always thanked them for anything they did for me. In fact, as time went on I began to have a strange sense of solidarity with the ICU staff. When I left the hospital it was as if I was leaving friends that I probably wouldn’t see again.

    Reducing everything to bureaucratic protocol won’t improve the situation it will only make it worse. Single-payer will yield worse care at a higher cost as all socialist solutions always do. I found that if you can see your care giver as an individual they can see you that way too. It’s just common sense. Of course, common sense is the most underrated factor in modern society.

    Regards,

    Jim

    • #30

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